[mirstarlyte]

I really need to know if suboxone can show up in a hair follicle test. I really hope so. Because I am being accused of using it, because a false positive came up for it in my urine. I am willing to do and pay for, whatever it takes to prove I did now relapse. So I need to know if it can. Because I would pay every penny I had to get a follicle test and prove my innocence... Thank you. Please Help!

[DrBill100]

Suboxone (buprenorphine and naloxone)

Please advise of any medications that you are prescribed and I can determine cross-reactants.

First order is to determine why it showed up in urine.

[mirstarlyte]

The only medications I take is Tramadol 50mg for a torn MCL... And Advil PM. And a month prior to my situation this had happened to another individual. And the only thing we had in common was the Tramadol. I do appreciate your reply. Thank you so much. Miranda

[DrBill100]

Miranda,

Just so I understand you question completely:

1) you submitted to a urine drug test (UDT)
2) the UDT showed positive for suboxone
3) you have not ingested suboxone
4) have requested a hair test to prove that you have not ingested suboxone.
5) you have a valid prescription for Tramadol.

One last question: Do you have a copy of the test results?

[mirstarlyte]

So yes I took a UA and came up positive for Suboxone. Absolutely no way, not only have I not I ingested it, I haven't even touched it. I was told that it didn't show in the hair. But I have a feeling that nobody wants to deal with it. I have a very valid perscription for Tramadol. Given also, that I sometimes take more than directed when I work... Which is up to 8-10/day. And I could get a copy of the false positive paper work if needed.

[DrBill100]

Miranda,

More directly, what I am looking for is specific identification of "suboxone" by the testing agency.

There are common chemical elements between suboxone and Tramadol that may be reasonably expected by a qualified testing laboratory. That is item number one. Advil isn't in the play.

However, there are clearly discernible differences and those should have been detected by the testing lab through confirmatory testing.

From my standpoint is necessary to understand if the errant results were obtained at the screening level or at the confirmation level.

[mirstarlyte]

What I can tell you so far, is that I tested positive for Suboxone in my urine. It was sent back for a re-test, and the results have not come back yet. They sent it for the re-test on the 26th. I would not be worried about the re-test if this hadn't happened to another person one month prior to me.And his 1st test came back positive for Suboxone, and then his re-test, also positive, which they say is virtually 100 percent accurate. And the only thing that we had in common,at all was the Tramadol. I am willing to do and pay whatever it takes to prove I did not use, if the re-test comes back positive like it did with the other individual. That's why I asked if Suboxone could be detected in the hair. Or the skin. Because I really did not take Suboxone. I feel helpless. Thank you for all you have done for me. I look forward to hearing from you.

[DrBill100]

What I can tell you so far, is that I tested positive for Suboxone in my urine. It was sent back for a re-test, and the results have not come back yet. They sent it for the re-test on the 26th. I would not be worried about the re-test if this hadn't happened to another person one month prior to me.And his 1st test came back positive for Suboxone, and then his re-test, also positive, which they say is virtually 100 percent accurate. And the only thing that we had in common,at all was the Tramadol. I am willing to do and pay whatever it takes to prove I did not use, if the re-test comes back positive like it did with the other individual. That's why I asked if Suboxone could be detected in the hair. Or the skin. Because I really did not take Suboxone. I feel helpless. Thank you for all you have done for me. I look forward to hearing from you.

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 and naloxone.

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.

