{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T21:10:32Z","timestamp":1792185032908,"version":"4.4.0"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"Importance<\/jats:title>The direct addition of buprenorphine to urine drug test specimens to mimic results suggestive of adherence is a clinically significant result, yet little is known about the phenomenon.<\/jats:p><\/jats:sec>Objective<\/jats:title>To characterize factors associated with the direct addition of buprenorphine to urine specimens among patients prescribed buprenorphine for opioid use disorder.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study of urine drug test specimens was conducted from January 1, 2017, to April 30, 2022, using a national database of urine drug test specimens ordered by clinicians from primary care, behavioral health, and substance use disorder treatment clinics. Urine specimens with quantitative norbuprenorphine and buprenorphine concentrations from patients with opioid use disorder currently prescribed buprenorphine were analyzed.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Nonprescribed opioid or stimulant co-positive, clinical setting, collection year, census division, patient age, patient sex, and payor.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Norbuprenorphine to buprenorphine ratio less than 0.02 identified direct addition of buprenorphine. Unadjusted trends in co-positivity for stimulants and opioids were compared between specimens consistent with the direct addition of buprenorphine. Factors associated with the direct addition of buprenorphine were examined with generalized estimating equations.<\/jats:p><\/jats:sec>Results<\/jats:title>This study included 507\u202f735 urine specimens from 58\u202f476 patients. Of all specimens, 261\u202f210 (51.4%) were obtained from male individuals, and 137\u202f254 (37.7%) were from patients aged 25 to 34 years. Overall, 9546 (1.9%) specimens from 4550 (7.6%) patients were suggestive of the direct addition of buprenorphine. The annual prevalence decreased from 2.4% in 2017 to 1.2% in 2020. Opioid-positive with (adjusted odds ratio [aOR], 2.01; 95% CI, 1.85-2.18) and without (aOR, 2.02; 95% CI, 1.81-2.26) stimulant-positive specimens were associated with the direct addition of buprenorphine to specimens, while opioid-negative\/stimulant-positive specimens were negatively associated (aOR, 0.78; 95% CI, 0.71-0.85). Specimens from patients aged 35 to 44 years (aOR, 1.59; 95% CI, 1.34-1.90) and primary care (aOR, 1.60; 95% CI, 1.44-1.79) were associated with the direct addition of buprenorphine. Differences by treatment setting decreased over time. Specimens from the South Atlantic census region had the highest association (aOR, 1.4; 95% CI, 1.25-1.56) and New England had the lowest association (aOR, 0.54; 95% CI, 0.46-0.65) with the direct addition of buprenorphine.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cross-sectional study, the direct addition of buprenorphine to urine specimens was associated with other opioid positivity and being collected in primary care settings. The direct addition of buprenorphine to urine specimens is a clinically significant finding, and best practices specific for this phenomenon are needed.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2023.0234","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T15:13:02Z","timestamp":1679497982000},"page":"459","source":"Crossref","is-referenced-by-count":9,"title":["Association of Patients\u2019 Direct Addition of Buprenorphine to Urine Drug Test Specimens With Clinical Factors in Opioid Use Disorder"],"prefix":"10.1001","volume":"80","author":[{"given":"Jarratt D.","family":"Pytell","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Colorado School of Medicine, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penn","family":"Whitley","sequence":"additional","affiliation":[{"name":"Millennium Health, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D.","family":"Passik","sequence":"additional","affiliation":[{"name":"Millennium Health, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William L.","family":"Bundy","sequence":"additional","affiliation":[{"name":"Millennium Health, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Dawson","sequence":"additional","affiliation":[{"name":"Millennium Health, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Saloner","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2S","key":"yoi230009r2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/ADM.0000000000000633","article-title":"The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update.","volume":"14","author":"Cunningham","year":"2020","journal-title":"J Addict Med"},{"issue":"10","key":"yoi230009r3","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.29409","article-title":"Trends