Drug Tests for Patients on Suboxone or Methadone

“Why do I have to do a drug screen? Don’t you trust me?”

Lately a few of my Suboxone patients seem to be questioning the need for drug screens. Some of them resent the tests, and resent paying for them.

So why do I do drug tests?

  • It’s good medical practice. Like many chronic illnesses, relapses happen. It’s better to detect these as early as possible, to discuss what happened, and if/how we need to change their treatment. If a patient has relapsed to opioids, it may mean that I need to increase the dose of Suboxone, if they were still able to feel an opioid high. If the relapse was to other drugs, it usually means we need to increase the “dose” of addiction counseling.
  • There’s a gold mine of information in relapses. I ask my patient what happened immediately before the relapse. Was she around people who were using drugs? Did she use drugs to try to get rid of an unpleasant emotion? Did she use drugs because she became complacent? The answers can help decide how best to avoid relapses in the future. If a patient is fortunate enough to live through a relapse, she can get information she can’t get any other way.
  • Drug screening benefits the patient by giving them accountability. Some patients are less likely to relapse with accountability. I’ve had patients say that the thought of having to talk about a relapse is enough to keep them from using drugs. This surprises me, but I’m glad.
  • Drug screening also shows them I’m serious about their recovery. I’m not just going through the motions of writing a prescription and getting paid for the visit. I really want my patients to recover and get their lives back.
  • Patients in treatment don’t always tell me when they’ve relapsed. In order for addiction to thrive, lies must be told. Otherwise honest people sometimes tell outrageous lies while they are in the throes of addiction. I see this as part of the disease. It’s not about them. It’s not about me. It’s the addiction.
  • I’m not a human lie detector. In the past, I smugly thought I could tell if someone had relapsed, so drug screens just confirmed what I already knew. After more experience, I know that’s not true.
  • It’s the standard of care. Even if the other reasons aren’t compelling enough to do drug screens, the vaguely increased regulatory oversight of doctors who prescribe Suboxone should induce them do drug screens. I know if my charts are ever audited by the DEA (unlikely), my state’s department of health and human services, or my state’s medical board (more likely), I want to show I’m doing things in the proper manner.
  • I don’t want to prescribe medications that will be diverted to the black market. Some doctors say, with some justification, that buprenorphine is a safer drug than most other illicit opioids, and we should look at black market diversion of buprenorphine as a form of harm reduction. However, governmental types don’t see things that way. The DEA certainly doesn’t. I don’t want to prescribe buprenorphine to people with the criminal intent of selling part or all of it. When I do urine drug screening, if there’s no buprenorphine present, that’s a serious matter. If the patient isn’t using what I prescribe, it’s likely they are selling it. Since such diversion of Suboxone endangers the whole program, it’s essential to stop prescribing for people who sell their medication.

These are my reasons for drug screening. Since I’m not going to stop doing them, addicts who object to screening have had to find new doctors. New opioid addicts who come to my office are told, both verbally and in writing, that I do drug screening. They can make their own decision about whether they want to see me as their doctor or go elsewhere.

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40 responses to this post.

  1. Posted by Momay' on June 13, 2011 at 12:41 am

    Although I’ve been in recovery for the last 8 years I do like to be held accountable for my actions. It’s like doing a job. If you have a job to do you usually have a supervisor that comes by to check on you every now and then to see how your doing. Do we get upset and ask our supervisors if they don’t trust us just because they come by to check up on things?
    No, we accept it and move on. The same with Urine Screens we do them and move on.
    When I started treatment with my provider I was informed in the beginning of my treatment that I would be required to submit to random Urine Screens and I agreed. Do I think she doesn’t trust me? No but she has a job to do, records to keep and so on. She is also held accountable and part of that accountability is being able to show that she is doing her job by following all rules and regulations.

    Selling Suboxone on the street is not recovery and buying Suboxone on the street is also not recovery. It is addictive behavior. Now days it is so much easier to receive treatment especially with Suboxone. I’ve had people tell me they don’t want to seek treatment through a doctor because they don’t want anyone to find out they are in treatment, they don’t want to fill a prescription of Suboxone because they don’t want their pharmacist to know their in treatment.

    For these people I don’t think they’re ready for recovery. In order to want recovery you need to be ready to give up that last hope of being able to fill a prescription of opiates. People who sell their Suboxone are taking a huge risk. Not only are they risking the chance of getting caught and or ending up in jail and loosing their provider, they don’t know what that other person is going to do with that Suboxone or what other drugs they may mix with that Suboxone.

    Reply

    • Well said!

      Reply

      • I am looking for help for my daughter; who has been in a treatment program with Suboxon; Had been doing well until some Insurance issues came up which seem to her as some misuse of or rather may i say taking advantage of her Insurance by the provider of treatment. She “called” them on the problem, so they dismissed her from the clinic. I am very concerned for her “life” at this time and desperate to get her some help. I would appreciate any info you could send me.

