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Old 05-26-2006, 09:12 AM   #1
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Hydromorophone and OxyCotin question

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 pisses 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...

Thanks


John Nicita

 
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Old 05-26-2006, 10:08 AM   #2
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Re: Hydromorophone and OxyCotin question

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.

Goodluck, Dave

 
Old 05-26-2006, 03:24 PM   #3
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Re: Hydromorophone and OxyCotin question

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

 
Old 05-26-2006, 09:46 PM   #4
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Re: Hydromorophone and OxyCotin question

Hey John,

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.

Good luck with the process. Take Care

 
Old 05-27-2006, 06:52 AM   #5
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Re: Hydromorophone and OxyCotin question

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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Old 05-30-2006, 06:36 AM   #6
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Re: Hydromorophone and OxyCotin question

I went into the office on Friday, armed with some information from here, as well as from my Pharamacist. I didnt get a chance to see the actual doctor, but the office is run by him and his assistant (capable of writing scripts). He breifly went over with me that

#1. My test was pushed along to a outside testing source, and that a gc was done.

#2. He prescribed me 7 more days of medication while he tried to get the results from my 2nd urine test. I did try to give blood when the 2nd test was taken, however after 4 or 5 tries and my vein rolling off his needle, I all of a sudden had to pee again. Nothing like someone digging in your arm trying to get blood and not succeeding.

#3. He gave me some speech about how the believed me and that they can always stand to learn something new, but I'm seriously starting to worry here.

I have no reason to lie, I have never even seen a "oxycotin" pill, been perscriped one or taken one. I have NO clue as to why it is showing up in my blood. I take my health serious, and have not taken anything other than what was prescribed. For instance, in the 1st gulf war I came home with Type 1 diabeties, age 27, first in my family, etc, etc. No one can explain it, But I have taken my diabeties so serious, I am now on a minimed pump (my point is, you really have to be concious on your diabetic management to have a doctor award you with an infusion pump).

This really worries me, I dont think one can win or even come out nuetral here, if the oxy isnt in the 2nd urine test, then it looks like I was on it and stopped (I guess its good that the 2nd test was taken before the results from the first were discussed), and if it comes back with Ocycotin still in it (which I can only guess It's going too if they do the same test, as it was there the first time, why not the second time). I understand the approach the doctor is taking, You dont want to perscribe this kind of medication to a illicit drug user, but It just pisses me off because I know I've never taken oxycotin yet some flaw in the test or lab is presenting my data as that I have. This isn't an employment test or anything like that, All I stand to loose is my ability to function and walk, and a real "narly" withdrawl period probally followed with some hospitialization (its been 5 years I've been on these meds). I just happened to goto a doctor that tests his patients randomly to make sure they are taking as perscribed or not on street drugs I guess.

I'm not really happy with the treatment, or the doctor right now, but I also understand that if I goto a diffrent doctor I will be labeled a dr. chaser, which is not what I am doing, although I may HAVE to move to a diffrent doctor if this doctor shuts me down. I know that the move should happen as quickly as possible, so that the dissatisfaction with the treatment can be focused on, I mean, if I had 5 years of coverage with no problems, and then immediatly have problems, one would think a quick move would make the most sense.

No clue what to do or where to go at this time, I am only NOT looking forward to Friday when I run out of medication again....

John

 
Old 05-30-2006, 06:41 AM   #7
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Re: Hydromorophone and OxyCotin question

I will keep you all updated, and look forward to future posts and threads on this. LIKE I SAID, I have no reason to lie, especially to this support board, it gains me nothing. Maybe some combination of my treatment alters something and we can help the next person who encounters this....??

John

 
Old 05-30-2006, 08:14 AM   #8
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Re: Hydromorophone and OxyCotin question

John - I really hope that everything works out for the best. I would hate to see someone like you who is following all the rules get in trouble for somethign you didn't even do!!! - Tina

 
Old 05-30-2006, 11:59 AM   #9
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Re: Hydromorophone and OxyCotin question

Hey John, What's strange is you keep saying they found OxyContin first via immunoessay and now the PA is saying they ran a GC/MS and found OxyContin. They would have first run the presumpive pee test, there would be no point and extremely costly to go straigtht to GC/MS with every sample.

I've just met too many people that will make up an answer rather than admit they don't know and say I need time to find out. Saying GC/MS was used sounds more like the right answer than the truth. Of all the reported oxycontin OD's when it was in the news, there was no way to tell if they took oxyContin, Percocet , Roxicodone, Liquid oxy,or any other form of oxycodone or product that contained it. How do they know it was OxyContin. GC/MS doesn't show the delivery method whether it was IV , oral solution or long acting tablet.

IS it possible you have an enemy that might have tipped the doc you were taking or selling oxyContin and this is why they are attempting to be so specific when it's not even possible to tell what form of oxy it was with GC/MS.Perhaps someone you refused to give a pill too, someone else that might benefit in some way by screwing your life up. If your financially able you could have your own hair folicle test done and it will be very specific, not brand specific, but timeline and drug specific over the last few years. Just a thought but rotten to have to go through when oxy and hydromorph share common metabolites.

