Inmates with False Positive Drug Tests Accused of Taking Suboxone

According to news reports, inmates in Attica, New York, were wrongly accused of using buprenorphine (generic for the active medication in Suboxone and, Subutex). Apparently their urine drug screening system had a glitch, and nearly fifty inmates had these false positive screens. The prisoners, their lawyers, and their families badgered the Department of Corrections to investigate further, and when they did question the drug testing company, the unexpected results were found to be due to lab error. Until the error was acknowledged, inmates received sanctions and punishments including solitary confinement. It took a little over a month to discover the tests were in error, but at least the error was caught and acknowledged.

This is a good example of the lack of credibility addicts and inmates have. If a known addict protests a positive drug screen, much of the time they’re assumed to be lying. It’s not only law enforcement personnel who think this way; treatment center personnel can begin to believe all addicts are lying when they say their drug test results are wrong.

We must remember that no test is 100% correct and there will be false positives (the test shows drug use where none occurred) and false negatives (drug use occurred but wasn’t detected by the test) on screening tests. Granted, the rates of error are fairly low, but if you do enough tests, some addicts will be falsely accused of using drugs that they didn’t use.

That’s why secondary testing is crucial for contested results.

Most drug testing has two parts. The first screening test is quick, cheap, and relatively accurate. Most of the time, this test is sufficient. But in situations where positive tests have major negative consequences for the person being tested, a second, more accurate (and more expensive) test should be offered.

The second test is usually based on gas chromatography. If chain of custody has been maintained, the results of this test meet the legal standard of “beyond a reasonable doubt.” In other words, while no test is 100%, this test is so close that the courts accept it as proof.

At the opioid treatment programs where I’ve worked, many patients claim that their positive screening tests are in error, and they haven’t used the drug in question. That’s when the second test should be offered. However, gas chromatography is more expensive, and the issue becomes who should pay this extra thirty to forty dollars – the treatment center or the patient?

At one treatment center where I’ve worked, staff tells the patient that the second test will be done if the patient requests, but if the test is confirmed as being a true positive, the patient pays the cost of the second test. If the second test does NOT confirm the questioned result, the treatment program bears the cost. Thus, most people who know they’ve used the drug in question don’t request the second test because it’s a waste of their money. And patients who know they haven’t used are understandably eager to have the second test done on their sample, so they can prove their continued abstinence from drugs.

Drug testing is essential in the treatment of addiction, but treatment centers should make sure their tests are done by a certified lab and interpreted by a trained physician if questions arise. Confirmatory testing should be offered as an option to patients who question screening results.

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14 responses to this post.

  1. Posted by Cynthia T. on March 3, 2012 at 3:30 pm

    Well this is certanly interesting. The last checkup I had on Suboxone tested positive for Methdadone which I have never taken in my life. Prior to this follow up, I didn’t even know what methadone was. I see a different Dr. every time I go and I got a good chewing out because of it. I have been doing really well on suboxone but after this visit i won’t be going back. i also tested positive for opiates which is the WHOLE reason I am taking Suboxone. I am doing this for myself, no one else. Why would i take opiates if I am taking suboxone? It’s not going to work anyway and the whole reason I wanted to start suboxone is to get OFF opiates. I was treated horribly that day and was very humiliated. I had to go on my lunch break ( I work as an Optometrist) so i am a professional. It’s a shame most places do not take insurance for suboxone Dr.’s. I was doing SO well. All day i was pondering how I could have tested positive for all those things!

    Reply

    • I’m sorry you had this experience.
      I do rapid screens in my office, and if I get an unexpected result or if the patient desires, I can send my patient to a drug-testing site that will do observed drug screens to be sent off for chromatography if they’re positive. That way, we know for sure.

      It’s not that uncommon for me to have Suboxone patients screen positive for opiates, especially early on in treatment. My approach is to say, “Tell me about this. Have you had a relapse?” and nearly always if they have used drugs, we discuss what happen and how, and try to decide together how we can make their treatment more successful. Chewing people out is of limited value because they feel attacked and get defensive.

      I have had much better results after I learned to view drug use as a part of the disease of addiction. I’m not saying drug use is OK, but if a patient has used drugs and is fortunate enough to live through it, let’s talk about what happened and learn from it.

      I did have one Suboxone patient screen positive for methadone once. I fortunately had a few extra methadone-only test kits in my office at that time, and when I used the second test, it was negative, and I was certain the first one was an error.

      Don’t give up on treatment. Vote with your feet, and find another doctor or treatment center.