      • If you daughter was doing well, then I would recommend she call other Suboxone physicians in her area and get back into treatment as soon as possible.
        If you think the doctor did something unethical then you can call the insurance sommisioner or the medical board.

  2. “Drug screening also shows them I’m serious about their recovery. I’m not just going through the motions of writing a prescription and getting paid for the visit. I really want my patients to recover and get their lives back.”

    This is very respectable. Certainly something that I admire and believe in. That you hold yourself to a high standard. Too many clinics I fear go through the motions and set a low bar for clients to reach. Accountability is a necessary ingredient in the recovery ‘recipe’.

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  3. Posted by JWC on July 21, 2011 at 9:23 am

    Hi Jan – Glad to find your blog. I am a physician who’s been prescribing Suboxone for less than a year. I’m getting some urine drug screens positive for other substances (cocaine, methadone, codeine) and patients who adamantly deny using these substances. They seen sincere in their recovery, and have been reliably coming to clinic appointments, and have been open with me about their lives. How do you handle these situations? If I was prescribing opioids for pain I would stop the opioid regardless of their story, but it doesn’t make sense to stop Suboxone for addiction if they are (possibly) showing signs of their addiction disorder. At the same time, I don’t want patients to feel like they have ‘permission’ to use cocaine.

    Reply

    • Hello and thanks for writing.
      That’s the dilemma. At what point do I decided my patient needs a more structured treatment environment? It’s never an easy answer. First I’d make sure my screens are accurate. I’d say besides doing rapid screens in the office, for patients who have positive urines but deny drug use, you have to send the urine to a lab for GC/MS, a secondary test that meets the “beyond a reasonable doubt” standard. It’s more expensive, but it’s one of the costs of being in treatment. Often I tell my patient that if this second test is negative, I’ll pay the $35 for the test, but if it’s positive, they will have to pay. Many times that leads to a discussion about how the drug use happened.

      I tell patients that using isn’t OK but if they’ve had a relapse, but the most important thing is that we talk about it, dicusss what happenend and how they can learn from it. I tell them that since they were lucky enough to live through a relapse, let’s learn all we can from it to help them going forward.

      It’s unusual to have a patient on Suboxone screen positive for methadone. Did he also have buprenorphine in the UDS? If he’s taking methadone, he’s probably diverting Suboxone so you’re not helping him & I’d stop right away and probably refer to an opioid treatment center for methadone treatment.

      I’ve seen a few false positive screens for amphetamines from OTC meds, but even rapid screens for cocaine are pretty accurate.
      If a UDS is positive for opioids, first I ask is the Suboxone dose high enough? If you’re up to 16 or 24mg, the patient’s opioid tolerance may be so high that the Suboxone isn’t going to work. If you’re using a small dose like 4 – 8mg, consider increasing.

      If my patient has had a relapse but otherwise had been doing well, my usual approach is to insist he/she get an increased “dose” of counseling. I offer an array of options: increase frequency of 12-step meetings (and document attendance), see my LCAS counselor who works in my office, or see another counselor of their choice if they have someone they prefer. I also refer to intensive outpatient treatment, but there’s only one place in my area that will agree to treat my patients while on Suboxone. Most programs around here are abstinence based, and tell me they will only treat patients after they’ve “stopped using drugs” meaning Suboxone. *sigh*

      If a patient’s had repeated relapses, I refer to the methadone clinic or to a detox/30-plus day inpatient treatment.
      Suboxone prescribed from an office really is meant for those patients who have a relatively stable life and not much other drug use. If there are repeated relapses, the patient probably needs more help than you can give in that setting.

      Reply

  4. Posted by Shawn on May 22, 2012 at 4:03 pm

    Hi, I have been on Suboxone for about 8 months. It has helped me completly stop taking Pain meds. Wonderful! I am a social drinker, and that has even reduced to a once a month thing now that I am on Suboxone. The only thing that bothers me about the drug testing is this: I like to go fishing once a month or so, when I go I like to smoke a very small amout of pot. It is not an everyday thing and I know it is less harmful than alcohol. That being said, it is frustrating to me that I can’t do what I want to do (smoke a joint once a month) and be on Suboxone. I am a very responsible person and just fell into the pain meds after an injury. I understand the reason for the screening and agree with it, but, I feel pot should be left out. If that is the worst thing the patient is doing, they wouldn’t even need treatment. Do you Docs understand what I am saying? Just like suboxone, pot is the lesser of the evils. I don’t even really like to smoke, I am just frustrated that I can’t. It makes for a tense situation where I can’t be totally honest with my Doc. Sucks, I want to be totally honest, but, as long as pot is considered the same as cocaine, I can’t be! Do you guys understand? I am not just trying to get by with somthing and not just trying to bend the rules, it is a real problem! I think we could go further with treatment if you guys looked the other way on a substance that grows naturally and stays in your system for a LONG time! That brings up another point…. The hard drugs are out of a persons system in 48 hours, all they have to do is quit two days before the visit. With pot, you can never smoke because of a screen every month! So the system allows the person to use hard drugs 28 days a month but not smoke pot once in that timeframe. Doesn’t make sence huh? I know it is an illeagle substance and I am not trying to change the world here… Just saying this: Please not stop helping someone because of pot, and please don’t consider it a relapse. It is not, not at all the same thing as pills!

