Clinicians Identify Buprenorphine “Spiking” In JAMA Psychiatry Study Supported by Millennium Health Researchers

SAN DIEGO, Calif. – March 22, 2023 – A JAMA Psychiatry study, led by Jarratt D. Pytell, MD, MHS, Department of Medicine, University of Colorado School of Medicine, and co-authored by Brendan Saloner, PhD, Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, and Millennium Health researchers calls attention to factors associated with patients who have urine drug test (UDT) samples suggestive of buprenorphine “ADD-IN” (commonly referred to as “spiking”). Buprenorphine is used to treat pain and opioid use disorder (OUD). Spiking a urine sample represents intentional addition of buprenorphine tablet or residue directly into the urine to mimic adherence with prescribed buprenorphine.

This cross-sectional study of 507,735 urine specimens from 58,476 patients with OUD collected between January 1, 2017 and April 30, 2022 found:

• For patients prescribed buprenorphine, a norbuprenorphine to buprenorphine urinary ratio of <0.02 identified samples suggestive of spiking
• 7.6% of patients had evidence suggestive of spiking
• Specimens suggestive of spiking were more likely to be positive for nonprescribed opioids
• Specimens obtained from primary care clinics were more likely be suggestive of spiking

According to lead researcher Jarratt D. Pytell, MD, “I anticipate a much-needed increase in the number of people gaining access to buprenorphine therapy. The results are tremendously timely, given they come on the heels of the elimination of the X waiver. This study highlights some of the complexities of prescribing buprenorphine. New prescribers of buprenorphine will need to learn how to conduct the increasingly complex initiation of treatment and then gauge whether it is successful or not. Spiking suggests that treatment is not working – especially in patients continuing illicit drug use. Detecting spiking allows clinicians to adjust or intensify the treatment plan.”

“At Millennium Health we have been tracking the enormity of the drug use crisis. This study suggests that spiking is an important patient safety issue, and it is not uncommon,” said study co-author Eric Dawson, PharmD, VP of Clinical Affairs, Millennium Health. “Detection of spiking requires definitive drug testing. Immunoassay based, point-of-care tests cannot detect spiking because they are generally incapable of quantitative analysis and differentiating buprenorphine from norbuprenorphine.”

The JAMA Psychiatry article can be accessed here.

About Millennium Health

Millennium Health is an accredited specialty laboratory providing medication monitoring via definitive urine and oral fluid drug tests to support improved clinical decision-making as part of treatment for millions of Americans with chronic pain, mental illness, substance use disorders, and other health conditions. Drug testing is used to obtain objective information about patients’ recent use of prescription medications and/or illicit drugs and helps monitor the effectiveness of treatment plans. We also conduct real-time tracking of emerging drug use trends to help researchers, public health officials, and policymakers address the significant increase in drug overdose deaths.

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Jody Schneider, Millennium Health
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