What can cause false positives on a urine test?

For many people, the idea of a drug test has a negative connotation, and being asked to submit to one may feel like chastisement or punishment. Given the way that drug use is socially stigmatized, this reaction makes sense, but for those seeking treatment for an opioid use disorder (OUD), Suboxone® drug tests are a critical recovery tool. This guide explores the importance of Suboxone drug tests, how they’re used during OUD treatment, and how to make the most of them.

Why are Suboxone drug tests during OUD treatment so important?

Suboxone is a combination drug comprising a mix of buprenorphine and naloxone (important safety information). It’s the gold standard for OUD treatment due to buprenorphine’s high efficacy in reducing cravings and promoting successful treatment¹, and a large percentage of individuals receiving medications for addiction treatment (MAT) are prescribed Suboxone to aid in recovery.

However, because buprenorphine is itself an opioid, prescribers need to make sure the medication is being used properly. If those conditions aren’t met, they may need to adjust the treatment plan to better serve that patient.  

Whether overseeing treatment remotely or in person, clinicians rely on drug tests to evaluate a patient’s progress and the treatment plan’s effectiveness. Suboxone drug tests during OUD treatment can tell a doctor if other opioids are present in the patient’s system and determine the presence of buprenorphine. If there are any unexpected findings, it may indicate that the treatment plan needs to change.

How remote Suboxone drug tests work

Taking a remote drug test is surprisingly easy and can be completed with a few simple steps:

• First, your treatment team will schedule a testing day with you and have a testing kit mailed directly to your address in discreet packaging. Once it arrives, you should store it in an area that stays room-temperature. Avoid leaving it in sunlight, and do not open the packaging.
• On the day of your test, you will join a scheduled video call with your clinician and open the package on camera with them. 
• Afterwards, take the test cup out of its sealed bag, and head to the bathroom to pee in the cup, making sure to hit the minimum fill line. You do not need to bring your camera with you for this portion of the process.
• Once this is done, show the cup to your clinician. Results will appear within five minutes, and the clinician can discuss the results with you.

During this process, the clinician is looking primarily for two things: the presence of buprenorphine (which indicates that the patient is taking their Suboxone properly) and the absence of other opioids.

While the idea of remote drug testing may seem strange to many, research suggests that the process is highly effective and can make opioid use disorder treatment more accessible² and successful. 

Ophelia’s approach to urine tests

At Ophelia, we conduct these remote drug tests to ensure that treatment is proceeding as planned. The goal is not to police patients on their habits and activities. We take a non-punitive approach to urine drug testing, meaning patients aren’t reprimanded or punished for a drug test that reveals the presence of other opioids or the lack of buprenorphine.

Instead, we use these results to tailor the patient’s treatment plan to their needs. If treatment isn’t working, we can discuss any problems that the patient is experiencing and what might help them thrive better. 

We also orient the treatment program to meet the patient’s goals and not our own. If we find an unexpected result, the first step is to evaluate the patient’s goals and see how we can help them get on track. 

What you need to know about false positives on urine tests

What is a false positive?

It is possible—but not common—for a remote Suboxone drug test to come back positive for non-buprenorphine opioids even if the patient isn’t using other opioids outside of treatment. This is known as a false positive. Past research indicates that 5-10% of drug tests may result in false positives³, but more recent research is needed as testing methods evolve.

If this happens, there’s no need to panic. Address the matter with your clinician to figure out the next steps. They may order another test and schedule a follow-up, and you’ll most likely discuss what the cause of the false positive was and how to prevent a repeat situation. 

What can cause a false positive drug test for Suboxone?

Remote urine tests are convenient and accurate, but they aren’t always as sensitive as the tests performed in a doctor’s office and analyzed in a lab. Remote Suboxone drug tests rely on reactive components in the test strips to detect the presence of certain molecules and then react to them, but these test strips can’t always differentiate between similar molecules with 100% precision³. When a secondary substance is detected and shows up on the test strip, this results in a false positive. 

False positive drug test results can happen after taking certain medications, whether prescription or over the counter, or even after eating certain foods. For example, cough and cold medications frequently use ingredients with chemical structures similar to opioids. If a person takes a cough suppressant before an opioid drug test, the results may come back positive for opioids, even though that patient isn’t misusing any non-prescription opioids⁴. 

Some antihistamines, like Benadryl®, and antibiotics may also result in a false positive for opioids. Prescription antidepressants may show up as amphetamines, and certain blood pressure medications may look like LSD on a drug test. Even common painkillers, like ibuprofen and tramadol, can result in false positives for various other drugs⁴.

Food-related false positives are far less common, but they can result from eating foods like poppy seeds⁵, hemp-derived ingredients⁶, and tonic water, which has small amounts of quinine, an antimalarial compound⁷.

Tips for reducing the risk of a false positive

Avoid known contaminants

The likelihood of returning a false positive during a Suboxone drug test is low, but not zero. To minimize the risk, it’s usually enough to stay away from the foods and drugs mentioned above for several days before testing. If you’re on other prescription medications that may cause a false positive, like an OTC decongestant or NSAID or a prescription antidepressant⁴, let your clinician know ahead of time.

Avoid detox methods 

If you’ve ever searched online forums or social media for advice, you’ve probably seen people claiming to have detox methods that can clear the remnants of many drugs out of your system before a test. And it’s tempting to think these methods can reduce the risk of a false positive. But there is no scientific backing for these claims, and you should avoid non-proven detox methods at all costs. Not only are these methods not shown to be effective, but they can also make people sick and create emotional setbacks due to unrealistic expectations.

Testing + treatment methods that really work

Urine testing is an important part of establishing an opioid use disorder (OUD) treatment plan. Your care team will be with you every step of the way, so you feel comfortable and confident about remote testing and understanding the results. Contact us today to discuss your needs with our intake team and get paired with care providers to begin your virtual OUD treatment.