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Butrans not showing on UDS?

Has anyone else been told that Butrans is not showing up on their urine drug screen despite constant use? Today during my monthly visit my PM nurse practitioner told me that in 4 of my urine drug screens over the past year my Butrans has not shown up.
I am on the 20mcg patch weekly and always wear it and change it as prescribed. I have some problems with the patch coming loose during the week because of heavy night sweats due to menopause. I always reapply the patch and use tape to keep it on. I also spray my skin with benzoin spray prior to applying patch and place them on my upper arms as my trunk sweats more heavily. In short, I have done everything possible to use the patches exactly as prescribed. I have reported the adhesive problems to my PM nurse prac, as well as to my pharmacy. I have always felt as if the patch's pain relief wears of after 5-6 days but I never change it early.
I also use Norco for breakthrough pain, meloxicam and amitriptyline daily and baclofen as needed for muscle spasm. I have had cervical spine fused at C4-5-6 and low back discectomy (no fusion) to L5-S1. I have several other bulging discs in neck and low back, as well as facet arthritis and bone spurs. I have neuropathy in both arms and right leg due to pinched nerves. I have had radiofrequency ablation of c spine as well as several rounds of lidocaine/steroid injections to cervical and lumbar spine.
Since starting pain management at this clinic 2.5 years ago my pain has been much better managed than ever before and I am able to be more active than I had for the previous 10 years. Before today no one at my PM clinic had said anything about the Butrans not appearing in my urine. I showed my NP the patch on my right arm (obviously filthy from the past week of wear) and also the tan line on my left arm where I had worn the previous patch.
Even after this, she stated she could no longer prescribe me Norco. She did give me a few to taper off of the medicine. She refilled all of my other meds, including my Butrans patch. She said the supervising physician will NOT under any circumstance allow me to be prescribed Norco at any time in the future. I am anxious and afraid that my pain will be out of control again. I was almost ready to file for disability due to pain two years ago and I was completely miserable. I was crying when I left the office today due to frustration and fear.
Now I am wondering why they are continuing to give me the medicine they claim I'm not using and not giving me the Norco, when hydrocodone has always shown up on my screens. Has anyone else had issues with the buprenorphine (butrans) not showing in their urine, and if so what is the explanation for it? I appreciate any answers/advice you may have. Thanks, Marilyn



  • sandisandi Posts: 6,343
    edited 08/23/2014 - 2:38 PM
    screen. It needs to be specifically tested for. If the proper testing isn't ordered, the butrans is not going to show up.
    I am wondering why they are refusing to fill the norco but continue to fill the butrans.
    Is the testing an in office screening or is it sent out for confirmatory testing?
    From the http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM220880.pdf
    "Laboratory Tests
    (Copy) Laboratory signs that may suggest substance abuse include elevated mean corpuscular volume (MCV) and abnormal liver enzymes.3,4,7
    Urine drug testing may yield unexpected results. The use of this technology requires understanding of specificity and sensitivity of the particular analytic method employed. Some urine tests for “opioids” or “opiates” that are immunoassay-based, whether for point-of-collection or laboratory use, do not, for example, reliably detect semisynthetic or synthetic opioid analgesics.3,6 "
  • Thanks Sandi. My PM does both office test and send out for confirmation. They do an extensive multi drug test which includes testing for Butrans metabolite and they were referring to the send out/confirmation test as the negative ones. I wonder if the patches falling off due to sweat and then being reapplied after drying out has an effect, or the heavy layer of benzoin to help patch adhere is the cause of the negative tests. It has me frightened that it will happen again and they will drop me completely.
    I also thought it was strange that they are discontinuing the Norco, not the butrans. I was frankly too shocked scared and hurt to ask that question. Today a co-worker said I should also have asked them to get another UDS and send to a different lab. They did collect a repeat test yesterday, but I won't hear results until my next month's appointment.
  • Both of those meds are Schedule III and should be treated the same. It sounds like maybe they are looking for an excuse to stop prescribing Norco. Did you actually see the test results in writing? I am also on Butrans, but I have never been required to do a urine test.
  • ToddrickTToddrick Posts: 15
    edited 08/26/2014 - 12:39 PM
    Funny that. I just had UDS and the PM asked me in disbelief I last took my Suboxone (Buprenorphine). The way he said it made it clear to me that it didn't show up on his screening. I had taken a quarter pill (.5mg) the night before.

