Well here goes- I had my appt with my pain management dr. the other day, for the first time ever he had me (and I believe everyone else) do a urine test he had me sign permission slip, I never thought anything abut it - he prescribes me 20mg ox and 10mg percs for breakthru pain. The day of the appt I did not have anything to take so the last thing I had was one 20 mg ox the morning before. Low and behold he came in and asked me if I was taking my meds like he prescribed - i truthfully told him yes and when the last dose was - he then proceeded to say that it should have showed up ( you could've knocked me over with a feather - I figured it would show up like neon lights - I have been on this meds for over a year. Anyway I was so stunned - he seemed disapointed but didn't say anything I was like I SWEAR TO GOD I know I looked totally stunned. Well he wrote my scripts then gave me my shots in my back and told me the test he did the previous month showed I also now have nerve damage in both of my legs. Well to say the least I was mortified, I felt like I disapointed him, maybe lost his trust(even though he didn't say anything) I know I was being truthfull - he just said they were having some problems with meds and I assume clients. I do not understand how this happened - I take my meds faithfully - the only other thing I do is drink gallons of Ice Tea and constantly pee oh and I smoke cigarettes Basic Menthol 100. I am upset not so much about the result of the test - I do not know how long meds stay in your system or if anything can mess this up - I should of asked him to do a blood work up on me - I know I did not lie, I just feel like I let him down. My family and friends told me to not worry so much that he must've believed me and trusted me or he would not have given me my meds and would have quit me right there. I just feel like I did something wrong (even though in my head and heart I know I did not do anything wrong) I'm not sure what will happen in the future, maybe call me back for a urine test and med count (I have no problem with that - I would glady do this. I guess I'm just wondering how I can stop feeling like a failure or that he might've lost trust in me or think that I misused his trust. Has anyone ever have this happen to them or know what would make my urine test come up CLEAN!! thanks for any replies that might help me understand what happened.
Last edited by greenyelady; 11-08-2007 at 09:14 PM.
Reason: left something out
MAN, OH, MAN!! Your situation leaves me feeling terrible for you! I was so, so sad when my Pain Management doctor moved--BUT I'm so glad that my Internal Medicine physician decided to just go ahead and provide my pain medicine (since the PM clinics in our area have a tremendously poor reputation). I just couldn't handle what you've gone through (emotionally speaking). Because I, unfortunately, have an entire host of medical problems--she decided to just simply write my PM meds.
I mention this because I do NOT live under any conditions, contracts, etc. Just as you, I would gladly submit to pill counts, urine tests, and/or blood tests for her. HOWEVER, I just don't think I could deal with the emotional portions of these constraints. Look at your feelings! You feel awful and did absolutely NOTHING wrong.
So...my PM partner...I actually have a suggestion! I think you should have a heart to heart talk with this guy. I truly get the feeling that he would listen to you. Furthermore, you would feel much better--I'm positive. From other portions of your post, I really don't think he will do anything detrimental to you since he continued to Rx your meds. If he thought you were "up to something", I think you would have been 'shown the door' when this awful set of events occurred. Your physician might have simply been protecting himself in a legal manner by performing this urine exam and having you sign a permission slip. Plus, he may have just stated that you were using your medications correctly in your records. A while back, I used to do medical transcription--and there is no telling what the doctor actually placed in it!! My friend, don't worry. Again, give yourself a break. Let him know that you care when you have that CHAT during your next appointment!
Again, other people might have a different "take" on the matter, but I think you are safe. Just get this off of your chest. He may even gain more respect for your situation after you discuss this with him. Make sure you are compliant in the BIGGEST way for a while!! I know you are already, but simply be exceptionally careful in case he tests you!
This entire story you've told is disturbing, and I'm sorry you've gone through all of this trauma.
Hi Greeny, Trust me, You are not the first although there are more acurate test on the market now than there were 4 years ago for testing for oxycodone. The same thing happenned to several other posters who ended up being discharged and their stories were so concernigng I did a little research and found quite a bit of info about testing for oxycodone and the difficulty and complete imposibility for some of the comercial test available to detect ocycodone, some can't find it at all, some can find the portion that breaks down into dilaudid which has easier metabolites to test for "a positve diluadid screen meant your taking your oxy" and some tests are quite acurate at detecting the metabolite seen only in oxycdone and not the 20% that turns into dilaudid, but the dilaudid metabolite is much easier and cheaper to detect.