    Reply

    • Interesting comment!
      My views have changed over the last ten years regarding patients on medication-assisted treatment who smoke marijuana. Initially, I felt that if addicts in treatment on methadone couldn’t stop using marijuana, I should taper them off the methadone program and recommend admission to a higher level of care, meaning inpatient treatment. Patients nearly always refused this recommendation, and left treatment.

      These days, I prefer to keep the Suboxone or methadone patient in treatment, and work on the marijuana issue. I usually see these patients more often than I would if they were not using marijuana.

      Marijuana use is an issue, for several reasons: once a person is diagnosed with addiction, it changes how I view their use of other drugs that cause euphoria. Once a person has an addiction diagnosis, they are at much higher risk of misusing other substances, to their harm. The brain doesn’t care if it’s “natural” or not, and by the way, cocaine, opium, alcohol…all these substances occur in nature, so that argument doesn’t wash. Plus, many natural things are deadly, like hemlock, arsenic, nightshade, and oleander.

      The other reason it’s a bad idea for an addict to smoke marijuana is that with addicting drugs, there appears to be some kind of kindling effect in the pleasure center of the brain. For example, some people only crave cigarettes when they drink alcohol. One drug often affects cravings for other drugs. We know that if a person is in recovery, they are at higher risk of relapse back to their original substance of choice if they keep using other drugs, even alcohol and marijuana.

      And then there’s another practical reason I counsel patients on Suboxone and methadone to stop marijuana: most have to buy it from someone, and dealers these days tend to have diversified product lines. They may also have pain pills to sell. It may not be such a big deal for the patient on Suboxone, but if you ever want to taper off Suboxone, there’s a relapse waiting to happen.

      I want to remind you that opioid addiction is a life-threatening disease. Why risk your recovery by using marijuana? Do you really need it in order to have a good time fishing?

      Marijuana causes much less harm to the body than all of the other addicting drugs, and many people use it without ill effects or addiction. But if you are a person with addiction, that changes everything.

      Reply

      • Posted by Joe on August 13, 2012 at 4:49 pm

        I am a current Suboxone patient and I smoke Marijuana every day. I became dependent on opiates after a bad relationship and now I have been clean for 8 months, with the exception of Suboxone and Marijuana. I feel that I am now in control of my life and I do no longer spend all my money, time, and effort in obtaining Oxycontin/heroin. I feel I have come a long way and I will never go back to being a salve to Oxycontin/Heroin I do not buy my pot from the streets I happen to live in Colorado where marijuana is legal to buy with a licenses. So I never put my self in the scenario where I maybe tempted to score some dope while buying my Pot. My Doctor who prescribes me my subxone recommended me getting my Marijuana License so I can be legal. However his recommendations indicated that if the law changes in Colorado He may not be able to prescribe me subxone while I am using Marijuana. I now take a fraction of my prescribed dose of subxone at one time I was given 4 8 mil strips per day now I take 1/8 of a 8 mil strip per day and I feel awesome. I do not believe marijuana has a negative effect on me as an individual I am a strait A student in a local University and I would not have had the success I have today if it were not for my subxone treatment regardless of the fact that I smoke Marijuana.

    • Posted by Jade Deller on July 17, 2012 at 5:57 am

      Omg thank you, I am struggling so bad, I just got percribed suboxen and for some reason have had the urge to smoke pot. But Im afraid I will get kicked out of the progam if I do. I already have and am now worried about how to get it out of my system without flushing out the suboxen, because they will test my levels. I’ve been searching the web for hrs trying to find a way to do so. Do you have any suggestions?

      Reply

      • I would suggest being honest. If I had a patient in a similar situation, I’d like to hear about how the relapse to marijunan happened, to help figure out the trigger(s). Continued drug use usually means you need a higher “dose” of counseling. Perhaps you and your counselor/doctor need more time to work on the psychological components of addiction.
        I believe patients that tell me about their drug use are making more progress in treatment than those who deny and try to cover it up. Because if we don’t talk about it, how can I help?

  5. Posted by Kara on October 17, 2012 at 5:08 pm

    Thank you for being a good doctor. I am struggling with my suboxone dosage right now..and I am terrified to tell my doctor. Your blog really helped me to find the courage to be honest with him. My doctor is a good man and I admire and respect him…and I want to be completely honest with him. I was afraid he would drop me if he knew the truth….and I feel now that he will want to help me and listen to me because of your blog. Thank you so much.