in and characteristics of buprenorphine misuse among adults in the US.","volume":"4","author":"Han","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"3","key":"yoi230009r4","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/ADM.0000000000000323","article-title":"Appropriate use of drug testing in clinical addiction medicine.","volume":"11","author":"Jarvis","year":"2017","journal-title":"J Addict Med"},{"issue":"9","key":"yoi230009r5","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.23019","article-title":"Polysubstance use among patients treated with buprenorphine from a national urine drug test database.","volume":"4","author":"Saloner","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"8","key":"yoi230009r6","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1093\/jat\/29.8.769","article-title":"Evaluation of buprenorphine CEDIA assay versus GC-MS and ELISA using urine samples from patients in substitution treatment.","volume":"29","author":"B\u00f6ttcher","year":"2005","journal-title":"J Anal Toxicol"},{"issue":"2","key":"yoi230009r7","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1093\/jat\/bkr020","article-title":"Patterns of free (unconjugated) buprenorphine, norbuprenorphine, and their glucuronides in urine using liquid chromatography-tandem mass spectrometry.","volume":"36","author":"McMillin","year":"2012","journal-title":"J Anal Toxicol"},{"issue":"5","key":"yoi230009r8","first-page":"577","article-title":"The metabolism and excretion of buprenorphine in humans.","volume":"12","author":"Cone","year":"1984","journal-title":"Drug Metab Dispos"},{"issue":"4","key":"yoi230009r9","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1093\/jat\/bkv003","article-title":"Determination of buprenorphine, norbuprenorphine and naloxone in fingernail clippings and urine of patients under opioid substitution therapy.","volume":"39","author":"Tzatzarakis","year":"2015","journal-title":"J Anal Toxicol"},{"issue":"6","key":"yoi230009r10","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1097\/ADM.0000000000000676","article-title":"Urinary buprenorphine, norbuprenorphine and naloxone concentrations and ratios: review and potential clinical implications.","volume":"14","author":"Warrington","year":"2020","journal-title":"J Addict Med"},{"key":"yoi230009r11","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/978-1-4939-3252-8","article-title":"Quantitation of buprenorphine, norbuprenorphine, buprenorphine glucuronide, norbuprenorphine glucuronide, and naloxone in urine by LC-MS\/MS.","volume":"1383","author":"Marin","year":"2016","journal-title":"Methods Mol Biol"},{"key":"yoi230009r12","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.drugalcdep.2017.07.040","article-title":"Interpreting quantitative urine buprenorphine and norbuprenorphine levels in office-based clinical practice.","volume":"180","author":"Donroe","year":"2017","journal-title":"Drug Alcohol Depend"},{"issue":"7","key":"yoi230009r13","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1093\/jat\/32.7.516","article-title":"Urinary buprenorphine concentrations in patients treated with suboxone as determined by liquid chromatography-mass spectrometry and CEDIA immunoassay.","volume":"32","author":"Hull","year":"2008","journal-title":"J Anal Toxicol"},{"key":"yoi230009r14","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.jsat.2017.10.002","article-title":"High prevalence of urine tampering in an office-based opioid treatment practice detected by evaluating the norbuprenorphine to buprenorphine ratio.","volume":"83","author":"Accurso","year":"2017","journal-title":"J Subst Abuse Treat"},{"issue":"4","key":"yoi230009r15","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1080\/08897077.2017.1356796","article-title":"Quantitative testing of buprenorphine and norbuprenorphine to identify urine sample spiking during office-based opioid treatment.","volume":"38","author":"Suzuki","year":"2017","journal-title":"Subst Abus"},{"issue":"8","key":"yoi230009r16","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"issue":"4","key":"yoi230009r17","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1097\/YCO.0000000000000717","article-title":"The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis.","volume":"34","author":"Ciccarone","year":"2021","journal-title":"Curr Opin Psychiatry"},{"issue":"7","key":"yoi230009r18","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1093\/oxfordjournals.aje.a009511","article-title":"Comparison of population-averaged and subject-specific approaches for analyzing repeated binary outcomes.","volume":"147","author":"Hu","year":"1998","journal-title":"Am J Epidemiol"},{"issue":"1","key":"yoi230009r19","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1111\/biom.2001.57.issue-1","article-title":"Akaike\u2019s