{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:39:57Z","timestamp":1790177997754,"version":"4.1.0"},"reference-count":18,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S147895152300086X_sec1a\"><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"S147895152300086X_sec2b\"><jats:title>Case description<\/jats:title><jats:p>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 \u03bcg\/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.<\/jats:p><\/jats:sec><jats:sec id=\"S147895152300086X_sec3c\"><jats:title>Discussion<\/jats:title><jats:p>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\u2013physician relationships.<\/jats:p><\/jats:sec><jats:sec id=\"S147895152300086X_sec4d\"><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s147895152300086x","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T07:03:07Z","timestamp":1690873387000},"page":"822-824","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Reliability of urine drug testing among patients on buprenorphine transdermal patch"],"prefix":"10.1017","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6266-6973","authenticated-orcid":false,"given":"Jaya","family":"Amaram-Davila","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhila","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Nancherla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9185-6108","authenticated-orcid":false,"given":"Joseph","family":"Arthur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Bruera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,8,1]]},"reference":[{"key":"S147895152300086X_ref5","unstructured":"ASCO (2021) American Cancer Society. Cancer Facts & Figures 2021. American Cancer Society. https:\/\/www.cancer.org\/research\/cancer-facts-statistics\/all-cancer-facts-figures\/cancer-facts-figures-2021.html."},{"key":"S147895152300086X_ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-020-0713-7"},{"key":"S147895152300086X_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2021.01.005"},{"key":"S147895152300086X_ref10","article-title":"Toxicologic testing for opiates: Understanding false-positive and false-negative test results","volume":"14","author":"Keary","year":"2012","journal-title":"The Primary Care Companion to CNS Disorders"},{"key":"S147895152300086X_ref18","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.6789"},{"key":"S147895152300086X_ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.6756"},{"key":"S147895152300086X_ref3","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-018-0143-7"},{"key":"S147895152300086X_ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-021-00910-8"},{"key":"S147895152300086X_ref16","unstructured":"Swarm, RA , Youngwerth, JM , Agne, JL , et\u00a0al. (2023). NCCN guidelines version 1.2023 adult cancer pain. From National Comprehensive Cancer Network."},{"key":"S147895152300086X_ref11","first-page":"859","article-title":"Buprenorphine - an attractive opioid with underutilized potential in treatment of chronic pain","volume":"8","author":"Khanna","year":"2015","journal-title":"Journal of Pain Research"},{"key":"S147895152300086X_ref9","doi-asserted-by":"crossref","first-page":"69","DOI":"10.5055\/jom.2021.0644","article-title":"Buprenorphine not detected on urine drug screening in supervised treatment","volume":"17","author":"Jamshidi","year":"2021","journal-title":"Journal of Opioid Management"},{"key":"S147895152300086X_ref12","doi-asserted-by":"publisher","DOI":"10.1111\/pme.12740"},{"key":"S147895152300086X_ref15","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2019-0242"},{"key":"S147895152300086X_ref7","doi-asserted-by":"publisher","DOI":"10.1136\/spcare-2022-003954"},{"key":"S147895152300086X_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.yrtph.2010.12.007"},{"key":"S147895152300086X_ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-018-0953-z"},{"key":"S147895152300086X_ref14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1533-2500.2010.00378.x"},{"key":"S147895152300086X_ref13","unstructured":"Mayo Clinic Laboratories Controlled substance monitoring panel, random, urine. TEST ID: CSMPU: Mayocliniclabs."}],"container-title":["Palliative and Supportive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S147895152300086X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T04:47:58Z","timestamp":1728449278000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S147895152300086X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,1]]},"references-count":18,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["S147895152300086X"],"URL":"https:\/\/doi.org\/10.1017\/s147895152300086x","relation":{},"ISSN":["1478-9515","1478-9523"],"issn-type":[{"value":"1478-9515","type":"print"},{"value":"1478-9523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,1]]},"assertion":[{"value":"\u00a9 The Author(s), 2023. Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}