Originally Posted by mirstarlyte
I can understand why you or anyone would be confused at the information available on-line. In order to interpret the various laboratory tests it is necessary to understand the various types of tests that can be performed and then to determine the cutoff level for the respective tests.
Your errant results likely involve both. The type of test performed and the cutoff. Tramadol can cross react with commercial immunoassays IA (that is a screening test and should be, but often isn't confirmed by more sensitive testing). The cross-reaction is usually observed at cutoff under 300 ng/ml
and the CEDIA (Cloned Enzyme Donor Immunoassay) test is particularly vulnerable.
This is of particular relevance because many labs use a cutoff of 100 ng/ml in order to detect the more common semi-synthetic pain meds (oxycodone, etc). Many are using a test that has not been properly evaluated at the cutoff they are using.
At any rate, Tramadol will cross-react with some opiate immunoassays showing a false-positive for buprenorphine
This relates to your test because Suboxone is composed of buprenorphine
The following laboratories show this cross reaction: Oracle Diagnostics Acro Biotech Rapid Drug Tests USDrug Testing
In addition Yale-New Haven Hospital's Urine Drugs of Abuse Testing Summary
(see CEDIA Opiate Immunoassay) indicates a minimal potential for cross-reaction, however, it must be noted that cross-reactions were [U]assessed at a setting of 300 ng/ml
The most substantial reference I have found (besides the lab cross react charts) is a 2008 study reported in Journal of Analytical Toxicology
, 2008 Jun;32(5):339-43 (abstract here)
The authors tested 3 different types of Immunoassays specifically for Tramadol and found “... that tramadol use can cause false-positive urine buprenorphine immunoassays, and this effect appears to be assay-dependent. Tramadol interference with the Cedia assay is clinically relevant, especially if the 5 ng/mL calibration cutoff is used.
The best way to clear this up is to request a chromatographic test. Not a hair test. It would be wise to have the test performed by an independent lab that you choose.
Not the lab that performed the initial test.
The above is a reasonable explanation based on my knowledge of tests and testing laboratories. An error in interpretation and failure to confirm the results. But there are other explanations as well. The error rate on some tests (IAs) run as high as 41%.
Most of this could be better investigated with a complete read-out of the test. You should get a copy of that for your records.