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Buprenorphine and Norbuprenorphine, Random, Urine
MessageORDERING GUIDANCE
For screening buprenorphine alone, order BUPS / Buprenorphine Screen, Random, Urine.
For comprehensive opioid screening, order TOSU / Targeted Opioid Screen, Random, Urine.
For situations where chain of custody is required, a Chain of Custody Kit (T282) is available. For chain-of-custody testing, order BUPMX / Buprenorphine and Norbuprenorphine, Chain of Custody, Random, Urine.
Additional drug panels and specific requests are available. Call 800-533-1710 or 507-266-5700.
Test Code
BUPM
Alias/See Also
Epic: LAB16323
Mayo: BUPM
Subutex
Suboxone
Buprenex
Mayo: BUPM
Subutex
Suboxone
Buprenex
CPT Codes
80348, G0480 (if appropriate)
Preferred Specimen
Specimen Type: Urine
Collection Container: Sterile Container
Specimen Volume: 1 mL
Minimum Volume
0.5 mL
Instructions
Collection Instructions:
- Collect a random urine specimen.
- No preservative
Additional Information:
- No specimen substitutions.
- STAT requests are not accepted for this test.
- Submitting <1 mL will compromise our ability to perform all necessary testing.
Transport Container
Sterile Container
Specimen Stability
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 14 days | |
| Ambient | 14 days | ||
| Frozen | 14 days |
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
| Gross hemolysis | OK |
| Gross icterus | OK |
Methodology
Liquid Chromatography/Tandem Mass Spectrometry (LC-MS/MS)
Setup Schedule
Monday through Friday
Report Available
3 to 5 days
Limitations
CAUTIONS
Urine concentrations do not correlate well with serum drug levels and are not intended for therapeutic drug management.
Reference Range
REFERENCE VALUES
Negative
Cutoff concentrations:
Buprenorphine: 5.0 ng/mL
Norbuprenorphine: 2.5 ng/mL
INTERPRETATION
The presence of buprenorphine above 5.0 ng/mL or norbuprenorphine above 2.5 ng/mL is a strong indicator that the patient has used buprenorphine.
Clinical Significance
USEFUL FOR
Monitoring of compliance utilizing buprenorphine
Detection and confirmation of the illicit use of buprenorphine
CLINICAL INFORMATION
Clinically, buprenorphine is utilized as a substitution therapy for opioid dependence and as an analgesic. Buprenorphine is a partial agonist of the mu-opioid receptor. These mu binding sites are discretely distributed in the human brain, spinal cord, and other tissue. The clinical effects of mu receptor agonists are sedation, euphoria, respiratory depression, and analgesia. As a partial mu receptor agonist, buprenorphine's clinical effects are decreased, giving buprenorphine a wider safety margin.(1) Buprenorphine has a prolonged duration of activity. The combination of decreased clinical effects and prolonged activity gives buprenorphine the added advantage of a delayed and decreased withdrawal syndrome, compared to other opioids.(1) Compared to morphine, buprenorphine is 25 to 40 times more potent.(1) As with any opioid, abuse is always a concern. To reduce illicit use of buprenorphine, it is available mixed with naloxone in a ratio of 4:1. When the combination is taken as prescribed, only small amounts of naloxone will be absorbed. However, if the combination is transformed into the injectable form, naloxone then acts as an opioid receptor antagonist.
Buprenorphine is metabolized through N-dealkylation to norbuprenorphine through cytochrome P450 3A4. Both parent and metabolite then undergo glucuronidation. Norbuprenorphine is an active metabolite possessing one-fifth of the potency of its parent. The glucuronide metabolites are inactive.(1)
The primary clinical utility of quantification of buprenorphine in urine is to identify patients that have strayed from opioid dependence therapy.
Performing Laboratory
Mayo Clinic Laboratories - Rochester
3050 Superior Drive NW
Rochester, MN 55901
Additional Information
Buprenorphine and Norbuprenorphine, Random, Urine
Last Updated: March 19, 2024
Last Review: N. Wolford, March 19, 2024