[mirstarlyte]

I just want to say thank you... So much. For taking time out of your day, to help me with this situation. I have support from my family, but as for my probation officer, and the whole panel of drug court, all that matters are the results and that is it. And I absolutely did not take Suboxone. This has already happened to somebody else, and I do not want it to happen to me, nor do I want it to happen to anyone else. I feel helpless, and my probation officer says that this can easily send me to prison. So I am scared, and very thank full I met you. I appreciate what you have done so much. I will bring the information you have given to me, to his attention on my appt. with him on Thurday. And hopefully it makes a difference. If there is anything else you can tell me, I would be very grateful. Thank you again. Miranda

[DrBill100]

I just want to say thank you... So much. For taking time out of your day, to help me with this situation. I have support from my family, but as for my probation officer, and the whole panel of drug court, all that matters are the results and that is it. And I absolutely did not take Suboxone. This has already happened to somebody else, and I do not want it to happen to me, nor do I want it to happen to anyone else. I feel helpless, and my probation officer says that this can easily send me to prison. So I am scared, and very thank full I met you. I appreciate what you have done so much. I will bring the information you have given to me, to his attention on my appt. with him on Thurday. And hopefully it makes a difference. If there is anything else you can tell me, I would be very grateful. Thank you again. Miranda

The information that I provided is 1) publicly available, and 2) scientifically and empirically verifiable via peer reviewed journals and/or other professional media cited, and 3) therefore any involved agency or individual is presumed to be aware of same.

You should cite the specific studies and/or resources noted above so far as they are consistent with the facts of you case. Please review and print out each that is applicable to your particdular case.

You should be successful. If not, please get back and we will devise other alternatives.

Good luck and either way please advise as soon as possible.

[mirstarlyte]

I also was wondering... Even though I have not used, could the re-test still come back positive, like it did with the other individual. And if so, could there be other ways to prove I did not take Suboxone? Also, what is a chromatographic test? I was told by someone on the drug court panel that it is what is being done with my urine right now, which is the re-test. I will definitely get a copy of the first result on Thurs and let you know. Also, is Suboxone detectable in the hair if I did have to go that route? I just want to know all of my options, because it terrifies me that I could go to jail for this, when I have been doing so good in my recovery. I will have 90 days sober on Nov 9th. Like I said before... Thank you from the bottom of my heart. I feel more confident each time I hear from you. Most people believe me, which is what helps me each day. And my probation officer along with drug court, want so bad to believe me. So I would really like to prove that I am willing to do whatever it takes, and stay sober in the process. I appreciate all you have done for me. You are a blessing. I never knew sites like this existed until I went searching for answers. You have probably saved thousands of people. Miranda

[DrBill100]

I also was wondering... Even though I have not used, could the re-test still come back positive, like it did with the other individual. And if so, could there be other ways to prove I did not take Suboxone? Also, what is a chromatographic test? I was told by someone on the drug court panel that it is what is being done with my urine right now, which is the re-test. I will definitely get a copy of the first result on Thurs and let you know. Also, is Suboxone detectable in the hair if I did have to go that route? I just want to know all of my options, because it terrifies me that I could go to jail for this, when I have been doing so good in my recovery. I will have 90 days sober on Nov 9th. Like I said before... Thank you from the bottom of my heart. I feel more confident each time I hear from you. Most people believe me, which is what helps me each day. And my probation officer along with drug court, want so bad to believe me. So I would really like to prove that I am willing to do whatever it takes, and stay sober in the process. I appreciate all you have done for me. You are a blessing. I never knew sites like this existed until I went searching for answers. You have probably saved thousands of people. Miranda

It is possible that a re-test could come back positive but it isn't likely. Chromatographic techniques paired with mass spectrometry can easily distinguish between various drugs. It prints out a spectral analysis. So there is no cross-reactivity as is present in the screening immunoassays. If this is the test being performed then it should clear you.

Hair testing isn't the wonder test it is made out to be. Different drugs incorporate into hair at varying rates. If need be I will check the specific studies. But first we need to know specifically what was found in the false-positive.

My problem with your situation is not knowing how they came to the conclusion that you had taken Suboxone. I need the specific metabolite that was identified because screening tests do not identify specific drugs... only classes of drugs.

As soon as you get the report we'll check each item and then determine how to proceed. Hopefully, it won't be necessary.

It would also be helpful to know what state you live in. Each state has differing requirements for laboratories and testing agencies.

