Presented at the 2012 AAPM Annual Meeting« Back

Concurrent Nonprescribed and Illicit Drug Use in Patients Prescribed Buprenorphine

Alexander Y. Guo, MS, ayguo@ucsd.edu¹, Rabia S. Atayee, PharmD BCPS¹, Brookie M. Best, PharmD MAS², Joseph D. Ma, PharmD³, Amadeo J. Pesce, PhD DABCC⁴, (1) UCSD Skaggs School of Pharmacy, La Jolla, California, (2) UC San Diego, La Jolla, California, (3) Pharmacy, La Jolla, California, (4) Millennium Research Institute, San Diego, California

Purpose: Because patients being treated with buprenorphine have a history of opioid dependence, they may be predisposed to misuse of drugs, specifically abusing nonprescribed or illicit drugs. Concurrent use of such drugs carries the risk of drug interactions. This retrospective data analysis, using urine drug tests, observed which nonprescribed and illicit drugs were most commonly used by subjects prescribed buprenorphine. Methods: Between 2008 and 2011, 202,266 urine specimens collected from clinical testing of pain patients from physicians' offices were quantified using LC-MS/MS by Millennium Laboratories. All data were de-identified and IRB-exempt status was granted by the UCSD IRB. Data included the drugs each subject was prescribed and the drugs that were detected. Subjects prescribed buprenorphine were screened for illicit and nonprescribed drugs. Results: In 5,197 subjects tested for illicit drugs, detection rates were: marijuana (21.0%), cocaine (9.3%), heroin (2.2%), and methamphetamine (1.9%). In 5,207 subjects tested for nonprescribed drugs, detection rates were: benzodiazepines (19.1%), oxycodone (13.1%), hydrocodone (11.0%), amphetamine (5.1%), morphine (3.3%), methadone (3.1%), and codeine (3.1%). Conclusions: Marijuana and cocaine were the most prevalent illicit drugs. Cocaine is the largest concern since it decreases exposure to buprenorphine. Benzodiazepines were the most prevalent nonprescribed drugs and are a concern since their concurrent use with buprenorphine can cause added respiratory depression. These findings highlight the importance of physicians educating their patients on the potential toxicity of drug interactions. References: 1)Myers DP, Augustyniak M, Molea J. Buprenorphine for pain management physicians: A dilemma or a therapeutic alternative? Tech Reg Anesth Pain Manag. 2005:9;216-220. 2)McCance-Katz EF, Ralney PM, Moody DE. Effect of cocaine use on buprenorphine pharmacokinetics in humans. Am J Addict 2009; 19:38-46. 3)McCance-Katz EF, Sullivan LE, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: A review. Am J Addict 2009; 19:4-16.

Funding: An unrestricted grant was given to the UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences to fund the summer internships by Millennium Laboratories, Inc. Disclosure: Dr. Amadeo J. Pesce is an employee of Millennium Laboratories, Inc.