#13: Testing Positive for Suboxone and Illicits Simultaneously

“Why are many of our patients testing positive for drugs such as Cocaine, Meth and THC, if they are appropriately positive for the Suboxone we are prescribing?” was a question I received this past week.  Prior to answering, I hesitated for a moment since, after all, this was a clinic that treated addicts.  Surely they know addicts use illicit drugs.  The light went on and I realized what they were really asking.  (Stop laughing!)  If our patients are taking their suboxone correctly, why are so many still testing positive for illicit drugs?  WOW!  What a great question.  Although many might scoff at this, stating the answer is blatantly obvious, without the education regarding MAT (medically assisted treatment), it is not.  In fact, as I ruminated over this, I concluded other than our scientists, most of my laboratory staff would have this same question.  Suboxone (Buprenorphine and Naloxone) is a FDA approved drug used in MAT programs to treat opioid abuse.  In other words it tends to block the desired effects of opioids on certain brain receptors, but does not interfere with the effect of the other previously mentioned drugs.  If a patient is being prescribed Suboxone, they can be abusing cocaine, methamphetamine or cannabis at the same time the Suboxone is helping them refrain from using opioids.  The type of therapy an addict may receive when going to “treatment” may differ depending upon the type of drug they tend to abuse. 

Pharmacotherapy has been around for a long time.  Antabuse, a drug used for alcoholics, for instance, has been available for over 50 years.  The alcoholic knows the reaction they will have if they drink alcohol will be so bad, they refrain.   Currently there are no FDA approved medications to treat cocaine, meth and cannabis dependence.  This does not mean that providers are not using drugs that have been found helpful in the treatment of these drugs.  In fact there is the real possibility of the approval of a vaccine for cocaine on the near horizon, which stimulates an antibody response that binds to cocaine molecules causing them to be too large to cross the blood-brain barrier, which nullifies the effect of the drug.  There are many different drugs legally used off market (not for their clinically tested purpose) by providers, to decrease the withdrawal of certain addictions.  With problems comes the pathway to solutions!  I can’t emphasize enough the value of running appropriate confirmation drug tests when a patient is being treated with medications for their drug of choice. 

Please use ILDP as a resource if you have any questions regarding testing or common trends we see.

As you enjoy this Friday, remember we don’t know the motives or circumstances that cause another’s behavior.  Drug seekers and addicts affect everyone around them.  When we hold onto resentment and blame, even for the patients we treat, we are filled with the same.  Booker T Washington said, “You can’t hold a man down without staying down with him.”  Have a great weekend and thank you all for your business. 

Lance Benedict

President/CEO Industry Lab Diagnostic Partners 
06/28/19

#12: Using Opioids to Treat an Opiate/Opioid Addiction

Affinity is defined as a spontaneous or natural liking or sympathy for someone or something.  Buprenorphine is a drug that has a high affinity for the human brains opioid receptors.  In fact it has a higher affinity (stronger binding ability) than other opioids and thus it will “knock off” other opioids and occupy a receptor (the mu receptor) thus blocking other opioids from binding to it.  

Buprenorphine is called a partial agonist.  Remember my blog on agonist vs. antagonist.   Heroin, oxycodone and hydrocodone are examples of full agonists.  Although Buprenorphine is an opioid and can produce typical opioid effects (euphoria) and side effects (respiratory distress), used in the correct dosages it will produce a sufficient agonist effect to enable opioid addicted individuals to cease the misuse of opioids without the severe withdrawal symptoms.  Essentially you are using a semi-synthetic opioid to treat an opiate/opioid addiction.  As an opioid people got creative and began to abuse it.  It is for this reason Suboxone (buprenorphine and naloxone) was developed.  The addition of naloxone was only to discourage misuse of buprenorphine. As I have discussed in the past naloxone has very little effect when taken sublingually, however can precipitate a withdrawal syndrome when injected.   

Studies show taking the medication alone is not sufficient for ceasing opioid abuse.  Treatments that include repairing family and social relationships, finding positive social support networks, obtaining employment and engaging in new forms of recreation and other activities that contribute to a healthy , active, balanced life style are all important components for recovery.   Recidivism rates are high in addicts and many times takes several attempts to get clean prior to success.  There is always hope. 

Our job as a lab is to assist you as the provider to ensure your patient stays on the correct path.  We partner with you in your treatment of your patient.  Making sure the patient is taking the prescribed meds and is not including illicit or unprescribed medication in their drug regimen by performing quantitative testing is essential in the treatment of an addict or a pain patient.  We appreciate your trust in us and are always here to assist you in any way we are able to.

On another point, many of the providers we do testing for have multiple talents.  Steve Montgomery, MD an addiction specialist who uses our lab, has written a children's book called “The Longest Storytime”.  Those of you familiar with “Goodnight Moon” will appreciate his book.  Dr. Montgomery is a very talented and caring individual who treats a lot of addiction patients with success.  Anyone with little children, grandchildren or knows someone with children can order this at https://www.authorhouse.com/en/bookstore/bookdetails/320543-The-Longest-Storytime.

“Never let success get to your head, and never let failure get to your heart”.  We thank you for allowing us to be your toxicology lab.  See you in two weeks.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners
06/14/2019