Good luck, Dave

 
Old 05-30-2006, 02:38 PM   #10
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Re: Hydromorophone and OxyCotin question

I'd bet your 1st statement to be correct. The guy who talked to me was rather upset that I made it into the office and he got stuck with me while the Doctor had been paged out to a important hospital visit. (I heard him bitching from around the corner). I really think they made a mistake and that because I am unknowledgeable put b.s. sentance 1 in front of 2 and grouped those in-front of 3. The fact that the doctor went out of his way to tell me "Normally, when this happens we turn the patients out the door, but you've been so consistent that give us a week and we will try to figure it out" sounds like they at least accept the fact that they could be wrong.

I kind of used what you educated me on in my "mission statement", and when I went back brought them statements from the internet, the mollecular breakdown, statement from my pharmacist. I went to talk to my pharmacist today and he told me that they actually called, he said he told them the same thing he told me, and they let him know they understood the likeness of the drugs and that advanced testing had been done, but he said they seemed "satisfied" with his statements and personal statements about me and my attitudes, etc, etc. He knows me as a type 1 diabetic on a Insulin Pump and he knows that only people who take their health serious gain the trust of a doctor for a insulin pump and humalog insulin.

I wish your statment #2 could be correct, as at least I wouldnt be freaking going looney tring to figure out how a substance I have never even seen, let alone taken got "in my system". But I just moved back to San Diego after 8 years away, and dont believe anyone is aware of what the heck is going on with me. I was hospitalized for 2 months and home hospitalized for 3 more months, through all that I only have my imediate family, no friends yet here... Good or bad....

Really does suck, doesn't it.

I feel like this place (doctors office) is wierd, I am not new to these treatments or doeses, but even through 3 Moves while at Kaiser I never had any issues or problems, and the first place I goto here on the outside of kaiser and they have me signing all kinds of forms that I will only goto this doctor and this pharmacy (seemed normal) and that random urine and blood test will be be performed and requested (i.e. they state they can call and request blood or urine at any time). <- that seened a little strange to me but, hey he said he has to be hard because he's accountable to the DEA... Reguardless, I'm not happy with him, and even if it does straighten itself out, I will be looking for another doctor.


John

Last edited by jnicita; 05-30-2006 at 02:43 PM. Reason: typos

 
Old 05-30-2006, 06:15 PM   #11
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Re: Hydromorophone and OxyCotin question

john
i feel so very bad for you i can understand what you are going though. I had to take a drug test at one of my pm dr and it came back as positive for xanas. I was so very upset because i new i hadn't taken it or anything like it.They didn't believe me .I cried and cried .I was so angry because i didn't feel as though noone believe me .Of course it was sent off to do gc/ms and they told me that it i truely haven't taken that drug it will come back negative. I was so stressed in my case it did come back negative they think that bendrl that i took was such a close match . So i do now that false positive do happen .And i totally understand what you are going though. Do you know that that dr office never said they were sorry at all even though they called me a lying addict .keep us posted good luck hopeful the truth will come out .I will keep my fingers crossed for you kelsey1

Last edited by kelsey1; 05-30-2006 at 06:37 PM.

 
Old 04-04-2008, 10:23 AM   #12
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Re: Hydromorophone and OxyCotin question

Hello I Am Here As A Result Of A Recent Urin Test Issue Myself : ( I Have Been On Oxycodone 5 And Or 10 Mgs For Over A Year Now I Have Had Several Urine Tests In The Past For The Detection Of Non Prescribed Drugs With No Issues But A Week Ago I Took A Random Test After Not Having One For Some Time And The Doc Called Mre To Accuse Me Of Having Not Just 1 Other Drug In My System But 2 He Said They Had Found Both Traces Of Hydromorphone And Dilaudid? I Said What The **** Is Diluadid I Had Never Even Heard Of The Drug I Was So ****** Off It Was Unreal And I Still Am Quite Unhappy Grrr Any How I Said To Him That Due To Being Out Of My Normal Meds Oxycodone 1 Day Early In Being In Pain I Had Taken A Vicodin I Had From A Previous Toothe Problem But Thats It. There Was No Convincing Him Otherwise He Made Jokes About This Finding He Was Cruel With His Words The Whole 9 Yards. Now I Must Say To Deny One Drug When I Admit To Another Is Reason For Concern But I Am Soo ****** Of Because I Have Never In My Entire Life Time Taked A Dilaudid? I Now Have An Idea How These Things Happen But Am Still In Need Of A Little More Clarification If Anyone Can Help Out How Does 40mh A Day Of Oxycodone And 10mg Of Hydrocodone Return A Positive Test For Diludid? I Now Rick Looking Like A Scumbag Drug Addict With A Lying Problem Which Is Not The Case I Fear Loosing My Right To Recieve Medications Which Are Very Much Needed? My Doctor Said He Wishes To End Our Relationship And I Should Find A New Doc But I Am Fearful This Issue Is Gonna Haunt Me Any Suggestions?

