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  • Shoreline... Can you advise me here... plezzzzzzz

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    Old 03-29-2004, 07:45 PM   #1
    susiek
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    Shoreline... Can you advise me here... plezzzzzzz

    How long Does Oxy Stay ????

    I have been on oxycontin since they came out in 95/96. I take 240 mg per day (I know I know, they say that's a high dose). My dr. wanted to check my levels and when I went for the urine test, it came back negative.... Has anyone else had this problem.... How long do they stay in your system. I have started Weight watchers and am drinking a TON of water (never drank a drop before this, I know... I'm bad) but I do take my meds as directed... Any ideas.... He is looking for an excuse to switch me to avinza (I've posted this before ... I'm not one for change, still morning the loss of my previous boss and she didn't even die, just got a new job... LOL)....

    Just trying to figure this out! I know they don't work like before but could the levels be that low that they appear non existant????

     
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    Old 03-30-2004, 05:31 AM   #2
    Shoreline
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    Re: Shoreline... Can you advise me here... plezzzzzzz

    Hi Suzie, I've seen this happen before, It has to do with the type of test they run. Quantitative or qualitative. IN Qualatative test you must test above a certain number of parts per ML to test positive, Quantitative tels you exactly what the results where where qualitative is just a yes or no test and you need a ceratain level to test yes for this med and Flushing your system with water can dilute urine to the point of testing negative by the standards of the test, a certaine number of ng per ml must be present to call it positive, you likely had some in your system, but not the level that would normally appear if you have diluted things to a point of very few ng per ml of urine. I can find the right test to take and numbers to look for. Give me a few hours.
    ;0 Shore

     
    Old 03-30-2004, 09:50 AM   #3
    Shoreline
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    Re: Shoreline... Can you advise me here... plezzzzzzz

    OK, Suzie,
    First of all, Urine tests "immunoassays" do not test for oxycodone in any standard panel tests. Without a presumptive positive where 300ng per ml of urine is found a
    gas chromatographic-mass spectrometric (GC-MS) would not even be done, and this is the only way to acurately detect Oxycodone.
    Do you really think they ran your urine through a gas chromatographic-mass spectrometric machine for a simple drug test? LOL
    NO WAY was this done.

    This is what I have found.
    Here is the link to the entire article to take to your doc and show him that false negatives are a common problem for detection of oxycodone use which falsely acuses patients of diversion.

    This is probaly going to exceed 10,000 characters because I copied 3 different articles that pretty much all said the same thing. Your doc and the lab may not even be aware of the problems involved in proper Oxycodone testing.
    Or perhaps he's very aware of the problem and that's why he's not throwing you out of the practice, rather switchng you to a med that is easily found in
    Presumptive UA/immunoassays As long as morphine is found, which is why he's doing the test, There isn't a need for GC-MS to confirm opiates because that's what they want to find in the first place.

    Only when this test is done for exclusion of employment or termination of employment would a lab need to do the confirmation with GC-MS to prevent a law suit for wrongful terminination for not doing the confirmationwith GC-MS

    As long as you haven't diluted your urine beyond 300ng per ml of urine. "300 nanograms per ML" Which wouldn't be hard to do, People have been fooling UA's for years simply by flushing their system and guzzling water. IF the UA does show a drug then a GS-MS test needs to be preformed to confirm the presumptive UA. I would bet thousands of people have lost their jobs or been denied employment without confirming the presumptive test due to the cost of the GS-MS testing procedure.

    [url]http://www.iatdmct.org/oxycodone.html[/url]
    Summary:
    Most laboratories use commercially available immunoassays to screen for opiates in urine. They do not normally confirm presumptive positive screening tests. These immunoassays were designed to detect use of the opiates - heroin, codeine and morphine but not other opiates such as hydromorphone, hydrocodone and oxycodone, etc. Clinicians and other users of laboratory services are often unaware that opiate screening methods are unable to reliably detect oxycodone use/abuse. Because of the potent analgesic effects of oxycodone, this drug is often used in pain clinics.

    In 2001, medical directors of pain management centers in Canada were concerned about oxycodone diversion, i.e. selling on the street, by some of their patients. Because of these concerns, urine drug screens were ordered in several smaller centers. Since the test results might be "negative" for oxycodone screening., individual patients could be wrongfully identified as diverting their prescription drugs to others. To resolve these concerns, urine specimens must be analyzed specifically for oxycodone by GC/MS or another robust methods in order to obtain an accurate indication of oxycodone use by these patients. Further, clinical and forensic laboratories may be unaware that one cannot adequately screen for oxycodone use by commercially available opiate immunoassays. In areas where oxycodone abuse is known or suspected, laboratories providing blood and/or urine drug screening services should alert their users about the limitations of their ability to screen for oxycodone. Thus, the emergence of oxycodone as a popular drug of abuse highlights the importance of on-going communication between the laboratory and the end users. The laboratory should update the users on the advantages and limitations of blood or urine drug testing.
    Oxycodone can be extracted from biological fluids by either liquid/liquid extraction or more recently, solid phase extraction techniques. Solid phase extraction techniques utilize C18, C8, or copolymeric columns. For greater sensitivity and detection, enzymatic hydrolysis with beta-glucuronidase can be used to increase the recovery of oxycodone from biological fluids.

