What Happens if I Fail a Urine Drug Screen During Treatment?

Drug urine screenings are a common part of treatment for opioid use disorders. The Substance Abuse and Mental Health Services Administration recommends routine drug tests [1]. 

The main reason for this is not to discontinue treatment or withhold treatment. Instead, the reason is so that doctors can determine if their patients are taking their medications properly or combining their medications with other substances, which can increase risk of complications or overdose. [1] 

Treatment teams usually understand that relapse is part of recovery. Without medications, up to 90% of people with OUDs relapse to drug use.[2] 

Your doctor doesn’t want to withhold your treatment. Hopefully, a positive drug screen will simply be an opportunity to start a conversation about why you are continuing to use in spite of being in treatment: is your dose too low? Are your opioid cravings controlled, but perhaps your cravings for another substance such as cocaine, alcohol or stimulants are not well controlled? 

Remember, the more open and honest you can be, the better. Most addiction physicians these days are well educated about the nature of opioid use disorder. Their aim is not to punish, or withhold treatment, but instead to keep you as safe as possible and to continue to evaluate your needs and how they can maximize your success during your treatment. 

How Are Drug Screenings Used During Treatment?

Buprenorphine, an active ingredient inside Suboxone, is a tightly controlled substance. Doctors must get special permission to prescribe it, and they must agree to take steps to keep their patients and their communities safe. Sometimes that means using drug testing to ensure their patients are using their therapy properly and safely. [3]

Drug screenings can help doctors understand if their patients are doing the following:

• Not using their prescription/”diverting”: It is an unfortunate reality that some patients may choose to give away or sell their prescriptions. By getting buprenorphine levels, doctors can ensure that the patient is in fact taking their dose as prescribed and not diverting.
• Using too little: Occasionally, individuals can rapidly metabolize Suboxone, and if their drug test is negative for Suboxone it may be a sign that they need a higher dose. 
• Using something else: Other illicit substances appearing in the urine test could indicate that the person is relapsing or using other substances that might be dangerous in conjunction with their suboxone.

Some teams use tests routinely, asking their patients to submit to tests every time they see them. Others use random test methods to ensure their patients aren’t intentionally preparing to pass the test. Some practices do not routinely test at all these days. The testing methods may vary depending on the individual prescriber’s choices or the policy of the clinic as a whole. 

What Substances Show Up in Drug Screenings?

Drug tests are variable, but most standard drug tests include tests for: [4]

• Benzodiazepines
• Gabapentin
• Marijuana (THC)
• Cocaine
• Methamphetamine
• Other opioids

Any of these substances could potentially be dangerous if used in conjunction with Suboxone.

Most “standard” drug panels do not include Buprenorphine (Suboxone), and this must be ordered separately. If your doctor is giving you Suboxone, they may order a separate Buprenorphine test along with your routine drug panel. 

What Happens After a Positive Test?

It depends on the policy of your clinic and of your prescriber. These days, most providers who prescribe Suboxone for OUD understand that relapse is a natural part of the process of this condition, and do not “withhold” treatment or discontinue Suboxone just because someone has a drug screen that is positive for opioids or other substances. A doctor would never discontinue insulin in a diabetic patient just because they were using cocaine. Instead, they would continue to treat the diabetes and also the cocaine use disorder as two separate medical problems.

In the same way, these days hopefully most doctors see polysubstance use disorders as really multiple use disorders – cocaine use disorder is separate from opioid use disorder. Just because someone is using cocaine, their doctor will hopefully not discontinue treatment for their opioid use disorder. Instead, they will hopefully use it as an opportunity to re-evaluate the treatment plan and make adjustments – maybe even increasing your dose, or connect you to additional behavioral resources for support – to better control your cravings to use.

After your test result, you’ll discuss the relapse with your team. You’ll focus on the following:

• Triggers: What happened right before you took illicit drugs? What happened in the weeks leading up to the relapse? Are their any factors that you can identify that are triggering you to use?
• Environments: Which people or places are creating environments that make it more likely for you to use? Are their ways to avoid those people or places?
• Mental Health: are there other underlying mental health conditions such as anxiety or depression that could perhaps be better managed to help you avoid drug use as a coping mechanism?

Then, you’ll create a plan to help you resist relapse. Talk openly and honestly with your doctor if you can – remember, they are there to help, not to punish. 

How to Avoid Failing a Drug Screen 

The first answer, is: don’t try “not to fail” a drug screen. The best policy is honesty. If you know you are likely to fail a drug screen because you have used other substances, tell your doctor right away, maybe even before taking the test. This way, they can start a conversation with you right away about what happened to lead to a relapse and how they can help right away to prevent any further drug use. 

Bicycle Health’s Policy on Drug Screen Results

Because Suboxone is a lifesaving medication, we aim to keep you on this evidence-based treatment as long as possible. We encourage patients to be honest and discuss relapses and close calls, so we can help maximize their chances of success in recovery.

Urine drug screens are one way to help hold patients accountable, so we don’t talk about “failing a drug test.” Relapse is often part of recovery.

If your urine drug screen shows substances that are not part of your recovery plan, it’s an opportunity for you and your provider to explore what’s going on. Your provider will not judge you but will attempt to understand your current circumstances and work with you to develop a plan that gets you back on track to a meaningful recovery.

Sources

1. Buprenorphine Quick Start Guide. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/sites/default/files/quick-start-guide.pdf. Accessed October 2022.
2. Suboxone: Rationale, Science, Misconceptions. The Ochsner Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/. 2018. Accessed October 2022.
3. Buprenorphine and Buprenorphine/Naloxone Diversion, Misuse, and Illicit Use: An International Review. Current Drug Abuse Reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154701/ March 2011. Accessed October 2022.
4. Polysubstance Use Among Patients Treated With Buprenorphine From a National Urine Drug Test Database. JAMA. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784053. September 2021. Accessed October 2022.
5. Predictive Factors for Relapse in Patients on Buprenorphine Maintenance. American Journal of Addiction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922612/. June 2013. Accessed October 2022.
6. Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/. September 2015. Accessed October 2022.