Buprenorphine positive oral fluid test with interesting reason provided by donor

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Buprenorphine positive oral fluid test with interesting reason provided by donor

Post by helent » Tue Nov 10, 2020 10:25 pm

An employee tested positive for buprenorphine on a random oral fluid (OF) test. 66 ng/mL ( cut off 5 ng/mL.) He is a construction worker.

He provided a recent ( October 2020) prescription written to his son - and stated that his son has an addiction problem and he administers the sub-lingual medication to his son, age 24 years, to ensure compliance with the medication as instructed; and that the medication must have entered his own system from that.

Rx: buprenorphine/naloxone 8/2 mg sublingual with instructions to apply 1 film under the tongue three times a day prn.

The laboratory scientist was consulted, and while he felt the donor was using the medication, resulting in a level in the OF higher than one would expect from finger contamination or skin absorption, he also felt it would be a difficult legal case and that any benefit of the doubt and plausibility of "story" would be given to employee.

We are asking that the son’s doctor provide a note regarding likelihood of skin absorption resulting in a positive OF test result. It is likely the doctor will support the argumant or ask the MRO to make that determination. I also think it is important the son's doctor is made aware of what is ‘happening’.

Here are some thoughts - are they reasonable next steps?

1) The employee should not return to work till he is evaluated by an SAP/addiction specialist, as he has drugs in his system. The addiction specialist might want to interview the son as well prior to providing recommendations.

2) The employee should have a fitness for duty exam prior to return to work, as he has drugs in his system.

3) If he is verified negative because one feels the story is "plausible", he should be put in an unannounced follow-up program for xx (?3) months - to ensure that if he is administering the medication to his son - that he is doing it correctly this time - with gloves - or watching his son administer it for himself. This decision to do additional testing may depend on the company policy.

Any suggestions would be much appreciated.

Thank you, HT

Robert Swotinsky MD
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Re: Buprenorphine positive oral fluid test with interesting reason provided by donor

Post by Robert Swotinsky MD » Wed Nov 11, 2020 6:22 pm

The medical literature does not describe positive buprenorphine results from inadvertent exposure. The medical literature does describe buprenorphine, including street (nonprescribed) buprenorphine, as a drug taken by opioid-dependent people to help ward off withdrawal symptoms.

A SAP could offer suggestions about treatment. Understand that treatment doesn't necessarily fix this problem. About 20-30% of people with opioid use disorder achieve long term abstinence. Relapse is common and expected. A th ree month follow up is too short.

If the job is highly safety-sensitive, you might want to ask this man for a release form to allow you to communicate w/the PCP. Then, ask the PCP for a printout from the PMP.

If the job is not highly safety-sensitive, then there's less priority to addressing his opioid use disorder. One would not want, for example, to be participating in exclusion from work due to taking a medication that is used (and encouraged to be used) to treat a health condition (i.e., opioid use disorder).

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