PDF(Pubmed)
Abstract：
BACKGROUND: Urine drug testing (UDT) plays a significant role in monitoring patients on chronic opioid therapy (COT) for non-medical opioid use (NMOU). UDT, at times, can be inconsistent and misleading. We present a case where a patient on a buprenorphine patch had false negative results.
METHODS: A female in her 70s with metastatic breast cancer presented with uncontrolled pain from a T6 compression fracture. She had no relief with tramadol 50 mg every 6 hours as needed. Due to an allergic reaction to hydromorphone, our team prescribed a buprenorphine patch of 5 μg/h. Subsequently, she expressed excellent pain control, and the clinician confirmed the patch placement on examination. She underwent a UDT during the visit. The UDT was negative for both buprenorphine and its metabolites. The literature review showed that false negative UDT results are relatively common among patients with low-dose buprenorphine patches. The combination of a thorough physical examination, a review of the Prescription Drug Monitoring Program, and reassuring scores on screening tools placed her at low risk for NMOU.
CONCLUSIONS: Buprenorphine has a ceiling effect on respiratory depression and a lower risk for addiction. However, when used in low doses, the drug might not have enough metabolites in the urine, leading to a false negative UDT. Such results might affect patient-physician relationships.
CONCLUSIONS: In addition to the UDT, a thorough history, screening for NMOU, physical exam, a review of PDMP, and a good understanding of opioid metabolism are necessary to help guide pain management.
METHODS: A female in her 70s with metastatic breast cancer presented with uncontrolled pain from a T6 compression fracture. She had no relief with tramadol 50 mg every 6 hours as needed. Due to an allergic reaction to hydromorphone, our team prescribed a buprenorphine patch of 5 μg/h. Subsequently, she expressed excellent pain control, and the clinician confirmed the patch placement on examination. She underwent a UDT during the visit. The UDT was negative for both buprenorphine and its metabolites. The literature review showed that false negative UDT results are relatively common among patients with low-dose buprenorphine patches. The combination of a thorough physical examination, a review of the Prescription Drug Monitoring Program, and reassuring scores on screening tools placed her at low risk for NMOU.
CONCLUSIONS: Buprenorphine has a ceiling effect on respiratory depression and a lower risk for addiction. However, when used in low doses, the drug might not have enough metabolites in the urine, leading to a false negative UDT. Such results might affect patient-physician relationships.
CONCLUSIONS: In addition to the UDT, a thorough history, screening for NMOU, physical exam, a review of PDMP, and a good understanding of opioid metabolism are necessary to help guide pain management.
摘要：
背景：尿液药物测试（UDT）在监测非药物阿片类药物使用（NMOU）的慢性阿片类药物治疗（COT）患者中发挥着重要作用。UDT,有时,可能是不一致和误导的。我们介绍了一例使用丁丙诺啡贴片的患者的假阴性结果。
方法：一名70多岁的女性转移性乳腺癌患者，因T6压缩性骨折而出现不受控制的疼痛。她没有根据需要每6小时使用曲马多50mg的缓解。由于对氢吗啡酮的过敏反应,我们的团队规定了5μg/h的丁丙诺啡贴片。随后，她表现出出色的疼痛控制，临床医生在检查时确认了贴片的位置。她在访问期间接受了UDT。UDT对丁丙诺啡及其代谢物均为阴性。文献综述显示，在低剂量丁丙诺啡贴剂患者中，假阴性UDT结果相对普遍。全面的体检相结合，对处方药监测计划的审查，和令人放心的分数筛选工具使她处于低风险的NMOU。
结论：丁丙诺啡对呼吸抑制具有上限效应，成瘾风险较低。然而,当低剂量使用时，这种药物的尿液中可能没有足够的代谢物，导致UDT假阴性。这些结果可能会影响医患关系。
结论：除了UDT，彻底的历史，筛查NMOU，体检,对PDMP的审查，和阿片类药物代谢的良好理解是必要的，以帮助指导疼痛管理。
方法：一名70多岁的女性转移性乳腺癌患者，因T6压缩性骨折而出现不受控制的疼痛。她没有根据需要每6小时使用曲马多50mg的缓解。由于对氢吗啡酮的过敏反应,我们的团队规定了5μg/h的丁丙诺啡贴片。随后，她表现出出色的疼痛控制，临床医生在检查时确认了贴片的位置。她在访问期间接受了UDT。UDT对丁丙诺啡及其代谢物均为阴性。文献综述显示，在低剂量丁丙诺啡贴剂患者中，假阴性UDT结果相对普遍。全面的体检相结合，对处方药监测计划的审查，和令人放心的分数筛选工具使她处于低风险的NMOU。
结论：丁丙诺啡对呼吸抑制具有上限效应，成瘾风险较低。然而,当低剂量使用时，这种药物的尿液中可能没有足够的代谢物，导致UDT假阴性。这些结果可能会影响医患关系。
结论：除了UDT，彻底的历史，筛查NMOU，体检,对PDMP的审查，和阿片类药物代谢的良好理解是必要的，以帮助指导疼痛管理。