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  6. Posted by April on May 12, 2013 at 12:46 am

    I have been on the Suboxone program for over a year now and I am now down to 2 & 1/2 mgs per day. The question I have is that I have bouts of insomnia and before I would take Ambien or Lunesta but I’ve been told that it could give a false positive as a benzo. Can they do that? I have the prescription for them but I don’t want to take the chance of that happening.

    Reply

    • It would depend on the type of test your doctor does – I have had test kits that seem to react as positive to Ambien. Since these medications have their own problems, please talk with your doctor about them.

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  7. Posted by Rose Christian on August 16, 2013 at 6:58 pm

    OI have been on suboxone for 2 years and only suboxone. My doctor uses the urine drug test cup and for some reason my past 3 test showed positive for methadone. I’ve never taken methadone. She refused to send it to the lab for further testing. What can I do because she is about to kick me out of the program. It really hurts when I know that I haven’t taken anything else. Can u please give me advice on what to do.

    Reply

    • This is bad. It’s unwise to take such severe action based on the test cup method. I recommend she have you go get a chain-of-custody drug test to include methadone and bupe, and if the preliminary on that is positive for methadone, send it for the more specific test, usually GC/MS or something similar. What she’s doing is unwise, and can be unfair to patients…like you. She’s risking legal action against her, I think.

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  8. ok, as someone who has battled opiate addiction for 23 years…10 years on the streets, doctor shopping, calling in my own refills, stealing from other patients (yes, I was in the medical field)…and then 13 years of being on methadone..let me tell you this. Yes, you are trading one addiction for another. But and this is a big BUT…after everything else has failed…in patient rehab, out patient therapy, 90 days programs in patient, 12 step programs, will power, being prayed over by God fearing people asking for a miracle, going to jail. losing my marriage, losing my home, losing my license, almost losing my only child, losing my family,losing my self respect, and wanting to just end it all….I finally found methadone. Since day one, May 21, 2003, I have had not one relapse. I have my life again, my family again, my relationship with my child again. went back to school and became a certified peer support specialist and substance abuse counselor (figured I could make something positive out of 10 yrs of hell and all the lessons that were so hard to learn). So, methadone has been my savior. I kinda look at it like this….we pray to God please help me, please send me something to help, anything to help….we he did…he sent the knowledge and science of suboxone and methadone. I do not feel “high” or get any type of euphoria at all. I simply feel normal and can function on a daily basis. If I even took any pill that was opiate based, it would do no good as I would feel nothing. I guarantee you if you met me on the street, you would never know I was a methadone consumer. I have tried to detox twice and could not get past a certain point without feeling the pain….so I have accepted that I have most likely done irreparable damage to my endorphins, serotonin levels, and brain chemistry that can not be fixed. BUT methadone replaces that damage and allows me to have a life, one that I can be a productive member of society with values and morals. I am not on what most would consider a high dose, but it is a dose that would kill a nonaddictive person.Because of that, I am extremely careful with my medication and keep in under lock and key at all times.
    I do not think methadone should be the first line of defense as it is a serious step, but thank God that it is an option for people like me!