  • No, they didn't show me the result. The NP was flipping through the chart saying "this one, and this one", but with chart turned so I couldn't see.
    I'm willing to try weaning off Norco, all they had to do was ask if that's what they wanted. I try to be as cooperative with their suggestions as possible. My biggest fear is that another test will show negative for Butrans despite the fact I wear them as ordered and that they will dismiss me as a patient. I'm upset that they claim the tests were negative 4 times this year, but this is the first I heard of it. Now I feel like they have lost trust in me as a patient. I also have lost trust in them as obviously something is wrong with the testing process and they won't listen to me.
    After brainstorming over the weekend I called the pain clinic and asked them if I could stop in weekly and have one of their nurses observe me change the patch to prove my correct use of it. It's not as if I could take it off later and reattach it-the dang things barely stick the first time! Normally the office will call back within 1-2 days. This time-no answer all week. So last night I videotaped myself opening the package and applying the patch. Not easy to do when you are a shy, private person embarrassed about their weight and struggling with decreased mobility d/t pain. Hope it helps, as I'm surprised they didn't just dismiss me from the clinic as has happened to so many of you. Prayers welcome!
  • sandisandi Posts: 6,343
    edited 08/31/2014 - 4:31 AM
    Nasacort is an over the counter antihistamine spray , that is commonly used for people who develop skin rashes from adhesives and of course nasal allergies. I used it with my fentanyl patches when I was on them. You spray it on the area where you are applying the patch.......let it air dry. Then once it is dry, apply the patch to that area. It prevents the histamine reaction that we tend to get from the adhesives and if it is the topical cream you are using that may be effecting the adhesion of the patches and the medication not showing up.
  • I'm confused on a couple things you said:1. I thought Nasacort was a prescription medication. The only OTC nasal sprays I know of are afrin and saline. 2. What cream are you talking about? I don't use any cream under my patches. I use benzoin (adhesive) spray and allow it to dry/become tacky before I apply the patch to help it stick. I don't know how sticky the Fentanyl patches are. Butrans have to stay one week at a time. I sweat heavily (good old menopause) and the sweat under the patch will at times make them come loose.
  • My mistake. I thought you were using an anti itch cream.
    Nasacort is now available without a prescription.
    Have you tried tegaderm or other bioclusive dressings? They help
    the patches stay in place despite sweating.
  • DobieloverDDobielover Posts: 17
    edited 10/02/2014 - 11:10 PM
    and I felt like I was well prepared. I had requested to speak with the supervising physician prior to my appointment with my nurse practitioner. The office staff said "sure, just come in a bit early and remind us". I wanted to discuss my test results with him, and that the manufacturer had suggested the UDS was likely negative for Butrans due to my using Benzoin spray under the patch to help with keeping patch adhered. And yes, Sandi I have tried Tegaderm, and medical tape as well.
    Of course when I got there, no I could not speak to the physician, he was too busy and/or had already left for the day. The NP was not willing to discuss any of the above with me she said, "I am not goig to prescribe you any narcotic pain medicine. Dr.EDIT will not allow me to do that because you lied to us and were not using your patches properly."
    It is so frustrating to be accused of something you have not done but I do not want to be without pain relief so I let her lay out her new plan which is this: Butrans patch 20mcg change weekly, Mobic 15mg daily, Amitriptyline 150mg nightly (for neuropathy), Baclofen 10-20mg 3x/daily as needed for spasm and she added Topamax started at 25mg nightly for neuropathy and increasing by 25mg each week up to a total of 100mg. Not sure why, as I already take something for neuropathy. She suggested Neurontin-tried before made me swell and Lyrica-didn't help and made me sooo groggy! She did say Topamax might help me lose weight, which would be great!
    Has anyone used it for neck/back pain? Did it help? So far I've had quite a few bad days, not many good. But in general I've had more mental energy than when I used hydrocodone for breakthrough pain. It's a good thing as I've needed it to deal with this pain!