[mirstarlyte]

I should have the information you need tomorrow, and post it to you by the evening. For now I can tell you that I live in Idaho, and am currently in the drug court program, which is new to Shoshone County. Thank you again. I will talk to you soon. Miranda

[DrBill100]

I should have the information you need tomorrow, and post it to you by the evening. For now I can tell you that I live in Idaho, and am currently in the drug court program, which is new to Shoshone County. Thank you again. I will talk to you soon. Miranda

Please be careful not to post information that could identify you personally. My only need for state information was to see if the state regulates testing laboratories.

[mirstarlyte]

Ok, so I got a copy of the false positive. All it says is Bupreno-positive 9. That is it. And it showed some other numbers that had to do with 17 (number of people tested) 0(no shows) and 1 positive (me). I asked what the cutoff was and he said 5. And my test was 9. I hope that helps. I know that I am lost in every way shape and form. Thank you again. So much.

[DrBill100]

Ok, so I got a copy of the false positive. All it says is Bupreno-positive 9. That is it. and it showed some other numbers that had to do with 17 (number of people tested) 0(no shows) and 1 positive (me). I asked what the cutoff was and he said 5. And my test was 9. I hope that helps. I know that I am lost in every way shape and form. Thank you again. So much.

That helps. The suboxone was simply a guess on someone's part based on the presence of buprenorphine. That solves that one. I was guessing too figuring that was the only thing it could be.

Please note that your numbers fit perfectly within the study, previous provided for Tramadol/buprenorphine false positive, Shaikh 2008. That is, all of the false positives appeared using a 5 ng cutoff. None at 10 and 20 cutoff and it is specifically noted "that tramadol use can cause false-positive urine buprenorphine immunoassays,"at the 5 ng cutoff. Did you provide them with that info?

Is there a column heading above the numbers? How do we know what the numbers mean?

[mirstarlyte]

There is nothing else on the sheet that they gave me. And I did tell them about the studies, but they won't really say anything to me, everyone is just waiting for the re-test results. All I am doing is praying that it comes back negative, so I don't have to keep fighting. Its exhausting trying to go through each day with a positive attitude knowing you could be facing punishment for something you didn't do. I am really sick right now also. Bad chest cold. I start taking a z-pack tomorrow. I think that's what it is... So Im so burnt out. Stress is consuming me. I won't give up, but I am running on E right now. You are a light at the end for me. You are the only thing that has kept me in high spirits beside my kids and my family. Thank you again. Oh, and the test was sent off for a re-test on the 26th. And its still not back. Does that mean anything. It will be a month tomorrow... That's a bit long right? And if there is urine left over from the retest, would it even be useable?

[DrBill100]

There is nothing else on the sheet that they gave me. And I did tell them about the studies, but they wont really say anything to me, everyone is just waiting for the re-test results. All I am doing is praying that it comes back negative, so I dont have to keep fighting. Its exhausting trying to go through each day with a positive attitude knowing you could be facing punishment for something you didnt do. I am really sick right now also. Bad chest cold. I start taking a z-pack tomorrow. I think thats what it is... So Im so burnt out. Stress is consuming me. I wont give up, but I am running on E right now. You are a light at the end for me. You are the only thing that has kept me in high spirits beside my kids and my family. Thank you again. Oh, and the test was sent off for a re-test on the 26th. And its still not back. Does that mean anything. It will be a month tomorrow... Thats a bit long right? And if there is urine left over from the retest, would it even be useable?

That is a very long time for a test. Usually 72 hours.

There should be enough for a re-test and it should be usable. You should choose another laboratory and request that the sample be sent there for retest. If need be of course.

[mirstarlyte]

I had court today. Nothing happened cause the results of the retest haven't come back yet. I appreciate all you have done for me. I guess we will just have to wait and see what the results say and take it from there.

[mirstarlyte]

Hello... Just letting you know that the retest finally came back, and it was negative. Thank you for all your help. I appreciate it a lot. You helped me out so much :)