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  9. I have a very serious question for you. I am a 39 year old homeschooling mother of 4, my youngest is 3 and I had him while on subutex which was a nightmare in & of itself. Now, I’ve been on suboxone, previously and during my pregnancy, subutex for 7 years now. First due to a pain med addiction due to severe back pain from 3 pregnancies. I’m a very small framed woman, weighed no more than 98lbs for many many years not including my pregnancies. Then as I was on a taper schedule I had a major injury result from a very awful car accident and had to be put on massive doses of pain meds. I was unfortunate to be on the faulty pain patches (fetynal, sorry on the spelling) and because I knew something was not right I literally begged my dr to take me off all pain meds even though I had a shattered left leg. Id rather deal with the pain then not feel what’s going on in my body. That was not even 2 months into my recovery. My left shin, both bones broken & shattered. Surgery, titanium rods and screws ect… So my dr put me back on suboxone. Previously I had only been on it for about 2 months and was on a taper schedule. So 7 years later. Here I still am. Stuck on it now. My life homeschooling my 4 children is crazy busy. I’ve tried & still try so hard not to take it. Throughout the years I asked my dr so many times that I wanted to get off of it but because during my injury recovery I had to have a surgery to remove some of the hardware bc it was beginning to protrude through my skin, I had to be put back on pain meds then back on suboxone. However. It’s been years and I have refused and will continue to refuse any further surgeries/cutting into my body. I’m fine, my leg is fine. However he’s kept me on it just incase. Now I’ve been a model patient. I follow all rules. Never had to take a drug test until this last 1-1/2 years. Then I take them every 3 months. Of course I pass. Now I’m told I have to take one every month and pay for it! I’m not only shocked but very upset. We cannot afford it. We have no health insurance. So yes we pay out of pocket for my suboxone and my appointments, everything! A medication I have been trying for years to get off of but been told I NEED to stay on. Now I’m stuck on it. It is not an easy medication to get off of if you’ve been on it the length of time that I have. I trusted my dr. All my drs. And I honestly now feel like I’ve been bamboozled in a way. Like I’m nothing more than $$$. So I completely see your point and understand why the drug testing. But why are the protocols always the same for every person? Why is noone treated like an individual anymore??? Seriously! I have a solid honest 7 year history with my doctor. He saved my leg when there were major complications. Without him I would’ve lost my foot and probably my leg from the knee down. But now I get treated like a number instead of a person. No warning on the supposed NYS law changed. Just told over the phone when I call for my script that I have to take yet another tox screen before dr will write my script. I say ok no problem I’ve just gotta figure it out w my husband bc we only have 1 vehicle & usually my husband just picked up my scripts. He also knows my dr very well and on a semi personal level. Not anymore. Now he is even treated like a number as well. Not only do I have to alter my children’s learning schedule but I have to pay for it as well??? Why? We live on a ridiculously tight budget as it is. And when I asked how much & told the receptionist $25 more a month is going to crush us, she chuckled!!!! And replied, ya it’s hard for everyone! Sure, ill bet. So hard for my dr who takes vacations out of the country every few months! Even though he’s supposed to be available 24/7 because he also participates with signatureMD! Which I had to pay $1650 to remain his patient. I’m sorry. I’ve completely lost all faith in the medical industry. My dr was once a holistic practitioner. And treated me wonderfully. Like a person not a $$$. Now…. You’ve read my story. I can’t trust any medical professional. And I know many who feel the same. It’s a sad sad time we live in, even if you do everything you’re told and follow all rules, pass every test, it’s still gonna cost you more and more and because of the medication you are on you’re labeled. I’m on it for maintence and “pain management” from my previous injuries yet I still get treated like some criminal junkie looking to score….

    Reply

    • Did you read my blog about why doctors do drug testing??
      you are getting drug tested every 3 months, which sounds plenty lenient to me. It does sound like your doctor has individualized care. New patients, and old patients who are having difficulties are usually drug screened weekly, then monthly if things improve.
      Your husband just picks up your prescription?? Standard of care is that the patient needs to be seen monthly. However, I do have a few very stable patients whom I see every other month.
      I have to say, I’m having a hard time seeing why you feel like you are treated “like some criminal junkie trying to score…”
      I don’t know what you are talking about with signatureMD, not familiar with that. But I’m guessing you paid for the Xrays of your leg without complaint, not sure why drug testing should be paid for by your doctor and not you.

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      • When I go in for my scheduled appointments the tox screen is included in the fee. Now and I’m not sure if this is just the office procedures because there’s alot of new staff due to the signatureMD, or if it is NYS laws/regulations. Bottom line is I was told last month that I would have to start taking monthly tox screens, ok no problem I said. I was also told it wouldn’t cost me. And no I did not pay for X-rays for my injuries it was all covered under no-fault as it was a car accident that was also not my fault as was decided in court. But that is history and has nothing to do with my issue at hand other than the fact that I’m still on this medication as a “just incase” something should happen that would require more surgery/going back on pain meds. My leg never fully healed there is a small gap between the bones I’m guessing due to the shattered pieces they had to remove. My surgeon was not great and never answered any of my questions. Anyhow like I said it’s history. My problem is being told it was NYS regulations and that I would not have to pay for it. Then when I call in like my dr tells me to, he tells me when to call as I’m not given a 30 day script but a 20 day script. He set it up that way a few years ago when there was a possibility of our family getting health insurance, long story. Bottom line he’s been a wonderful doctor, very accommodating and I’ve followed all rules, everything he’s said I need to do. Passed every tox screen for 7 years ect… Again I was told no you shouldn’t have to pay for it, it’s a NYS regulation and when I call as I’m supposed to I’m told something completely different. I wonder if my doctor even knows. I pay $1650. A year to keep him as my dr. I pay $30 for every visit which includes my tox screen, it’s a discounted fee because I’m a signatureMD member and already paid the $1650. It’s consierge medicine I’m told. The something completely different is that now I have to either have an appointment every month ($30) which now will not include the tox screen so add $25 to the office visit fee or just come in and do the tox screen with the fee of $25 that originally last month they told me wouldn’t cost me any additional. That’s why I’m upset. We cannot afford any additional fees. We don’t have credit cards. I don’t work due to my injuries, I used to be a server in a fine dining establishment. I had worked there for over 12 years. My husband works full time and I’m not going to sit & boo hoo about our pitiful income. No I am not on disability. I should be. But I felt even though we really need it, and I am labled permanently partially disabled I did not take it. I believe there are other people out there more in need. I do work from time to time but it’s very limited as I cannot stay on my feet for more than 4 hours. Anyhow, my life and history is not the issue. The issue is NYS continually changing the rules and applying them to everyone no matter that everyone is an individual. Taking the discretion out of the doctors hands and basically making them treat everyone the same when in fact everyone is not the same. Increasing the costs for everything also. This is what I’ve been told by my drs office staff. And the reason I said being treated like a “criminal junkie” is because that is how certain members of the staff treat me. They open the door to bring me back & shove that cup in my face in front of every other person in the waiting area. My dr is not just a suboxone dr. There are patients there for many other things. I don’t like or feel comfortable with strangers seeing what is going on and yes I did say something to that particular staff member of whom I do not know her title. I don’t know if she’s a nurse or not, I’m assuming she is bc there is a PA on staff along with a massage therapist and another dr and several nurses & staff members. My pharmacy also has a few that are horrible to me which is why my husband usually handles things the picking up, dropping off ect. That and the fact that I homeschool our 4 children and ever since my accident I really do not like driving. I only drive when I have to. Yes driving causes me stress and anxiety. Yes my dr knows. No I do not take medication for it. I do not take any meds other than the suboxone and I’ve already stated why I still take it. We live as natural a lifestyle as we can. Organic/natural foods, supplements, exercise. As healthy as we all can. I apologize for the length of this post. I wanted to clarify a bit on my previous post. Thank you for this blog it is very informative.