Basicalyy I found statements from the Canadian health ministry that discussed the inabilty to test acurately for oxy, an article from the US armed services comitee and the US army about which test could and which test couldn't detect oxy. I doubt all docs are aware of the testing process and exactly which commecial test from various manufacturers the lab they send the sample to uses. If he can't tell you the name of the test, "brand name by manufacturer" then likely he doesn't know.
If he's read the same articles and considers the half life, dose and when your last dose was, he may klnow of the problem and not how to resolve it. Basically 2 years ago, my doc changed labs to a true forensic lab that actually uses gas chromatography/mas spectrometry like you see on CSI and we had to sign waivers for finicial reponsabilty should our insurance not cover the entire cost. We basicaly went from a 30 dollar test to an 800 dollar test and had to agree to cover any uncovered portion. But this lab is spot on and knows which test are acurate , which aren't and which to use
With the testing procedures he uses know , he can comfortably discharge a patient with complete cerainty the test was acurrate, but there are still labs out there using cheaper less capable rapid commercial immuno essays they buy in bulk test kits that are known to have problems in detecting oxy acuratetely. If your doc was going to take that test as gospel, he would have acted upon it.
Just so everyone understands, when drug screens are done, they have to look for the metabolite fo each drug and each opiate has it's own detectable metabolite. It's not like there is one common thing they test for that any opiate will trigger. If they want to know if you use heroin, they have to specifically look for the heroin metabolite. If they want to know if your taking morphine, they have to loook for that metabolite, if and so on and so on. The cheaper the test, the fewer drugs it will detect and the fewer
metobolites are looked for. There is huge misconception that if your taking opiates, they get a positive result for all opiates. If this were true, than they wouldn't know the difference between oxycodone and heroin use.
Testing ability has improved, but at a significant cost. If you didn't have to sign an agreement specific to the test that you wil pay any uncovered portion, they aren't using the latest, most expensive and comprehensive technology.
Some docs know his and some don't Their specialty isn't drug testing, they trust an outside lab to use a quality test and expecting every lab to use the most capable test is like expecting every hamburger you ever ate to have been made from 100% sirloin beef. "best analogy I can think of at 5am."
Things seem to be OK or your post would have been very different, but in the furure, knowing testing is a posibilty, never dilute your urine with large amounts of fluids prior to a PM apointment where you may be tested and make sure your being seen before you run out. A second false negative may not be looked away from so easily.
I agree with Shore and Conductor. I would only add that at my job we have to drug test many people. We use a contract with a reliable company. I had a client who after a year of clean screens, tested positive for cocaine. I was so upset with this client, but they swore up and down they didn't use. After unsuccessfully trying to get them to admit the use, I asked that the sample be re-tested. Guess what?? It was negative. It was a lab error. There are so many things that can happen to the sample and/or test. If your PM doc is doing in the office tests, they are even LESS as reliable as a lab.
Bottom line, do not dilute your sample. Be very vigilant and on the up and up. Talk to your doctor.
Take a deep breath. You are going to be fine. Take care my friend!
Sadly, the same thing happened to me. After 15+ years with the same pain management doctor, and after being told on visit after visit that I was a "model" patient, I was given my first random drug screening. I was called on Wed. morning, picked up the paperwork that afternoon, and I took the test the very next morning. In fact, I was there when they unlocked the doors (nothing to fear, right?). Lo and behold, my doctor's office called the following week and told me that NONE of my rx'd meds had shown up but darvocet, which I have NEVER taken, did show up. I insisted there had to be a mistake - I was freaking out and thought my heart was going to bounce out of my chest. I asked to take a second test that very same afternoon and was told "no - there are second chances. I had a signed pain contract and I was in violation of it. End of story. I then made several phone calls attempting to make an appt. with this doctor to discuss the situation. He refused to see me. So I finally wrote a letter and told him what I wanted to tell him in a face-to-face office visit: I have no idea what happened.
