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December 2020

Case Study: Sleight of Hand During Buprenorphine Administration - Combing Drug Testing, Observed Dosing and Telehealth to Support a Challenging Patient

A 26-year-old F with opioid use disorder ‘reconnects’ with an outpatient treatment program “to get back on Suboxone and then get the shot.” She has a history of fentanyl use disorder with use, despite Rx of buprenorphine/naloxone. Also, UDS showed her to stop taking, or only intermittently take, the buprenorphine around her fentanyl use. At the start of COVID-19, the plan was to have sufficient obs doses and on-site dosing to safely give the SC buprenorphine, but she didn’t follow-up. “Now I’m ready.” This case features a discussion of buprenorphine induction and stabilization in order to safely give the SC buprenorphine monthly injection. Drug testing during COVID-19 as well as supporting challenging patients with limited ‘on-site’ resources will be discussed. On the on-site obs dose, the patient was caught taking a piece of buprenorphine/naloxone film pre-wrapped with cellophane, which she reported “was an accident. I had it open and didn’t want to lose it, so I wrapped it up.”

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References

Full Case Discussion can be found here: https://youtu.be/jiKiuzgmUuE

  1. Jarvis M, Williams J, Hurford M, et al. Appropriate Use of Drug Testing in Clinical Addiction Medicine. J Addict Med. 2017;11(3):163-173. doi:10.1097/ADM.
  2. Substance Abuse and Mental Health Services Administration. Clinical Drug Testing in Primary Care. Technical Assistance Publication (TAP) Series 32. May 2012. Accessed December 12, 2020. Available at: http://store.samhsa.gov.
  3. American Society of Addiction Medicine. ASAM COVID-19 task force recommendations: Caring for patients during the covid-19 pandemic, Adjusting drug testing protocols. September 18, 2020. Accessed December 12, 2020. Available at: https://www.asam.org/Quality-Science/covid-19-coronavirus/adjusting-drug-testing-protocols
  4. Stolbach, A., Mazer-Amirshahi, M., Schwarz, E.S. et al. ACMT Position Statement: Caring for Patients with Opioid Use Disorder during Coronavirus Disease Pandemic. Med. Toxicol. 16, 484–486 (2020). https://doi.org/10.1007/s13181-020-00800-9 
  5. Wiegand TJ., Siegrist M. “Buprenorphine metabolite profiles in urine drug monitoring – induction, compliance and adulteration examples.” Millennium Research Institute Annual Conference Program Committee Award.  The American Society of Addiction Medicine (ASAM) Annual Meeting, Baltimore, MD, 2016.