      Reply

  2. Posted by dbc3913 on March 3, 2012 at 10:49 pm

    “This is a good example of the lack of credibility addicts and inmates have. ” – Exactly. However, this is the natural order of society. As you *appear* to your community to be more insane, or on the fringe, you must go to greater lengths to prove any case you make. In the case of inmates, already stereotyped by society, I am surprised they had the resources to uncover this error. I believe these types of errors probably go far beyond jails and are almost never reported. They may very well make the difference in someone’s career.

    Reply

    • The sorry state of our prison system deserves a blog all its own. My fiance works as an LCAS in a jail treatment program, and some of the behavior he describes is abominable. I’m talking about the jail staff, not the inmates.

      Reply

  3. Posted by Wayney on March 7, 2012 at 1:10 am

    I can only imagine the problems those false positive tests caused for those inmates. It’s sad that it took so long to find out the error. And I highly doubt the prison issued an apology to the inmates. One would think that after the first 10 or so people denied using something that was a medication they all tested positive for, that the prison would be asking questions and considering that there just might be something to the prisoners denials. But that is indicative of the problems with our penal system.

    The pain clinic I am treated at has mandatory random testing for ALL patients irregardless of their history and whether addiction is something they have struggled with. I know at least once a year if not more often I will be surprised with a drug screen. I have no problem with this as I have nothing to hide. I was entering my 2nd year of treatment there and it was time for my surprise UA. At the time I was on hydrocodone.I took my hydrocodone every 6 hrs as allowed. We were ALL surprised when the test showed that I did not have hydrocodone in my system but was positive for a different and stronger narcotic. They had just switched to a new brand of test and commented that they had a few people that had results that were odd. So they either retested me using one of their older test kits or sent the results off to be retested in the lab. I am not sure which. Either way, everything was fine because I never heard anything else about the subject.

    At first I was worried that there would be a problem because of the false negative for hydrocodone, but thankfully both the doctor and the NP, who was the one I saw more often knew me better than to believe I wasn’t taking my hydrocodone. In fact, anyone who knows me can tell if I’m even overly late on a dose of my pain meds so it would have been obvious I wasn’t taking them if that were the case. The NP actually laughed at the thought I was taking a stronger narcotic without telling them or using something illegal. She did so because of the fact I’d been resisting changing meds to something stronger and more effective. She NEVER pushed me too hard or made me feel bad over my decision. She understood and while we disagreed about my need for a different med, she respected my opinion and that it is MY body. The sad thing is my resistance was stupid. I knew that I had little to worry about regarding addiction and that tolerance can be handled as can physical dependence. I’d written an article on addiction, dependence, tolerance and chronic pain. But old habits die hard. I’d been hoping to find an RA med that would help the pain by getting the disease process under control. But, finally I got tired of waiting for what isn’t going to happen and decided to switch from hydrocodone only to using it as a PRN med along with fentanyl patches. I am so thankful I finally decided to make that step. The relief was wonderful. Between that, the RFA for my lower back pain, and finally getting an RA med that is working, I began to feel better. It didn’t mean I was able to return to work. But it did mean I was able to do a few things with my family and not end up in bed for a week or more afterward. I am thankful that my NP did not give up on me but was patient and recognized that I just needed a bit more time to adjust or work through the need to change.

    Now 5 years later, I would change in a heartbeat if either she or the pain doc suggested it. I did in fact do so when I needed to switch from fentanyl to methadone after I lost insurance and could not afford the fentanyl. It turned out to be a gift in disguise as methadone is even better at controlling my pain. I am thankful I had the control it gives as I went through the physical therapy to re-learn how to feed myself, dress myself, care for myself, etc. as well as stand, and walk. I needed to do those things after a fall and then complications of infections as well as essentially being unable to move on my own during part of an 11 mo hospital stay and then 2 years in a nursing home. During the hospital stay when I was not alert and being given IV medications, I was on morphine. It did not give adequate relief apparently as my family and the staff both reported that when they would come to care for me, I would cry out at the lightest of touch. Once I was alert and able to take oral medications, I was put back on methadone and the relief was night and day.