It's a sad, painful saga and the emotional toll it takes is perhaps worse than the physical. Like you, what bothered me the most was that I had had a wonderful relationship with this doctor and he and his staff treated me like gold. When I thought about what this doctor must have thought of me, I ws sick. I imagine he thought he had been hoodwinked yet again. This was sooooo not true. I still have no idea how my test turned out as it did. None of you know me from adam, but I'm as honest as the day is long. I'm the idiot who always plays by the rules and colors within the lines. This isn't about me, so I won't go on except to say that my GP took over my pain management and aside from that HUGE relief, he went on to tell me that he didn't have much faith in urinalysis drug screenings.
Be thankful that your doctor has kept you on as a patient. But at the same time, it seems this is has been very troubling for you and for that reason, I would attempt to meet with him to speak about what happened. You have nothing to be ashamed of. Nothing. All the best to you.
If they don't find it in your system, they fear that you are "diverting" the drugs somehow. Many people are not in real pain, but get the drugs for others, to sell, for recreational use, ect. In these cases, there would often not be drugs in the patient's system because they have diverted them, and are not taking them for any legitament pain or health problem.
This is so scary. I don't get tested where I am at now, but where I was before (we moved to another state) we had a urine and blood test every month. They said they were doing a study on the blood levels and the meds, who knows, but I always got a copy of the tests and it was weird as I took my meds at the same time and the levels in my blood varied quite a bit. I guess I should be happy it showed up!
I want to thank everyone who responded to me. Just to clarify on my tea drinking Everybody and anyone who knows me or sees me alot knows I always have and had a pint of Schneiders tea - I always was like this - I drink it all day long (and I wonder why I don't sleep at night) I always have one when I visit my PM Doctor. But thats a whole other matter. I just really wanted to say I wasn't trying to dilute anything but I will talk with my PM Dr about that and how upset I was and also that I appreciated that he believed me I think I just had issues with it because I never would imagine that would ever happen. I do take my meds as prescribed ALWAYS. My PM Dr is a very kind and compasionate Dr. I feel bad that he is having these problems when he is the one who is helping us patients to be able to have a somewhat normal life - one without so much pain. I appreciate it and would never do something (on purpose) to misuse or lose the trust he has in me as a CP patient. I'm so sorry I seem to be just rambling on so I'll stop - once again I appreciate everyones response and I will take everyones suggestions thank you all I do feel a little bit better and I'm sure after I talk with Dr. I'll feel fine.
Sorry, I wanted to say the nurse had me use the restroom and leave sample on back of toliet- within 10 min they had results so a friend of mine (she's a nurse) said they must've used a dipstick (I think thats what she called it) She said the stick couldv'e been bad and she also said since I pee (sorry) a lot I couldv'e got it out of my system in the 26 hr period???not sure about that but I did want to throw that out there on the testing done so quick
Sorry Green!! I didn't mean to give the impression in my post that you diluted your sample on purpose! Not at all! I am like you with your tea, except mine is water. I have to keep in mind to not drink so much before my appts. so that my meds will show up....if they test me. I have been there nearly three years, and they only tested me one time. It came up positive for oxycodone (which is what I take), and that was after 48 hours no meds. (I had to stop the meds for a procedure, wonder why they did the test then)?? Anyway, if I had really loaded up with the fluids in those 48 hours, it may not have shown up.
Bottom line, I did not mean that you diluted on purpose.....just that your regular intake of fluids may dilute the sample, and you may want to not drink so much next time....due to what has happened.
I pray that this is the end of this nightmare for you! Try not to worry. Talk to your doctor when you see him next, and I think you will be reassured and feel much better.
Seriously...I am glad this was all explained. Until you guys explained what you meant by "diluting"--I had absolutely no idea what you were talking about!! I'm glad you all explained this to me.
Plus, Dave (Shoreline) gave us a huge education on these various types of tests. It's frightening to know that many people have been treated so poorly and so unfairly due to the varying qualities of these "drug" tests. Dave taught us a great deal of information! Thank you.
Actually, thanks to all of you for bringing these multiple subject matters to the attention of our Pain Management Community. We need to be keenly aware of these matters because of the way they directly affect us. People who are NOT involved in the management of Chronic Pain don't even remotely understand the importance of these things!
OK...I guess I got the irritation off of my chest!
Butterfly girl, I know you didn't mean I did it on purpose. I just wanted to get all my info out so that others wouldn't think that . Once again to all who answered me Thank You so much. I feel better just knowing if I have a problem there are people out there who I can share my thoughts with.