Drug testing or Narcan for Buprenorphine?

[CarabinerSD]

I have a couple patients on Buprenorphine for pain management (not substance use). Question is whether we need to do regular UDS + Narcan for these patients if they're being treated for pain and not substance use disorder? Obviously we do screening for the regular opioid patients but what about Buprenorphine? I don't want to tie up staff time / resources if it's not needed. Thoughts?

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[kstarm]

I don't do narcan but it is a good CYA move as often times people have other opioids around if they are now on bupe. I still due UDS once a year for my stable patients. I don't think there is a single case report of someone having an overdose just on bupe, I believe the only cases had ETOH or benzos on board and thus the screening for illicits.

 

[hopefulgasman]

I prescribe narcan once for any opioid and UDS once a year if no concerns

 

[1 Up]

Buprenorphine can still be sold on the street and abused. Much lower street value, but it happens.

 

[bubaghanush]

No one is abusing butrans on the streets. But it's still a schedule 3 so just do the UDS.

Edit: When Suboxone is sold on the streets, generally not for abuse. It's so they can prevent withdrawal and go to work in between heroin binges.

 

[Dansk2011]

For those of you prescribing buprenorphine is it actually showing up on drug screens? I don't really manage meds (have like maybe 10 patients on opiates essentially all of which I assumed care for) but one is on butrans. He gets a UDS every 3 months per requirements by his workers comp. It never shows up on uds which ours doesn't test for specifically and wouldn't show up positive for opiates. Also doesn't show up on more complex testing but my understanding is the dosing for pain is so low vs for oud that it's not enough to be picked up on our standard thresholds (10 ng/ml), at least from what I was told by the lab....I've had this issue in the past as well in other jobs.

 

[BobBarker]

No, butrans typically doesn’t get picked up on confirmation.

 

[PMROralBoards]

I would still get a random UDS occasionally especially if the bupe you are talking about is suboxone. People do in fact buy suboxone on the streets. Butrans maybe not. It could also catch if they are taking something else like oxy or fentanyl.

 

[Ducttape]

you have to specifically order a LC/GS study to find buprenorphine use. the levels are very low and can be lower than threshold if you are only reported Positive or Negative. ask for the quantitative number.

and you have to specifically check a "full" UDS to look for drugs of abuse.

i do not "screen" for buprenorphine use on those not being prescribed that, because the incidence of someone abusing buprenorphine is very low.

for those on butrans, look and see if the patient is wearing the patch...

 

[BobBarker]

Agree. There is also evidence on most people of the previous weeks patch.