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Old 08-24-2009, 12:16 PM   #1
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Possible Urine Neg for prescription will I be dismissed?

I have been in pain management for several years. I have a pain contract. I have had urine tests and never had an issue. I take meds as directed.

Over the past week, I have been sick with some sort of stomach bug, vomiting, diarrhea etc. More than once, vomited my meds...amongst other things.

Friday, I had my normal 3 month appt at pain management and had to give a urine sample. I am concerned that when they test me for my meds, not enough if any will be detected due to the vomiting. Should I be worried?

Also...I left with my normal 3 scripts for the next three months. IF my doctor decides to dismiss me - which i would have a real issue with - how would I know? Do they call? Do I get a letter? Am I allowed to talk it over and explain myself? and do most pm docs boot you the first time, or do they just monitor you more closely? Bearing in mind I have never given them a problem, ever.

Sorry for all the questions. Thanks for any and all help.

 
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Old 08-24-2009, 01:06 PM   #2
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Re: Possible Urine Neg for prescription will I be dismissed?

Unless you have vomited all your meds up, every time you have taken them, for a few days before your Dr's appt then i wouldn't worry. Did you tell this to your Dr.?

 
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Old 08-24-2009, 01:29 PM   #3
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Re: Possible Urine Neg for prescription will I be dismissed?

Hi,

Yes, I told doctor and nurse about it. Nurse gave me the hairy eyeball. Gotta love it.
I did vomit most of my meds unfortunately. Do you happen to know when/how long it takes to get results if there is an issue? I've been doing this for years (going to pain management - not vomiting, haha) and never had a problem with my urine tests or anything of the sort. good relationship with doc...though nurses leave something to be desired.

I also have anxiety issues, though I manage those w/o the help of meds, but the thought of being dropped by my pm doc is causing some unpleasant anxiety, which is why I was wondering how and when drs normally contact a patient if there is an issue and/or they wish to cease treatment.

Thanks again

 
Old 08-24-2009, 10:44 PM   #4
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Re: Possible Urine Neg for prescription will I be dismissed?

So, if I read this right, you're worried about the meds not showing up at all? Unless you vomited within 5-10 minutes of your dose, a good portion of it was absorbed.....Enough to show up in a tox screen at least. Also, I doubt that you vomited up every dose, did you? The window of detection is 24-48 hours, meaning that anything you took in regards to your script, would show up for 24-48 hours.

Also, if you did in fact vomit right after you took your meds, then I suspect you went through some type of withdrawal. If not, then your meds were absorbed, at least partially anyway.

Protocol for UAs are for the nurse to ask the patient the last time the patient took their meds. This is so they can match the results of the tox screen. It's very important for the patient to be as accurate as possible because some meds aren't detectable for more than 36-48 hours, so if it has been a while since one took their meds, they need to factor that in. This Q&A would have been a good time to tell the nurse about your vomiting. You should have also told your Doc when you saw him.

You probably got the "hairy eyeball" look because the Docs and nurses have heard every excuse in the book. I'm not saying that your case was an excuse, I'm just saying that the staff have probably gotten to be skeptical with a good number of patients for the obvious reason(s).

Each Doc office is different in regards to how they notify patients. Some do it by registered mail, while others call the patient in for some type of consultation. Protocol is for a consultation so that the patient has an opportunity to respond. UAs aren't 100% accurate, thus, hearing from the patient is important before dismissal. However, some Docs don't want to face the patient, so they send a registered letter dismissing them and then ban them from making any appointment.

The good news is that you must be a trusted patient for your Doc to give you three months worth of meds via post dated scripts. Thus, chances are he won't dismiss you without some type of meeting. It could happen at your next appointment....Where he asks you about the UA....But I doubt it. Again, protocol is for a consultation and then a weening script.

If your UA is suspect, he might put you on some type of probation, or watch you more closely. They are other monitoring things they can do if they feel it's necessary.

Best of luck to you. I'm sure you are anxious. Chances are that at least some of your med was absorbed, so I wouldn't worry too much. If you haven't heard anything within a couple of weeks, then it's probably a pretty good sign.

Regards,

Ex

 
Old 08-25-2009, 10:33 AM   #5
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Re: Possible Urine Neg for prescription will I be dismissed?

