Wedsday was my return to my "new" pain mangement doctor after 5 years at Kaiser. I was greated with a small staff and detailed why I was told my urine test came back with HIGH concentrations of Oxycotin and that They believed I have a "drug problem" and was basically attacked and put down for a few hours. The problem here is that I DONT TAKE ANY thing that isnt prescriped to me.
I am currently prescribed 200mg of MS Cotin via 100 mg time release twice a day, and 24 MG of hydromorophone via 4 mg tablets 6 times a day.
I cant tell you or anyone why Oxycotin was in my blood work, UNTIL I went looking for answers at my Pharmasist and talking with a relative also a pharmasist.
All the time my doctor was preaching to me, he kept talking about my MS Cotin and how no oxycotin should show up, where was I getting it, how was I getting it, he looked up records somewhere and started naming doctors that my father and grandfather (Im John A Nicita III) (So two other john nicita's out there) (this alone ****es me off, the fact that he didnt run socials or birthdates was a real disapointment).
I found out that my hydromorophone (dilaudid) mollecur structure is C17H19NO3 X HCL
and that OxyCotin is
C18H21N04 x HCL
both sharing the same molecular structure with a VERY slight difference on the additional Carbon and Hydrogen molucules. STILL look at the relevance.
I was told by both pharmacists that without Gas based advanced testing (not a urine test) that these two on the processed exertion by the liver and the compounds found before breaking down COULD NOT be deciphered diffrent, and that this is exactly what was happening, one was showing as another on a basic in house urine analysis. He went so far as to say oxycotin is probally prescribed 20x more often that Dilaudid and that familarity with it is probally missing within the pain management clinic I attended.
#1. Could my pain "specialist" be so incompetent that this happened?
#2. I am sitting here shaking from withdrawl as I wait for this doctor to further diagnos what might have happened and they analyze a 2nd urine sample, I tried to give blood, but now that I hear what I mention above, I am pretty confident that the same results are going to come back, and the same treatment is going to come from this doctor.
#3. I need these meds, every bone from my pelvis down (minus toes) is structured with metal, I had 3 accidents , 2 that happened while I was still filled with metal from the first in 2 years, and basically have had my bones crushed and pulverised twice, diagnosed as not being able to walk (But have and do walk by sheer NOT GIVING up, although I am in imense pain from doing so)
#4. Dont really want to point out incompetence in my doctor, that never gets you anywhere, yet I understand I cant just leave and search elsewhere, dont want the label of a seeker of easy pain management, man I should have never left Kaiser, 5 years with no PROBLEMS, and then this BS in the first 2 months of new pain managment.
Any comments or corrections or cofirmations apperciated...
Hey John, You doc may simlply may not be aware of the testing methods used at the lab and which is the most acurate test. But your right, legally they are suposed to confirm a positive test with either GC/MS or liqudid chromatography.
MY wife takes percocet and MSC and her last test came back with the MSC and hydromorphone, 20% of oxy is metabolized into hydromorph and that's the easier drug to find so it's generally what they look for. It just depends on what your docs specialty is as far as pharmacological knowledge or simply going by a report.
There is plenty iof literature about the difficulty in detecting oxy and the commonality between Oxy and Dilaudid. IF your going to fight it,. you need to know exactly what test was used and who makes it and talk to the manufacturer of the test to find it's limitations and how it interprets drugs in the same synthetic keto opiate family.
Did they not fnd any hydromorphone, that's odd but likely a unique quality of that particluar test. I bet the doc can't even tell you if EMIT, TDx, or TLC was used or another comercial immunoassays was used and it dos make a difference as far as detection rates, variables and limitations.
Your Rph is very corect that these comercial Pee test are presumptive positives and must be confirmed. However a doc isn't a the same as a court hearing where if someone is going to jail for posesion, they better get the drug right and follow proper protocol and do the follow up confirmation using gas or liqudid chromatography. When this test is done for exclusion of employment or termination of employment a lab needs to do the confirmation with GC-MS to prevent a law suit for wrongful terminination.
I guess I'm trying to say, your doc isn't necesarrily obliged to confirm his testing method and I'm not sure what recourse you have without proving you experenced compensable damages due to a faulty test and lack of confirmation. A letter from the manufacturer of the test explaining how the test used actually works seems like the most reasonable thing to obtain.
hi,
i was wondering since you said that you are having withdraws,did you dr take you off all your meds? if so i don't think they can do that,til they get a confirmed test can they? that is soo not fare..good luck keep us posted.kelsey1
Sorry to hear about the test results. Shoreline is completely right here. The problem with a pee test at your doc's office is generally they are the same tests that you can buy online. There is not alot of scientific testing that goes into that process.
You really need a GC/MS test. Shoreline mentioned criminal prosecution and testing. When this happens, a forensic lab generally test the urine/blood. The urine is spun and its a pretty detailed process, but the end result is the metabolite of the drug and what that matching up for. For instance, the metabolite of hydrocodone (Vicodin) is Hydromorphone (Dilaudid). The metabolite of Marijuana is Delta-9 THC.
The testing where they stick a test stick in your pee and it tells them what drug you are on, is not very reliable other than to say that you have that drug of a metabolite of that drug. This, like your case, can cause major problems. If they were using the test just to see if you were taking opiates when you are only prescribed benzo's, then this test would be accurate.
Unless you are willing to pay for a forensic test of your urine, you may not have a lot of recourse as previously pointed out.
This is wierd,i had just the opposite happen.tho it wasn't brought up to me at the time as my PM was aware of the metabolization process,but it freaked the hell outta me when I saw my test results and wondered why no one happened to mention the fact that this test stated I had dilaudid (the hydromorphone)in my urine but I had never ever taken any or been Rxed any.it was then that i found out that when oxycontin is metabolized one of the things it breaks down to is hydromorphone.maybe that same thing happens in some sort of a reverse order??who knows but man that really does suck to do that to you.Hopefully this episode will just be a real sad memory soon, unfortunetly a rather painful one for you.i really DO feel for you john,good luck,marcia
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11-20-01,placement of hardware for failed fusion
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