Last edited by FREDNESS; 04-04-2008 at 10:26 AM. Reason: SPELLING

 
Old 04-04-2008, 11:06 AM   #13
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Re: Hydromorophone and OxyCotin question

Sorry to hear this about you situation, I haven't been back to report on this topic, but I do have some hope for you. I'll tell you what happened to me and all, maybe it can help you or someone else.

#1. I went and talked to my pharmacist, you should be getting your prescriptions of pain meds from the same location every-time. Your pharmacist is paying attention to you when you pick up your prescription, he's also usually talking to you, and getting to know you. When I saw my pain doctor, I suggested that he contact my pharmacist, funny, he already had, having my pharmacist tell him that I was honest and trustworthy, and didnt come to pick up my prescriptions acting like a addict.

#2. I asked to be retested AS quickly as possible, before time passes for the drugs to dissipate. Any positive should be verified with another positive, I asked my doctor and told him I've never given him reason to doubt me, something must have happened with the other test. He was willing to do, this, and of course the next test the next day didnt show ANYTHING that the first one did.

#3. I talked to my old chronic pain doctor. (I had to change due to insurance reasons). My new doctor had already called my old doctor, who told him that he had no reason to ever think that I was abusing my medications.

#4. I talked to my regular doctor that sent me to the specialist. I told him of the situation and prepared him that I might be needing emergency treatment for withdrawls because my doctor was going to pull my meds because of some positive urine tests, I explained that they were incorrect and that I would submit blood or urine at a seconds notice to prove the first one was a mistake.

I never ever took anything not prescribed to me unlike you, who took the vicodin. Mostly because compared to what I am taking (30 mg/day of diladid, and 300mg/day of MS Cotin) vicodin wouldnt do jack for me, my as well take asprin. Make sure you keep the bottle showing that it was prescribed to you at one time, at least it doesn't look like you have a street connection. If I was in your boat, I would have told him when I got my new script that I had to take a vicodin I had from a previous prescription because of "x", but hell, when your in pain, we do anything.

#2. Above is the most important. our insurance will pay for the test, and if he's doubting you, get one before enough time passes that lets him think that it could have naturally disappeared. I took my second one the next day, and not 1 trace of the 2 other chemicals showed up, it took about another 6 months with appointments every 3 weeks before I got the trust back, but HE NEVER apologized or anything. For the last year at least, I get my scripts every 30 days in the mail or by stopping by the office, but I only have to go in once every 120 days or so. So you can salvage the relationship. The last thing you want to do is start looking for another chronic pain doctor, that raises FLAGS with them.


Good luck, I still think that I got a bum test, by someone that was careless and just didn't give a **** about my well being, how else could Oxycontin show up in my urine?

Stay strong.

John

 
Old 04-17-2008, 06:14 PM   #14
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Re: Hydromorophone and OxyCotin question

hi, I'm new and I am not sure how to post on here...if its wrong I'm sorry. here is my issue...I have severe RSD been on a pain contract for about 4 years. never had a problem until last Friday. my 12 year old went to the dentist on Thursday, up crying all night because of the pain she was feeling...called dentist early eve thurs. just a machine. called Friday morn. no dentist to see her or prescribe anything but made an appt for sat morn at 9 when they opened. told to call her primary doc. told them her problem. asked what to give her, doc said he would call in something for pain till she could get in. I said just give her 2-3 pills she should be fine. he gave her 10 . she took 2 and a half and I still have the other 7 and a half. this was the same day I was to go p/u my hard copies for my morphine and oxycodone. diff doctor. when I got there they wanted a drug test. gladly took it. asked when I last took my pills I said 1pm morphine (1 pill). and about 5 mins ago for my oxy(2 pills). I got a call today that I had vicodin in my system. I said 100% not possible. I did not take it. how could I test positive for that. the only meds I took that day were my oxycodne, morphine, thyroid meds, hormone patch and Tylenol allergy and Dayquil. the nurse said that I had high levels of opiates. please, could someone explain this to me. I asked for a copy of the test and now the dr wont call me back

 
Old 04-17-2008, 07:06 PM   #15
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Re: Hydromorophone and OxyCotin question

Quote:
Originally Posted by punki1 View Post
hi, I'm new and I am not sure how to post on here...if its wrong I'm sorry. here is my issue...go to the main Pain Management board page and then click on the New Thread button at the top left of the page

how could I test positive for that. the only meds I took that day were my oxycodne, morphine, thyroid meds, hormone patch and Tylenol allergy and Dayquil. the nurse said that I had high levels of opiates.
well, no doubt you had high level of opiates if you had just taken your oxycodone. are they not smart enough to realize that? I don't know how they could differentiate between hydrocodone & oxycodone unless they did a really expensive drug test which I doubt they do. I would offer to take another test. Was it a urine test or blood test? the real way to know would be a blood test. I would offer to come back and take a blood test but don't way too long, like call them tomorrow and offer.

brian

Last edited by brianpain33; 04-17-2008 at 07:07 PM.

 
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