High prevalence of urine tampering in an office-based opioid treatment practice detected by evaluating the norbuprenorphine to buprenorphine ratio

Anthony J. Accurso, Joshua D. Lee, Jennifer McNeely

Research output: Contribution to journalArticle


The prevalence of urine tampering within office-based opioid treatment (OBOT) is not currently known. This study was a cross-sectional analysis of an OBOT practice in New York City that experienced both a change in provider and a change in electronic medical record software. At that time, every patient in the practice received a urine drug test for “quantitative buprenorphine metabolites.” Methods Outcomes of the first three urine drug tests were tabulated and analyzed with specific attention to the frequency of buprenorphine-positive (bup +), norbuprenorphine-negative (norbup −) samples, a pattern consistent with urine tampering. Results On the first sample 6/33 (18%) of patients submitted bup +/norbup − samples, and an additional 3 patients submitted bup +/norbup − samples on subsequent urine tests. Retention to the end of the study period among patients with bup +/norbup − samples was 33%, while in those with bup +/norbup + samples it was 96%. A scatter plot of norbuprenorphine vs. buprenorphine levels estimated that a ratio of < 0.2 indicated tampering. Conclusion Testing for buprenorphine metabolites yields valuable clinical information. The prevalence of a result pattern consistent with tampering by “urine spiking,” the addition of unconsumed buprenorphine into the urine sample, may be higher than previous estimates. Previous lower cutoffs of the norbuprenorphine:buprenorphine metabolic ratio may miss a substantial proportion of these likely tampered samples.

Original languageEnglish (US)
Pages (from-to)62-67
Number of pages6
JournalJournal of Substance Abuse Treatment
StatePublished - Dec 2017


ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health

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