Urine specimen detection of concurrent nonprescribed medicinal and illicit drug use in patients prescribed buprenorphine

J Anal Toxicol. Nov-Dec 2013;37(9):636-41. doi: 10.1093/jat/bkt082. Epub 2013 Sep 29.


Patients being treated with buprenorphine usually have a history of opioid dependence and may be predisposed to misuse of drugs. Concurrent drug misuse increases the risk of life-threatening drug interactions. This retrospective data analysis observed which nonprescribed and illicit drugs were most commonly detected in the urine of patients from pain management clinics taking buprenorphine with or without a prescription. GC, LC/MS and LC-MS-MS were used to quantify 20,929 urine specimens. The most prevalent illicit drug used in both the groups (prescribed and nonprescribed buprenorphine) was marijuana, followed by cocaine. The most prevalent nonprescribed medications abused by both the groups were benzodiazepines, followed by oxycodone and hydrocodone. The overall prevalence of illicit and nonprescribed drug use was significantly higher in subjects who used buprenorphine without a prescription versus prescribed use. Of the concurrent use of marijuana and cocaine with buprenorphine, cocaine is most concerning since it decreases exposure to buprenorphine (lower area under the concentration-time curve and maximum concentration). The concurrent use of nonprescribed benzodiazepines with buprenorphine can cause excess sedation leading to respiratory depression and even death. These findings highlight the importance of educating patients about these potential toxicities. Furthermore, pain providers should consider expanding the spectrum of drugs that they monitor in patients under treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biotransformation
  • Buprenorphine / pharmacokinetics
  • Buprenorphine / therapeutic use*
  • Chromatography, Gas
  • Chromatography, High Pressure Liquid
  • Chronic Pain / drug therapy*
  • Drug Interactions
  • Humans
  • Illicit Drugs / urine*
  • Narcotics / pharmacokinetics
  • Narcotics / therapeutic use*
  • Opioid-Related Disorders / rehabilitation*
  • Opioid-Related Disorders / urine*
  • Reproducibility of Results
  • Retrospective Studies
  • Substance Abuse Detection / methods*
  • Substance-Related Disorders / urine*
  • Tandem Mass Spectrometry
  • Treatment Outcome


  • Illicit Drugs
  • Narcotics
  • Buprenorphine