    I feel sorry for anyone who has either a false positive or a false negative on a drug screen and has problems because of it. Any doctor who relies on an initial test without going to a second, more accurate test is irresponsible in my eyes. The method you described of deciding who pays for the secondary testing makes perfect sense to me. When in doubt, check it out. As for the commentor who was chewed out, I agree, vote with your feet and find a different treatment center. I would also find out if the doctor who chewed you out is the one in charge or if they are under another doctor. If they are under another doctor, I’d be letting them know exactly why you are leaving. Being chewed out by a doctor is not going to help a patient with their treatment. It will cause the patient to feel bad. I know if a doctor chewed me out, especially based on an error, I’d feel as if they viewed me as a child or something. That is not conducive to a good doctor patient relationship. If you have no other options for finding a different practice, I would be asking if there were anyway possible to not be seen by that specific doctor in the future.

    Reply

  4. Posted by Lisa on January 18, 2013 at 6:48 pm

    I am really upset I was givin a drug test by my dr to get refills on my tramadol and Tylenol 3, I also take naproxen. I went to the dr to get a flu shot and he said I was doin drugs and said I tested pos for suboxine and morphine and other opioids I ve never taken any of those. As I was leavin the dr the nurse saw someone else tests were mixed in with mine but doesn’t explain the suboxine or morphine. I am really upset and don’t know what to do

    Reply

    • First of all, since codeine breaks down into morphine in the body, that positive isn’t a surprise, but expected. And there have been reports of false positives drug screens for buprenorphine (Suboxone, Subutex), so please talk to your doctor and ask that he send your urine sample for a confirmatory test that will rule out false positives.

      Of course, that won’t help you if your sample was sent in under another patient’s name. did you watch the nurse seal the sample to send it to the lab? Or was it sitting with other samples before being sealed in the sample bag? I’d recommend talking with your doctor, who hopefully knows the morphine is from the codeine you’re prescribed. If he doesn’t know this, it’s possible mistakes are being made in performing and interpreting drug screen results.

      Reply

  5. Posted by sherri on April 2, 2013 at 10:53 pm

    i have been given drug test and i have showed a false positive for suboxone i dont take it nor any other pills i dont take any drugs i am on probation and in rehab i am tested 10 times a month i cant do any drugs at all why would i fail for this suboxone i didnt even know what it was till i failed for it can someone tell me why i showed a false positive for this i only take ibuprofen for my headaches?

    Reply

    • Some cases of false positives have been seen, including in the criminal justice system. Ask them to do the second, more specific test, because the first screening test must be wrong.

      Reply

  6. Posted by rachel agent on September 18, 2013 at 4:24 pm

    I googled false postives for soboxone because I failed my test TODAY for suboxone. I am also on a drug program in my area and tested twice a week and have been for almost two years. I have never failed a test and never had a reason to fail one. I have been taking drug court very seriously and am happy to say I have been clean and sober for almost two years. I have came across sherries post on other sites. she said she was taking ibuprofen (and on another site, baking soda and water, for heartburn) THAT got my attention…I have been having super bad heartburn and over two days took some extra extra strength tums and also asprin and anaciamenaphin ….I am so scared I have lost the respect of my judge and my case workers….I know that these people trust me and care for me because they are sending it to a lab first before sentencing me to serve 40 days in jail….I only can hope that a lab will not be fooled by some tums and Tylenol. Please check into antacids showing up as suboxone. I had never heard of that drug until today

    Reply

    • You MUST make sure the lab does a second, more specific test on your sample. With so much at stake, it would be unethical to go by one screening test. The second test is usually based on some sort of chromatography, but all you need to tell your drug program is “Send it for the more specific test.” They should know what you mean.
      False positives do happen.

      Reply

  7. Took lortab for pain but tested positive for methadone, I am in trouble, Need advice immediately. how is this possible. I never ever took methadone and will most likely go to jail for it

    Reply

  8. I’ve been on Subutex for about nine or 10 months now. The last 2 UA’s I had came back that I didn’t have my medicine in my system. I’m in constant pain from various health issues. This medicine saved my life, my marriage and has helped me take better care of my soul spiritually. I don’t know why this is happening. I do smoke pretty heavy and was told by the pharmacist not to smoke for 15 minutes after taking it. I always waited that long. I have hep C and was told about a “coconut oil pull” where you put the coconut oil in your mouth and hold it 20 mins. It suppose to help pull toxins out where the liver isn’t doing it so good. I told my doctor and he told me not to do this anymore and I won’t. He’s a very good doctor, the best and it kills me for him to think I’m lying to him about taking my medicine. I pray when I go back my last UA is straightened out. I don’t know what I’ll do if he kicks me out. Idk if that’s the cause of it or not, if I knew what was causing it it wouldn’t have happened a second time. Thanks for listening. God Bless!

    Reply

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