information criterion in generalized estimating equations.","volume":"57","author":"Pan","year":"2001","journal-title":"Biometrics"},{"issue":"2","key":"yoi230009r20","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v015.i02","article-title":"The R package geepack for generalized estimating equations.","volume":"15","author":"Halekoh","year":"2006","journal-title":"J Stat Softw"},{"issue":"1","key":"yoi230009r21","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1080\/08897077.2015.1088496","article-title":"Optimizing psychosocial support during office-based buprenorphine treatment in primary care: patients\u2019 experiences and preferences.","volume":"37","author":"Fox","year":"2016","journal-title":"Subst Abus"},{"issue":"4","key":"yoi230009r22","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/ADM.0b013e3181cc9610","article-title":"Patients\u2019 reasons for choosing office-based buprenorphine: preference for patient-centered care.","volume":"4","author":"Korthuis","year":"2010","journal-title":"J Addict Med"},{"issue":"5","key":"yoi230009r23","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/ADM.0000000000000146","article-title":"A survey of ASAM members\u2019 knowledge, attitudes, and practices in urine drug testing.","volume":"9","author":"Kirsh","year":"2015","journal-title":"J Addict Med"},{"issue":"2","key":"yoi230009r24","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1176\/appi.ajp.2019.19060612","article-title":"Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder.","volume":"177","author":"Williams","year":"2020","journal-title":"Am J Psychiatry"},{"issue":"3","key":"yoi230009r25","doi-asserted-by":"publisher","first-page":"137","DOI":"10.7326\/M17-3107","article-title":"Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study.","volume":"169","author":"Larochelle","year":"2018","journal-title":"Ann Intern Med"},{"key":"yoi230009r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.102722","article-title":"Unintentional drug overdose: is more frequent use of non-prescribed buprenorphine associated with lower risk of overdose?","volume":"79","author":"Carlson","year":"2020","journal-title":"Int J Drug Policy"},{"key":"yoi230009r27","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.drugalcdep.2019.06.015","article-title":"Urine is superior to oral fluid for detecting buprenorphine compliance in patients undergoing treatment for opioid addiction.","volume":"203","author":"Ransohoff","year":"2019","journal-title":"Drug Alcohol Depend"},{"key":"yoi230009r28","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.drugalcdep.2017.12.040","article-title":"Addressing discordant quantitative urine buprenorphine and norbuprenorphine levels: case examples in opioid use disorder.","volume":"186","author":"Holt","year":"2018","journal-title":"Drug Alcohol Depend"},{"key":"yoi230009r29","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108881","article-title":"Structural and organizational factors shaping access to medication treatment for opioid use disorder in community supervision.","volume":"226","author":"Kennedy-Hendricks","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"yoi230009r30","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.drugalcdep.2018.09.007","article-title":"Understanding the use of diverted buprenorphine.","volume":"193","author":"Cicero","year":"2018","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"yoi230009r31","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1080\/00952990.2022.2081923","article-title":"Trends in characteristics of fentanyl-related poisonings in the United States, 2015-2021.","volume":"48","author":"Palamar","year":"2021","journal-title":"Am J Drug Alcohol Abuse"},{"key":"yoi230009r1","volume-title":"Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63","author":"Substance Abuse and Mental Health Services Administration","year":"2020"},{"key":"yoi230009r32","unstructured":"Ahmad? F, Cisewski? JA, Rossen? L, Sutton? P. Provisional drug overdose death counts. national center for health statistics. Accessed July 29, 2022. https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug-overdose-data.htm"}],"container-title":["JAMA Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/articlepdf\/2802549\/jamapsychiatry_pytell_2023_oi_230009_1682621880.06332.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T15:20:35Z","timestamp":1683127235000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/fullarticle\/2802549"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,1]]},"references-count":32,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapsychiatry.2023.0234","relation":{},"ISSN":["2168-622X"],"issn-type":[{"value":"2168-622X","type":"print"}],"subject":[],"published":{"date-parts":[[2023,5,1]]}}}