    Post edited to remove name of specific doctor. The moderator team
  • I have tried and I had somekind of reaction. My PM would like for me to take this drug for nerve pain also. I was on 2400mg of gabapentin and it worked great but made my brain fuzzy but it worked. I have also used the Butrans patch but had to stop since It basically burnt my skin so had to stop that. That really helped but lost its effectiveness about the 5 th day. I now take 800mg of gabapentin and between 6 to 8 norco but pretty ineffective due to using since June of 2013. I also have zanaflex 2 x daily 4mg. Oct 6th Norco goes to a schedule 2 drug so my remaining refills will be invalid. I wish I had somekind of answer for pain and thinking about stepping up to Percocet. My PM offered it but I will be seeing a new Pulmanary guy and I should run it by him first since lung functions are not so good. I always get to see my PM personally hopefully that never changes but I also try different tools, injections, trigger point, just last week had the bilateral facet joint injections to see about having RFA. I begin another round of physical therapy today due to my 4 level PCDF, seems like about every 3 months, probably for the rest of my life which is why I have not had the L5/S1 fusion that they want to do. Now I have 2 tears in my knee cartilage and if course osteoarthritis . Never ending. Good luck
  • I appreciate the good luck wishes-same to you. Sounds like you have a lot on your plate! I have other modes of pain relief too-I get epidural, facet, and trigger point injections to neck every 6 months and low back about once a year. I have some stretches and relaxation exercises I use throughout the day and an OTC muscle rub that works well. My pets help my depression .and of course my anti-inflammatory, antidepressant, muscle relaxant meds and my Butrans. I'm just whining at the loss of my breakthrough pain med. Eventually I'll have to "build a bridge and get over it". I just appreciate this forum to vent and freak out a little. I had finally achieved adequate pain control and functionality after 10 years of undertreated pain and now this. I'm feeling a little emotional about the loss.
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 10/05/2014 - 5:42 PM
    Dobielover. I'm so sorry you've been through all of this & I'm glad you've been able to vent here. I hope it's helped a little. Are you now considering finding a new pain management doctor? I'd be extremely bitter about the whole experience & I'm not sure I could be comfortable with them being in charge of my care. Trust is a 2 way street & incredibly important in a PM relationship for me. Sorry again ;-(
    Osteoarthritis & DDD.
  • I have requested a referral to another pain management physician for a 2nd opinion. As English Girl said, my PM and I are having trust issues with one another. Not a good place to be with your PM. I had requested to schedule more cervical ESI injections with current PM as it's always helped and has been 8 months since my last. In the past they have always scheduled. This time they said "we need to pre-auth with your insurance and will call you". It's been 2 weeks and no call.
    I think they may not be getting as much reimbursement as they want from my insurance and that is where their bad attitude come from. Actually come Jan 1 there are changes to my employee health plan which will make it more cost-effective to see the PM guy I'm going to for a second opinion as he is the new preferred provider. Let's hope he is mine too! I've heard he is hard on overweight people and tells them they must lose weight before he can do anything else to help their pain. I am very obese, so I hope he's willing to be patient with me while I try to get some of this weight off!
  • I hope that this consult turns out well for you, and that you can find a new doctor.......Sometimes, things happen for a reason that we may not understand at the time, but it winds up being the best thing that could happen for us....I hope that is true for you.
  • Did you ever find out why the Butrans did not show up in your system??? I have the exact same issue!! I am in a legal battle right now and I have been on the Butrans Patch for a while now and it has NOT been showing up on EVERY drug test but 1.
    Long story....my "parents" have taken my meds from me. I was supposed to have a pill count with my Pain Clinic in November, 2015 (I am just now finding out this as of last night bc the Pain Clinic recently added a Patient Profile website, that on 2 of my drug screens the Butrans patch did not show up). I have been on the patch for a while. The patches do tend to not stick to my skin (due to sweating, showering, life) very well, as I am sure anyone who uses the patch notices this about the patch within the first few days. It is a week long patch. I have no idea why it would not show up on the UDS!!
    As of right now, I have had the same patch on since Thanksgiving Day, 2015. However, I am called in to do a UDS every single week due to an ongoing legal case. I have NOTHING to hide!!! I'm just confused at why the patch showed up as Suboxene in only 1 test, which was done on Dec. 22, 2015, and no other drug screen I have taken since the first time I went to court in Nov. and then last night I find out that the Butrans didn't show up on 2 drug screens I have taken with the pain clinic.
    I do not put anything on my skin before applying the patch, other than taking a shower, so there is soap and water. Can someone please tell me why this is happening with the Butrans patch?!?! Would a blood test or hair sample help confirm that I have the patch on and for how long???? I mean, if I didn't have on the patch...wouldn't I be experiencing withdrawal symptoms??? I'm very confused!
  • SavageSavage United StatesPosts: 5,427
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  • SavageSavage United StatesPosts: 5,427
    edited 01/08/2016 - 6:20 AM
    Could you please explain what you mean by your parents have taken away your meds?
    More information would be useful.

    Re the patches not adhering, I'm on fentynl and I called manufacturer.
    Company sent me free of charge, the tegaderm proper covering for such med patch.
    They also told me to let them know when I need more and they would send out more boxes of covering....still free of charge.

    When you read instructions accompanying patches, it explains how not to help them adhere.
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • I'm kind of confused about your story. You're in a legal battle - over the drug tests I assume? Your parents stole your patches right before a med count? You've been wearing the same patch for 6 weeks?????? Suboxone has the same active ingredient as Butrans, so I would assume that is a test positive. If you clarify the story a bit more we may be able to answer questions but at the moment there is not enough details to make sense of everything.
  • sandi123ssandi123 Posts: 456
    edited 01/08/2016 - 7:56 AM
    Then that is why you are failing the urine testing.
    There are several companies that make the bioclusive dressings that you can use over the patches to help them adhere.
    Nexcare, tegaderm, op-site are a few of them and you can purchase them in any drug store.
    Avoid taking long or overly hot showers, make sure your skin is completely dry, and apply the patches in places where the muscle movement is minimal, and body hair isn't present.

  • sttnursessttnurse parson tnPosts: 1

    i was just at my PM clinic and discharged stating my butrans was not showing up in my uds and I where it and change it every Tuesday, she did not care that I showed her the patch on me and the rash it causes where I wear it.


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