Thanks so much for your informative reply.

Yes, I told the doc that I was sick for the few days leading up to my appointment. Actually, because I am normally a rather boisterous person, and love making people laugh, my doc included, and was rather quiet and 'green' he actually asked me if I was ok b/c I wasn't my normal self.

Come to think of it, I guess I may have been going through some slight withdrawals - I hadn't thought of that...I thought I was having allergies - but I had a runny nose and was sneezing a bit. They weren't full-blown WD's. I went through that when i first moved here from out of state, before I had a job and insurance to pay for a doctor. THAT was horrific.

I appreciate the help from everyone. UGH...a couple of weeks! I think I may have heart failure by then.. [smile].

Either way, i have no control over what is going to happen, so I'm going to just do what I gotta do each day and wait and see.

Thanks bunches again.

 
Old 08-25-2009, 11:24 AM   #6
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Re: Possible Urine Neg for prescription will I be dismissed?

I will say this.....Of the two possible scenarios for "failing" a UA, it's a lot easier (and plausible) to explain why something is "not" there vs why something is there that's not supposed to be.

I don't mean to scare you even more, but all UAs have what they call "thresholds"....Meaning that your drug level has to be above a certain limit in order to test positive. This is because the same UAs are used for PM as they do pre-employment & etc....They don't want to falsely accuse someone...i.e. second hand smoke, poppy seeds on a bun, and etc.

Thus, if your med amt falls below the threshold, you may test "negative" even though it's actually in your system. This is especially true for those who have fast metabolisms. The window of detection isn't nearly as wide as many think it is....So, combining a fast metabolism with a situation where a med was taken 24-36 hours prior, it's not unusual for a "negative" result.

I still think you'll be fine, unless of course you immediately threw up your meds. And if not, you've probably covered yourself by mentioning all this to your Doc. Like I said previously, this is a much better situation than the alternative. And given that you were sick, there is some doubt there as to the validity of the test. If you've not had any other issues with them, then I suspect they will let it slide, but maybe watch you closely. It's a very good sign that they let you have three months worth of scripts at a time.

Best of luck to you with this.

Ex

 
Old 08-26-2009, 08:40 AM   #7
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Re: Possible Urine Neg for prescription will I be dismissed?

Most doctors drug tests do not detect for "amount" of a drug in your system.

It just detects "if the drug is present" and like Ex said even though you did vomit I'm sure a portion of the pill was absorbed into your blood stream.

You can throw up whats in your stomach but not whats in your blood. (Which will result in you urine likely showing the same)

So as long as the drug is present in your blood stream/urine that is all they check for. If they tell you they check the amount of the drug, they are probably just trying to scare you to make sure you don't do any funny business with there meds.

I've been to two PM clinics and all the drug test check is for the presence of the narcotic you are taking such as Oxy or Morphine, I have never seen or heard of a test that they check the amount of the drug versus your dosage. I think that would be too much, it would require likely taking a blood test and sending it to an outside lab.

You are probably just peeing in a cup and then the docs office has this thing they dip in your urine or it is actually on the cup itself and it will tell you which drugs are in your system, such as opaites or even illegal drugs such as Marijuana or Cocaine.

Why does anyone here have there docs office actually check the amount of a drug found in there urine or by blood test or is it just for the presence of that opiate?

Last edited by Leo123; 08-26-2009 at 08:44 AM. Reason: Clarity

 
Old 08-26-2009, 09:02 AM   #8
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Re: Possible Urine Neg for prescription will I be dismissed?

I believe they send the urine out. and that levels actually are tested as compared to your prescribed dosage.

They use Ameritox RxGuardian

Last edited by moderator2; 08-26-2009 at 11:09 AM. Reason: posted disallowed website(s) - please read the posting rules

 
Old 08-26-2009, 09:53 AM   #9
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Re: Possible Urine Neg for prescription will I be dismissed?

quote:njfibromom Re: Possible Urine Neg for prescription will I be dismissed?

--------------------------------------------------------------------------------
I believe they send the urine out. and that levels actually are tested as compared to your prescribed dosage.
________________________________________ __________________

Interesting: have they actually ever shared the results with you and showed the actual levels. Because I'm not aware of any docs office that does this, probably on account of the test being exepensive. Do you have to pay for the test out pocket or is there an additional special charge for this test?
(if you don't mind my asking)

Thanks

Last edited by Leo123; 08-26-2009 at 09:53 AM.

