Oral fluid (OF) is an attractive option for compliance monitoring during opioid agonist medication-assisted treatment (OA-MAT) because collections are observed and may be OF is less likely to be substituted and adulterated than urine. How does the sensitivity of oral fluid testing compare to that of urine testing?
The detection rate of BUP is significantly higher in urine in patients undergoing OA-MAT and false negative results may be obtained when OF is utilized alone. In the cited reference, buprenorphine and/or metabolites were more likely to be detected in UR (p < 0.001). The majority of patients prescribed BUP were positive for BUP in UR (97%) as opposed to OF (78%).
Ransohoff JR, Petrides AK, Piscitello GJ, Flood JG, Melanson SEF. Urine is superior to oral fluid for detecting buprenorphine compliance in patients undergoing treatment for opioid addiction. Drug Alcohol Depend. 2019 Oct 1;203:8-12. doi: 10.1016/j.drugalcdep.2019.06.015. Epub 2019 Aug 1. PMID: 31394416