I will introduce this topic by typing my response to a reader who asked whether buprenorphine, the active ingredient in Suboxone, shows up in urine drug tests. More specifically he asked whether companies have the ability to test for buprenorphine. I will end the post with a question… so please stick around to the end!
There are tests out there—multi-panel dipstick tests– that react ‘positive’ to Suboxone in the opiate panel. Or at least there used to be; I used to see that reaction with a brand of tests I no longer remember, that I used several years ago. For the past couple years, every dipstick brand that I have purchased has responded ‘negative’ to buprenorphine (or naloxone for that matter) as an ‘opiate,’ and positive in the ‘buprenorphine’ column (i.e. so I know that the urine truly contained buprenorphine). I pay more for dipstick tests that have a separate panel for buprenorphine, but yes, that test is available if a company wants it. From what I have heard from owners of companies or from people privy to the inner workings of companies, some businesses will do a dipstick first, and then send only positive samples to a lab for more formal testing in case a firing is challenged in court. They do the dipstick first because it is MUCH cheaper- $5 for a dipstick test, and several hundred for a laboratory test for several substances. It costs more for each test at the lab, so companies will only have the lab test for the substance of concern.
I assume that it comes down to the attitude of the company, but there may be issues that I am not aware of. I assume that some HR folks know what bupe is, and deliberately choose not to test for it, believing that it is a medication in most cases and not a drug of abuse. I’m sure there is a company somewhere that tests for bupe to catch any sign of even ‘prior’ addiction, but that has not been the experience of the people who have written to me. I have not heard from anyone who tested positive for buprenorphine in a random test—but I will put the question on my blog and see what comes up!
So there is my question: has anyone tested positive for buprenorphine in the workplace? Has anyone tested negative who takes buprenorphine? Please share your responses in the comment section below, so that I will have more than guesses for people who write. My attitude, for what it is worth, is that your medication list is your own business, providing that the medication does not influence your ability to perform your job. But I realize that the answer to the question can be complicated. For example, I was first treated for opiate dependence in 1993, and was completely ‘clean and sober’ for many years, active in 12-step Recovery and regularly attending meetings. Every two years I received a re-appointment packet at the hospital where I worked, and one question was ‘Do you have a chronic illness that affects your ability to care for patients?’ I knew what the question was getting at— but to my way of thinking, as a person who had been clean for several years and who was never planning on using again, the correct answer was clearly ‘no, I had no illness that affected my care of patients.’ But when I relapsed in the year 2000 the hospital made much of my answers to that question, reporting to the Board that among my other (much more significant) transgressions, I lied on my re-appointment packets. I was going to defend myself by saying ‘it depends on what the meaning of ‘is’ is…’ but someone else used that excuse before I could use it!!
The problem people face with workplace drug testing– at least something that would be considered a problem for those sympathetic to people on buprenorphine– is that people are often asked to provide a list of the medications they are taking BEFORE the test. If not for that question, they could go take the test and explain themselves in the event of a positive result. But if asked about medications beforehand, the worker must decide whether to disclose a history of addiction to an employer who may be overly judgmental, or keep the medication use private and risk being accused of lying.
To those who are going to write that ‘taking buprenorphine is impairing a person and therefore the person must put the info out there,’ I will say in advance that my patients on buprenorphine, who take the medication properly, are NOT impaired by any definition of the word. They are completely tolerant to the mu receptor effects and are getting no ‘opiate effect’ from the medication. I will also point out the double standard applied to addiction. A person with a history of epilepsy is at risk for losing consciousness while operating a crane from a seizure. A person with diabetes is at risk for the same from a hypoglycemic reaction. Someone with heart diseast could drop dead of a lethal arrhythmia while driving a school bus filled with children. Should opiate addicts who are doing the ‘right thing’ and keeping their addiction in remission be forever identified as ‘addicts’ to employers?
As always, thanks for your comments; please also be sure to join the forum if you have not already. You will note that when leaving a comment, it will take a day or so to get read and approved; I do that because there are people who have nothing better to do, apparently, than respond that I am ‘a little bitch’ or call me some other name– for reasons that are not always entirely clear! When I read such comments I always get a mental image of Mr T. saying ‘I pity the fool!’ (then I think of the scene in Pee Wee Herman’s Big Adventure where Mr. T. says ‘I pity the fool… who doesn’t eat my cereal!) I guess you really have to be there.