Addition of a Drug By the Patient to a Urine Specimen Being Used to Screen for Therapeutic Compliance

Patient selection: patient being monitored for compliance to an opioid such as buprenorphine or methadone prescribed for opioid use disorder.

This practice is associated with:

(1) therapy in a primary care setting (vs behavioral health)

(2) absence of direct observation during urine specimen collection

The practice can be successful if only the parent drug is tested for. It would fail if the testing also included:

(1) detection of metabolites excreted in the urine such as norbuprenorphine

(2) a screen for other drugs of abuse

Risk factors for using drug addition to mask diversion:

(1) opioid use disorder

(2) diversion

(3) urine test positive for other drugs of abuse