 
Old 08-26-2009, 11:55 AM   #10
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Re: Possible Urine Neg for prescription will I be dismissed?

To be quite honest, i can't remember. The last test I had was one year ago. I had different insurance. My form here says they bill insurance company and patient is responsible for any copays, deductible or non-covered services as dictated by patient's insurance company.

Not sure how they work, rumor has it that they do a qualitative (yes/no) test and then send out for quantitative (to measure actual levels) regardless - I don't see the logic, if you're going to send out for the big test, why not just do that to begin with - but I digress...

The girl who took my sample told me she was from ameritox, so i guess maybe they have reps/techs in office who do the dip tests and then they send them out? All i know is I have a carbon copy of the test request form. It has the types of meds I take, frequency, last dose and doesn't say what type of test, just a box checked "Run Panel as Specified By Physician".

Hoping all is ok. Just read some disturbing threads about this company and mixing up lab work. I'm such a lucky duck lately...[sigh]

 
Old 08-26-2009, 07:54 PM   #11
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Re: Possible Urine Neg for prescription will I be dismissed?

Most labs do send back the amount of med in your system, or the official result. After all, the test is measured in ng/l....As I mentioned in my last post, the med has to register a certain level for it to be a "positive."

Conversely, the "cheap" tests, or dip stick, simply measure the presence of the drug...A "yes" or "no." These tests can be inaccurate, but again, are inexpensive and can be done quickly in a Doc's office. The simply dip the stick into the urine.

The standard tests are sent out to a lab for analysis. However, I wouldn't get too worried about the actual level. There are lots of variables involved and practically impossible to tie the Rx amt to the test result. First, metabolism is a big factor. Some are fast, some are slow, and some are what they call "super metabolizers." These are the patients labs worry about because their metabolisms are so fast that a test can show negative, simply because it's moved through their system quickly.

Secondly, when one last took the med is a factor. For example, if one's appointment is at 2pm and the last dose was 8am, one will have a relatively high level. However, if the last dose was before bed, then the amt in their system will be much lower. If the last dose was the morning before, it may not show up at all. Factor in everyone's metabolism being different, and the two together are a huge variable.

Lastly, other meds one takes, as well as one's diet can effect the test level. Someone who urinates a lot, or drinks a lot of water, can dilute the result more so than normal. Also, a diet high in fat will increase one's level (more potent).

In summary, there are many interacting variables involved and trying to pinpoint test results back to an Rx is very difficult. As Leo said, Docs are merely looking for the presence of the med. I guess an outlier, or something very unusual, would maybe garner some concern, but again, I'm not sure there's much scientific certainty behind such, unless some criteria were in a controlled like setting.

The moral of the story is that it's critical to be as accurate as possible in answering the nurses questions about when one last took their meds. The reason for these questions is so they can try to establish a link to the test result, and even possibly explain undesirable results. For example, if one tests "negative" for the presence of their BT med, but they reported that the last time they took it was 36 hours earlier, then there's a reason why it's negative. However, if one said they took it 8 hours prior, and it's negative, then there is a problem. Testing protocol calls for these questions and they don't normally permit one to change their answers after the fact.

Hope this information helps.

Regards,

Ex

 
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Old 08-27-2009, 11:13 AM   #12
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Re: Possible Urine Neg for prescription will I be dismissed?

Ex,

Your reasoning below is 100% as to "that even if you have the numbers of the actual amount of med in your system, there is no way to really tie it in to your dosage, ON account of all the things you mentioned such as a persons varying metabolism, when your last dose was, what you ate that day, etc..etc..etc..

WHich is why the PM docs I've been to usually only check for presence of the opiate? And I think most PM offices do the same.

Why does your check the actual amount in your system and have they actualy given or shown you the results? (Just curious if you don't mind my asking) Oh and do you have to pay for this test and how often do they do it?>

 
Old 08-27-2009, 02:00 PM   #13
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Re: Possible Urine Neg for prescription will I be dismissed?