  10. Posted by Maria on September 25, 2013 at 1:27 pm

    Hi I need some advice ASAP. I go to my psychiatrist and get prescribed 12 mg of subutex and 6 mg of xanax per day. I do not have insurance. I have been on subutex for 2 years or so and Xanax for 6. I have been at this office for 2 years and with this doctor for 9 months. The office does random drug testing and received my second one last month. I thought there would be no issue with the test that they send out to the lab from last month, however just this past weekend I ran out of my subutex early and had too many things to do to be sick from the sub withdrawal which is very bad for me for some reason. I made a huge mistake and hated myself the whole time for picking up to get me through the two days. Somehow lasts months test came up saying morphine was detected and I haven’t done anything like that and was so shocked yet so scared because they had me take another test to send out to the lab and I knew I would fail but can’t twice in a row even though I honestly don’t know why morphine came up from last months test! The only thing I may have taken was Vicodin that I was prescribed for a dental issue. Could that come up as morphine? I got so scared I added a bit of water to my urine. This will never happen again but I’m afraid this is my last chance! Will everything come back diluted? I can’t stop shaking. I can’t eat or sleep and I feel horrible and don’t know if I just screwed myself or if I can go speak to him in person and tell him I was. Soo scared I wasn’t thinking and did something so terrible? I need these medications. I can’t lose my doctor. What will it say coming back from the lab? My ex passed away from a seizure from Xanax withdrawal so something like this is my biggest fear. I can’t go all month shaking in a corner not knowing what the dilution may have done and if they may just give me another test? or if it will show up anyway ? Please help!!!

    Reply

    • I think your best option is to get honest with your doctor.

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    • Posted by delite66 on September 27, 2013 at 9:14 am

      Maria,
      It sounds like you had a relapse. Even though it was a brief one, you still need to realize that something is going on that caused you to have this….I noticed you said that you ran out of your suboxone early. That must mean that you were taking more than was prescribed and then you were facing going through withdrawals, which is why you used. The vicoden will test positive for opiates, not morphine. So I am not sure why you tested positive for morphine but honestly, positive for opiates or positive for morphine, does not really matter which one in the end. If you are honest with your doctor and tell him the truth, then maybe he will increase your suboxone amount and you will not have to worry about running out too early in the future. Now, that does not mean there will not be a price to pay. He may ask you to come in more often, he may drug test you more often, he may monitor you more, whatever. But after a while you will earn back his trust and be okay. If I were you I would tell him that I took more suboxone that I should have and ran out early and that is why you ended up getting opiates. Then tell him that you have really struggled with telling him the truth, but wanted to have a relationship built on honesty. Believe me, in the end all will be okay. I know from experience!
      Delite66

      Reply

  11. Posted by Lisa Marie on October 21, 2013 at 3:52 am

    Hi I just recently started seeing a Dr for suboxone about a month and a half ago, well last time I went the night before my appt I took a Xanax (un prescribed) I obviously tested positive for benzos, my dr didn’t like it and only gave me 2 weeks worth of suboxone and wants me back in 2weeks to retest me. Now every website says it can stay in my system for 6 weeks now I haven’t taken any Xanax since then but it’s only been 2 weeks is it still gonna be in my system or no?

    Reply

  12. Posted by Lisa Marie on October 22, 2013 at 12:49 am

    Great thank you so much!! I normally don’t take Xanax but I’ve been having a lot of anxiety lately maybe it’s from stopping all the Vicodin. I don’t know, who knows!! But thanks for the advice.

