{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T17:01:58Z","timestamp":1740157318541,"version":"3.37.3"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,1,15]],"date-time":"2020-01-15T00:00:00Z","timestamp":1579046400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,1,15]],"date-time":"2020-01-15T00:00:00Z","timestamp":1579046400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000893","name":"Simons Foundation","doi-asserted-by":"publisher","award":["429570"],"award-info":[{"award-number":["429570"]}],"id":[{"id":"10.13039\/100000893","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Addict Sci Clin Pract"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Urine drug monitoring for medications for opioid use disorder (MOUD) such as buprenorphine can help to support treatment adherence. The practice of introducing unconsumed medication directly into urine (known as \u201cspiking\u201d samples) has been increasingly recognized as a potential means to simulate treatment adherence. In the laboratory, examination of the ratios of buprenorphine and its metabolite, norbuprenorphine, has been identified as a mechanism to identify \u201cspiked\u201d samples. Urine levels of naloxone may also be a novel marker in cases where the combination buprenorphine\u2013naloxone product has been administered. This case study, which encompasses one provider\u2019s practice spanning two sites, represents a preliminary report on the utility of using urinary naloxone as an indicator of \u201cspiked\u201d urine toxicology samples. Though only a case study, this represents the largest published evaluation of patients\u2019 naloxone levels to date.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>Over a 3-month period across two practice sites, we identified 1,223 patient samples with recorded naloxone levels, spanning a range of 0 to 12,161\u00a0ng\/ml. The average naloxone level was 633.65\u00a0ng\/ml with the majority (54%) of samples &lt;\u2009300\u00a0ng\/ml. 8.0% of samples demonstrated extreme values of naloxone (&gt;\u20092000\u00a0ng\/ml). One practice site, which had increased evidence of specimen tampering at collections, had a greater percent of extreme naloxone levels (&gt;\u2009\u00a02000\u00a0ng\/ml) at 9.3% and higher average naloxone level (686.8\u00a0ng\/ml), in contrast to a second site (570.9\u00a0ng\/ml; 6.4% at &gt;\u20092000\u00a0ng\/ml) that did not have known reports of specimen tampering.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>We postulate that naloxone may serve as an additional flag to identify patient \u201cspiking\u201d of urine samples with use of the combination product of buprenorphine\u2013naloxone.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13722-020-0178-9","type":"journal-article","created":{"date-parts":[[2020,1,15]],"date-time":"2020-01-15T15:02:33Z","timestamp":1579100553000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Use of urinary naloxone levels in a single provider practice: a case study"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2196-1789","authenticated-orcid":false,"given":"Jill S.","family":"Warrington","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaitlyn","family":"Booth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory S.","family":"Warrington","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Francis-Fath","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,1,15]]},"reference":[{"key":"178_CR1","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1176\/appi.ps.201300235","volume":"65","author":"CA Fullerton","year":"2014","unstructured":"Fullerton CA, Kim M, Thomas CP, Lyman DR, Montejano LB, Dougherty RH, et al. Medication-assisted treatment with methadone: assessing the evidence. Psychiatr Serv. 2014;65:146\u201357.","journal-title":"Psychiatr Serv."},{"key":"178_CR2","first-page":"23","volume":"18","author":"JR Velander","year":"2018","unstructured":"Velander JR. Suboxone: rationale, science, misconceptions. Ochsner J. 2018;18:23\u20139.","journal-title":"Ochsner J."},{"key":"178_CR3","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/ADM.0000000000000323","volume":"11","author":"M Jarvis","year":"2017","unstructured":"Jarvis M, Williams J, Hurford M, Lindsay D, Lincoln P, Giles L, Luongo P, et al. Appropriate use of drug testing in clinical addiction medicine. J Addict Med. 2017;11:163\u201373.","journal-title":"J Addict Med."