Amaram-Davila Jaya, Reddy Akhila, Clark Matthew D, Nancherla Anita, Arthur Joseph, Bruera Eduardo
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Palliat Support Care. 2024 Aug;22(4):822-824. doi: 10.1017/S147895152300086X.
Urine drug testing (UDT) plays a significant role in monitoring patients on chronic opioid therapy (COT) for non-medical opioid use (NMOU). UDT, at times, can be inconsistent and misleading. We present a case where a patient on a buprenorphine patch had false negative results.
A female in her 70s with metastatic breast cancer presented with uncontrolled pain from a T6 compression fracture. She had no relief with tramadol 50 mg every 6 hours as needed. Due to an allergic reaction to hydromorphone, our team prescribed a buprenorphine patch of 5 μg/h. Subsequently, she expressed excellent pain control, and the clinician confirmed the patch placement on examination. She underwent a UDT during the visit. The UDT was negative for both buprenorphine and its metabolites. The literature review showed that false negative UDT results are relatively common among patients with low-dose buprenorphine patches. The combination of a thorough physical examination, a review of the Prescription Drug Monitoring Program, and reassuring scores on screening tools placed her at low risk for NMOU.
Buprenorphine has a ceiling effect on respiratory depression and a lower risk for addiction. However, when used in low doses, the drug might not have enough metabolites in the urine, leading to a false negative UDT. Such results might affect patient-physician relationships.
In addition to the UDT, a thorough history, screening for NMOU, physical exam, a review of PDMP, and a good understanding of opioid metabolism are necessary to help guide pain management.
尿液药物检测（UDT）在监测接受慢性阿片类药物治疗（COT）的患者是否存在非医疗性阿片类药物使用（NMOU）方面发挥着重要作用。然而，UDT有时可能并不一致且具有误导性。我们报告一例使用丁丙诺啡透皮贴剂的患者出现假阴性结果的病例。
一名70多岁的转移性乳腺癌女性患者因T6椎体压缩性骨折导致疼痛无法控制前来就诊。按需每6小时服用50毫克曲马多未能缓解疼痛。由于对氢吗啡酮过敏，我们的团队为她开具了5μg/h的丁丙诺啡透皮贴剂。随后，她表示疼痛得到了很好的控制，临床医生在检查时确认了贴剂的位置。她在此次就诊期间接受了UDT检测。检测结果显示丁丙诺啡及其代谢物均为阴性。文献综述表明，低剂量丁丙诺啡透皮贴剂的患者中，UDT假阴性结果相对常见。全面的体格检查、对处方药监测计划的审查以及筛查工具上令人安心的评分表明她发生NMOU的风险较低。
丁丙诺啡对呼吸抑制有封顶效应，成瘾风险较低。然而，当低剂量使用时，尿液中的药物代谢物可能不足，导致UDT出现假阴性结果。此类结果可能会影响医患关系。
除了UDT检测外，还需要详细的病史、NMOU筛查、体格检查、对处方药品监测计划的审查以及对阿片类药物代谢的充分了解，以帮助指导疼痛管理。