    Reply

  13. Posted by Soulless201@gmail.com on November 25, 2013 at 1:05 am

    I am a addict who is not in treatment I struggle to keep my self from getting sick all the time I want to get treatment but I don’t wanna quit pot I know from stopping before with treatment that if I quit pot for help I will relapse pot keeps me from doing the harder drugs just letting you know from a honest point of view

    Reply

  14. Posted by Kristen on May 10, 2014 at 6:20 pm

    I am a CNA and recently tested positive on a drug test forva home care job for Methadone and Benzodiazapines, which i have prescriptions for BOTH.. I am not “nodding out” or in the least bit unable to perform my duties. Ig is ridiculous thatvi cannot work in my area of expertise whenvi have been on a regulated program for THREE YEARS and am coming down of Methadone slowly. I understand their concern, but i attended orientation for two days and the supervisor sat there and saw i wad COMPLETELY alert and functioning. I am so angry. All i want is to get a job and work and it seems impossible for me to do this.so frustrated. Please HELP!!

    Reply

  15. Posted by Carol on July 15, 2014 at 5:33 am

    I have been on suboxone before. I got forced off when my insurance cut off and I didn’t have the money to pay for it. I relapsed pretty bad. I managed to stay sober for a year and a half after the last relapse, but then because of chronic pain I have due to nerve damage from a herniated disc (which I had surgery to fix, but the nerves are still damaged) I relapsed again six months ago. I couldn’t get in to a suboxone doctor until recently so I bought 3 subutex a day for a month just to go ahead and get myself off of the opiates and heroin. I now have a doctor, but he is all about getting me off of the suboxone in 4 to 6 months, when I know for a fact that I do not do well with that and would prefer to just do suboxone maintenance until I am more comfortable. He immediately dropped me from the 3 I had been taking to 2 a day, even though I told him I am very uncomfortable at this dose and I don’t seem to be adjusting to the drop well at all. He will not listen to me when I say that I just want to maintain for a little while and says that the drugs in my body are the devil and I need to get the devil out (he is a very devout Muslim and is very insistent that I must stop in order to get the devil out of my life, which doesn’t bother me because I am a Christian and think similarly about the heroin, but not about the suboxone that I believe is actually saving my life and that God is the one that put me on the path to suboxone.) Anyways, I don’t know how to talk to this man to make him see that I know my own body and my own mind and I have been down this road before and know what I want and need. I have been looking around trying to find another doctor in my area, but at the moment they are all booked up and at their patient limit. Please, if you can give me any advice as to what to say to him to show him that I am not a drug addict trying to cling to my drugs, but rather someone who is really trying to stay clean and knows realistically what I am capable of right now, I would really appreciate your input. I am in a panic at this point that he is going to just keep dropping me without listening to what I have to say. I have an appointment with him in 2 days and if you can give me any pointers to get him to listen I would be so grateful.

    Reply

    • Posted by Carol on July 15, 2014 at 6:19 am

      This is Carol again, replying to myself for the doctor. I forgot to add that they are also testing levels and saying that my levels weren’t high enough for having taken 3 8 mg suboxone strips/subutex pills a day. I was getting them off the street so I was taking whichever one I could get trying to keep myself from both withdrawing and from relapsing. I was not abusing them. I was taking exactly what I was initially prescribed the first time I was in the Suboxone program and it was working. My question, though, is how accurate are those level tests? I feel like the doctor thinks maybe I was lying to him or something, but that is really how much I was taking, even though the test says my levels were lower. Now I am extremely uncomfortable due to him lowering me down a whole 8 mgs in one day. By the time I go to bed each night I am having the runny nose, headache, cramping stomach, and insomnia I would have from withdrawing. The rest of the day I’m fine, but I just can’t make it through the night without the symptoms popping back up. They’re definitely not as severe as they would be if I were just going cold turkey, but I have always been told that I should take what is necessary for me to feel, I guess the word would be “normal”, and he will not listen to a word I say. He seems to be on a mission to get me off of the suboxone on his schedule, no matter how awful I feel in the process. Like I said in the post this is a reply to, can you please help me find a way to get through to this man?! Is there anything I could have taken or done to effect the accuracy of that level test? Or is it just one of those tests that aren’t all that accurate? And is he allowed to ignore what I say and just go ahead with his detox plan? Is there anyone I can complain to if it keeps happening? I also said this before, but I am trying my hardest to find a new doctor but in the meantime I have to figure out a way to work with this man because he is the only option I have at the moment to stay clean. I cannot go back to buying them on the street from the same people that would also try to sell me all kinds of other things. That is not conducive to my staying sober, and was only a temporary fix until I could get in to get help from a professional. I’m sorry for going on and on so much, you just seem like an amazing doctor and your blog is so informative that I figured you might know what I should do in this situation. Thank you!