},{"key":"178_CR4","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.jsat.2006.11.008","volume":"33","author":"WB Jaffee","year":"2007","unstructured":"Jaffee WB, Trucco E, Levy S, Weiss RD. Is this urine really negative? A systematic review of tampering methods in urine drug screening and testing. J Subst Abuse Treat. 2007;33:33\u201342.","journal-title":"J Subst Abuse Treat."},{"issue":"1","key":"178_CR5","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.jfda.2017.01.001","volume":"26","author":"SY Lin","year":"2018","unstructured":"Lin SY, Lee HH, Lee JF, Chen BH. Urine specimen validity test for drug abuse testing in workplace and court settings. J Food Drug Anal. 2018;26(1):380\u20134.","journal-title":"J Food Drug Anal."},{"key":"178_CR6","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.jsat.2017.10.002","volume":"83","author":"AJ Accurso","year":"2017","unstructured":"Accurso AJ, Lee JD, McNeely J. High prevalence of urine tampering in an office-based opioid treatment practice detected by evaluating the norbuprenorphine to buprenorphine ratio. J Subst Abuse Treat. 2017;83:62\u20137.","journal-title":"J Subst Abuse Treat."},{"key":"178_CR7","doi-asserted-by":"publisher","first-page":"28","DOI":"10.2174\/1874473711104010028","volume":"4","author":"MA Yokell","year":"2011","unstructured":"Yokell MA, Zaller ND, Green TC, Rich JD. Buprenorphine and buprenorphine\/naloxone diversion misuse, and illicit use: an international review. Curr Drug Abuse Rev. 2011;4:28\u201341.","journal-title":"Curr Drug Abuse Rev."},{"key":"178_CR8","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1080\/08897077.2017.1356796","volume":"38","author":"J Suzuki","year":"2017","unstructured":"Suzuki J, Zinser J, Issa M, Rodriguez C. Quantitative testing of buprenorphine and norbuprenorphine to identify urine sample spiking during office-based opioid treatment. Subst Abuse. 2017;38:504\u20137.","journal-title":"Subst Abuse."},{"key":"178_CR9","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1111\/pme.12663","volume":"16","author":"D Lee","year":"2015","unstructured":"Lee D, Bazydlo LAL, Goldberger BA. Spiking in a pain medicine clinic: an attempt to simulate adherence. Pain Med. 2015;16:1449\u2013511.","journal-title":"Pain Med."},{"key":"178_CR10","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1093\/jat\/bkr020","volume":"36","author":"GA Mcmillin","year":"2012","unstructured":"Mcmillin GA, Davis R, Carlisle H, Clark C, Marin SJ, Moody DE. Patterns of free (unconjugated) buprenorphine, norbuprenorphine, and their glucuronides in urine using liquid chromatography-tandem mass spectrometry. 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Clin Drug Invest. 2014;34(6):421\u20139.","journal-title":"Clin Drug Invest."}],"container-title":["Addiction Science &amp; Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13722-020-0178-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13722-020-0178-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13722-020-0178-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T00:13:02Z","timestamp":1610583182000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascpjournal.biomedcentral.com\/articles\/10.1186\/s13722-020-0178-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,15]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["178"],"URL":"https:\/\/doi.org\/10.1186\/s13722-020-0178-9","relation":{},"ISSN":["1940-0640"],"issn-type":[{"type":"electronic","value":"1940-0640"}],"subject":[],"published":{"date-parts":[[2020,1,15]]},"assertion":[{"value":"15 July 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 January 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 January 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"According to the policy defining activities which constitute research at the University of Vermont\/University of Vermont Medical Center, this work met criteria for operational improvement activities exempt from ethics review.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Samuel Francis-Fath and Kaitlyn Booth are salaried by Aspenti Health, a laboratory focused on population health management for Substance Use Disorders. Jill S. Warrington carries a non-salaried position as Chief Medical Officer at Aspenti Health. She also is a member of the community advisory council at Blue Cross Blue Shield of Vermont.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"3"}}