Quote:
Originally Posted by Leo123 View Post

Why does your check the actual amount in your system and have they actualy given or shown you the results? (Just curious if you don't mind my asking) Oh and do you have to pay for this test and how often do they do it?>
I've seen my test result because I've asked to see it. The lab has the cut off range right next to whatever your test result is. I've also read this many places as I've been in PM for over 12 years and have done a pile of research on a variety of topics. I think the Docs who use the "dip stick" tests are trying to save their patients money. These tests are in the $15 range and can be done right in the office. Conversely, a full lab work up is hundreds of dollars. It's covered by insurance, however. I would imagine that Docs who choose this method don't want to fool with dip stick testing and feel better about a lab's accuracy overall.

As far as "paying" for test, one's particular level is just part of it...You really don't pay extra for it if that's what you're asking. I've heard some really interesting stories here on HB about some companies who charge upwards of a $1K, and provide all sorts of data back to the Doc. But again, I would argue that it's unreliable for the reasons I listed as well as unnecessary.


Most PM Docs test random....Protocol calls for at least once a year. Some do it more often. At my clinic, I've heard stories where it's been more than a year, and eventually a Doc, nurse or someone will notice and then order a test...Essentially override the system. At my clinic, the computer randomly picks who gets tested. When I've been tested, the pee cup is waiting for me when I go into the individual exam room! If you can't produce a sample, you must go to the hospital and have blood drawn. If you don't report within 45 minutes, it's considered a failed test.

Hope this helps.

Ex

 
Old 08-27-2009, 04:55 PM   #14
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Re: Possible Urine Neg for prescription will I be dismissed?

Quote:
Originally Posted by Executor View Post
Most PM Docs test random....Protocol calls for at least once a year. Some do it more often. At my clinic, I've heard stories where it's been more than a year, and eventually a Doc, nurse or someone will notice and then order a test...Essentially override the system. At my clinic, the computer randomly picks who gets tested. When I've been tested, the pee cup is waiting for me when I go into the individual exam room! If you can't produce a sample, you must go to the hospital and have blood drawn. If you don't report within 45 minutes, it's considered a failed test.

Wow, that is some strict rules my PM clinic is nothing near that level of strictness. Actually beleive it or not I;ve asked the Dr. what does he do if someone fails a test or comes back positive for an illegal drug and actually he says he'll talk to the patient find out what is going and be understanding in some cases and not just kick somebody of there needed meds. I know some offices if you fail you don't even get a chance to explain yourself it out the door and see you later and personally I think that attitude should be illegal, what happened to doctors taking an oath to do what best for the patient, what kind of attitude is that to just kick someone out without even discussing it with them.

So Ex, at your PM office if you fail the test I take it it's syonara see you later?

 
Old 08-27-2009, 07:43 PM   #15
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Re: Possible Urine Neg for prescription will I be dismissed?

Quote:
Originally Posted by Leo123 View Post

So Ex, at your PM office if you fail the test I take it it's syonara see you later?
Yes....If a patient "fails" the UA, then they are sent a certified letter dismissing them immediately, and they cancel any pending appointments they may have. The letter does say that a "wean" script is available to titrate them down. They also block the person on the computer from making any future appointments. I've personally seen small stacks of certified letters waiting to go out....Sitting on the receptionists desk or whatever. The secretary told me once that they dismiss at least a couple of people every week.

If the UA shows up any street drugs or "illegals", they turn your name over to the DEA. They don't mess around, that's for sure.

While some may disagree, I have to say that I support their strictness, because it ensures that they will stay in business and that my care is not threatened. I hear too many stories where patients show up for their appointments and a sign is on the door stating the office has been closed.

The unfortunate fact of the matter is that when someone fraudulent penetrates a successful PM practice, they can threaten the care of everyone. For example, if a person gets caught selling their meds, or ODs and dies, a Doc's office can be shut down overnight. And of course, the larger a PM practice is, the more likely something like this can happen. Thus, I think large practices have to be more strict than smaller practices or GPs....Where they don't treat that many people.

It's the world we live in today....Because Docs are held accountable for the actions of frauds and cheats, they must have a zero tolerance policy. These policies are also supported by the DEA, which in turn, maintains a good working relationship with the Doc. As the cliche goes, "a few bad apples spoil the bunch."

Regards,

Ex

 
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