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Old 11-03-2008, 05:34 PM   #1
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MS contin ER showing up on drug screen as Dilaudid

This is very important for those of you taking morphine sulfate extended release.

My dad suffers from chronic pain due to a spinal cord injury. A few months ago, his doctor told him that he would no longer prescribe his meds (morphine sulfate er, and ms ir for bt meds), and sent him to a pain doctor that also specializes in addiction. My dad went in for his first monthly appointment and was given a drug test. Now, my dad is paralyzed from the waist down, and cannot get out of bed by himself. He lives in a very small town and only gets up for a few hours per week. He would have no way of getting street drugs. It just wouldn't be possible. The doctor called him about a week after the drug test and told him that he tested positive for Dilaudid, and would be immediately placed in detox. My dad has a lot of serious health conditions and would have to probably do detox in the intensive care unit of the local hospital. Detox would be an incredible stress on his health. The doctor that did the drug test grilled my dad's wife, and accused her of giving my dad dilaudid to keep him sedated. He told my dad that he (my dad) was a drug addict. My dad was very distraught and incredibly worried that his pain would go untreated. My dad asked that the original urine sample be retested. The doctor told him he would, but that nothing mattered to him expect the piece of paper he had in front of him that said my dad tested positive for dilaudid. He said no amount of retesting would ever convince him otherwise.

About a week after the original confrontation, the doctor called back and said he had spoken with the lab and they determined that morphine sulfate extended release can sometimes show up as dilaudid (hydromorphone?) in a drug screen, and apologized. How could a pain doctor and addiction specialist not know this?! This has made me very worried, because I also take morphine sulfate ER. If you take this medication and have to submit to a drug test, make sure you talk with your doctor about this. I don't know if this has ever happened to anyone else, but it just speaks to how even pain doctors can be uninformed about these things.

 
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Old 11-03-2008, 07:41 PM   #2
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Re: MS contin ER showing up on drug screen as Dilaudid

Thank you for posting this very valuable piece of information. Honestly, this stuff is incredibly scary...To think that someone would be kicked out of PM due to a mistake by the lab. We have two lab stories back-to-back this week....There is another thread about a false negative....Very scary!

Regards,

Ex

 
Old 11-04-2008, 06:41 AM   #3
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Re: MS contin ER showing up on drug screen as Dilaudid

I have been in PM for 5 months and haven't had to do a random UA yet but my Dr did say she does them randomly. Now I am scared that I will have an issue with mine and I have NEVER strayed from my medications at all. I want to ask questions about thresholds, false negatives etc but am also scared that it will look suspicous to "know so much". Boy.... we CP'rs have a lot more to worry about even when we DO follow the rules....

 
Old 11-04-2008, 06:24 PM   #4
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Re: MS contin ER showing up on drug screen as Dilaudid

The key with drug testing is protocol. The most important protocol aspects I think are:

(1) Sophisticated testing. If a Doc uses a "dip stick" test and something comes back unconventional, the sample should be tested using a more sophisticated method. Dip stick is a cheap, easy way to test, but isn't as reliable as a regular UA. Patients should not be judged solely on a dip stick. The sample should then be analyzed more sophisticatedly.

(2) Test with zero threshold. If testing with a threshold and test is negative, re-test with zero threshold. This eliminates false negatives, or the reason most patients are wrongly dismissed.

(3) Before dismissing a patient, the Doc should call the patient in to get their side of the story. Too many Docs dismiss without speaking to the patient. All accused should have an opportunity to defend themselves.

(4) It's critical that patients give very accurate information as to when they last took their meds. This input data variable is key to determining if a patient may have metabolized their meds quickly. Some Docs don't acquire this information. For example, this is important when there is a significant spread between testing and med schedule. For example, a patient last took their meds at night, but is tested late in the day. This should be factored into to the results. Additionally, patients who regularly take narcotics can often metabolize them very quickly...And if you factor in thresholds, it can compound the problem.

Hope this info helps.

Regards,

Ex

 
Old 11-05-2008, 03:52 PM   #5
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Re: MS contin ER showing up on drug screen as Dilaudid

the pain dr should know this; time to change drs again....i had a broken neck, and severed spinal cord....initial paralysis, but my movement has come back, but left me with constant excruciating pain....i have taken everything in the book, and am now on methadone and, morphine sulfate for breakthrough

 
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