      Reply

      • I have no idea how you can change your doctor’s mind. As time goes on, we have more evidence to support maintanence with buprenorphine rather than time-limited treatment, but from your description I doubt you can say or do anything to change his mind.
        And if you are talking about urine levels of buprenorphine, the science is NOT exact enough to say with a dose of 16mg per day you should have “X” level in your urine. Urine levels don’t correlate well enough with the dose that’s taken by the patient to be able to say a patient is or is not taking the correct amount of medication. I’ve heard of doctors dismissing patients because the “levels were too low.” True, if the prescribed medication isn’t in the urine sample at all, the patient may not be taking the meds, but it’s scientifically unsound to use levels in urine to say what dose the patient is on.
        I suspect there’s a shady lab that’s been selling their services by overstating their capabilities, and some doctors are falling for it. It does a great disservice to patients.
        Yes, what he prescribes is left up to his medical judgment. your best bet is find another doctor, who does not have a set schedule for tapering but looks at each patient individually.

      • Posted by delite66 on July 17, 2014 at 12:34 pm

        Carol, Is there a methadone clinic anywhere near you? The reason I ask is because most methadone clinics are also treating with suboxone/subutex. They will make sure you have the right dosage and will not rush you to taper off either. In fact, you can be on a maintenance dose forever if that is what you choose for yourself. Just wanted to throw that option out there for you!

  16. Posted by Carol on July 20, 2014 at 10:45 pm

    Ok. Thank you for the info. I know I’m taking it how I am supposed to be, so I guess it’s something going on on their end or like you said it’s just not a reliable test. To delite66, yes there is a methadone clinic, but where I am it is not a safe place to go. It is actually very dangerous where it is located and I have had two different friends robbed and assaulted going in. I do have one more question for the Doctor, though. My doctor’s office said they accept my insurance and that for the first visit they would charge me $200 cash and that after they confirmed with my insurance that they would pay them that I would get a refund check from the insurance company. I’m now scheduled for my second appt and they told me to bring $100 cash with me. When I asked why, since I have insurance, they said that I would get a refund when they charged my insurance. My insurance provider’s website is saying they haven’t filed a claim yet. The way they said it, it sounded like they would charge them after the next appointment, but it almost sounded like she was saying what she had to say to get me to stop asking. Is this some sort of scam or is this normal? I can’t afford to keep paying them in cash when I have insurance that should be paying for it. Why have they still not charged insurance and should I speak to my insurance company about this? They are in my network, I checked. They also still haven’t gotten my prior authorization for my prescription, so I’m being forced to pay $17.59 a day for my two strips. The prior authorization request was sent to them last Monday from my pharmacy, so I don’t know if maybe there is just a time delay between when they receive it and when it’s approved, but I really can’t afford much more of this and I can’t find any other doctors in my area. I just want to know if all of this is normal, because to me this just feels like things drug dealers pull and that’s exactly what I am trying to get away from. Thank you so much for answering my questions. It is so nice to have someone knowledgeable about this to ask what is right and wrong!

    Reply

    • I’d give your doctor’s office the benefit of the doubt at this point, but I’d also ask to speak to the office manager and ask for confirmation that they will file claims with your insurance provider for re-imbursement. If they say they accept your insurance, that’s what I would assume. If they don’t accept your insurance, then you have to pay your doctor and file a claim with your insurer yourself – with your paid receipt from your doctor – and wait to be re-imbursed.

      Reply

  17. Posted by Lyb on August 4, 2014 at 12:37 am

    My 24 year old daughter has been in and out of rehab for the past few years for iv opiate.. she started suboxone from a clinic.. I have heard that it is possible for the strip to also be melted and injected? is this true? She is on probation and will be drug tested once a month by her PO.. will the suboxone show?
    thank you all

    Reply

    • Yes, apparently some people can inject the suboxone and despite the naloxone, still feel the buprenorphine. I do think most people are much less likely to inject it than the buprenorphine without the naloxone added.
      Suboxone won’t show unless PO tests specifically for buprenorphine.

      Reply

  18. I am currenty on suboxone and i took a xanax and failed one drug test,and i have another one coming up very soon and i took a xanax today.will i be cut off if i am honest with my doctor?

    Reply

    • I don’t know. That would be your doctor’s decision. But addiction thrives on secrets.
      When I see a patient who admits to using drugs while in treatment, it’s just a starting point. The most important thing is that you didn’t die from an overdose, and there’s important information to be gleaned from any relapse.
      I think it’s great when patients tell me about relapses, because then we can figure out how to avoid them in the future. We can talk about relapse triggers, coping strategies, and so forth. At some point, though, especially with benzos, I might have to decide the patient needs more care than I can give and recommend inpatient treatment. That’s a big step and I don’t usually decide that based on one slip.

      Reply

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