    Methods used for the detection of 6-keto-opioids, such as oxycodone, include commercial immunoassays, thin-layer chromatography (TLC), liquid chromatography (LC), automated liquid chromatography (REMEDi), liquid chromatography-mass spectrometry (LC/MS), gas chromatography (GC), and gas chromatography-mass spectrometry (GC/MS). Despite the numerous techniques, only gas or liquid chromatography coupled with mass spectrometry is the acceptable confirmation technique for quantification of opiates - morphine and codeine ( Note - oxycodone is not currently included as one of the SAMHSA analytes ) in urine according to the Department of Health and Human Services (DHHS) guidelines for drug testing of federal employees (12).

    In general, immunoassays are not well suited for the detection of 6-keto-opioids, such as oxycodone, due to the low antibody cross-reactivity of the commercial opiate kits. Cone et al. showed that each of the 6-keto-opioid compounds had concentration-dependent cross-reactivities in commercial opiate immunoassays, and each had the potential to produce positive urine screening results (13). Furthermore, Smith et al. compared several commercial immunoassays to GC-MS and demonstrated that oxycodone present in urine was detected by TDx® opiates (TDx; Abbott Laboratories) and the EMIT® d.a.u. opiate assay (EMIT; Syva) for 6-24 hrs. However, the quantitative responses from these assays expressed as ng/ml of morphine equivalents were substantially lower than GC/MS determinations (8). As a result, immunoassays are not well suited for monitoring the therapeutic use, compliance, or abuse of oxycodone. Therefore, it might be advisable to confirm any immunoassay screening tests with increased urine opiate concentrations by using a suitable chromatographic method.

    Toxi-Lab ATM thin-layer chromatography (TLC) drug detection system can also be used for the detection of oxycodone in urine specimens. However, therapeutic dosages of oxycodone might be below the detection limit of this system at 1.0 mg/L in 5ml aliquots. However, Gobar et al. demonstrated that oxycodone in urine samples of pain management patients was detected by TLC and then confirmed by GC/MS with cutoff limits of 300 ng/ml for both assays (15). Furthermore, the sensitivity and specificity for both assays were 72.7 and 84.2%, respectively.

    Oxycodone can also be detected and/or quantitated in biological fluids by gas chromatography with FID or NPD detection. Confirmation by GC/MS in the full scan mode shows principle peaks at m/z 315, 230, 70, 258, and 140. GC/MS utilizing selective ion monitoring (SIM) of principle ions will increase assay sensitivity so that detection limits of 10 ng/ml can be achieved. At these detection limits, therapeutic use, compliance, and oxycodone abuse can be monitored.

    In GC/MS, the choice of derivatization agents is one of the most important factors in the accuracy and precision of the method. Many derivatizing agents can be used including acetic anhydride (16), bis-trimethylsilytrifluoroacetamide/trimethylsilyl (BSTFA/1% TMS) (17), heptafluorobutyric anhydride (HFBA) (17), pentafluoropropionic anhydride (PFPA) (17), and MBTFA (18). Problems encountered with some GC/MS methods include instability of derivatives, poor chromatography, unsuitable ions and abundances, incomplete derivatization, derivatization side reactions, inadequate recovery, loss during hydrolysis, extended run times, and interference or coelution of other opiates (19).

    Recently, an improved GC/MS method for the simultaneous identification and quantification of opiates in urine was reported (20). In this method, methoxyamine was used after enzymatic hydrolysis to form methoxime derivatives of the keto-opiates, which were extracted using solid-phase columns and derivatized with propionic anhydride/pyridine. This method demonstrated acceptable precision, the lack of cross-interference from other opioids, short analysis time of about 6.5 min, and a small sample volume of 2.0 ml urine.

    Finally, LC/MS has been used to determine the concentration of oxycodone in plasma (21). This method was selective and rapid with a analysis time of 2 min. A small sample volume of 1 ml plasma was alkalinized and extracted with 2% isoamyl alcohol in n-butyl chloride. After evaporation and reconstitution in 15% methanol-85% water containing 0.1% acetic acid, the sample was analyzed by LC/MS. The limit of quantification was 1 ng/mL., and the limit of detection, 33 pg/ml. In addition, this method was linear from 1 to 100 ng/mL. In comparison, an automated LC - REMEDi is capable of screening with a sensitivity of 150 ng/mL. However, the major problem is that oxycodone is eliminated quickly from the blood as a result of its short half-life.

    Overall, the analysis and quantification of oxycodone is increasingly important as its use and abuse becomes more widespread. In addition, pharmacogenetic typing of individuals taking oxycodone may be recommended, because oxycodone is metabolized to oxymorphone by cytochrome (CYP) 450 2D6. This enzyme is polymorphic with a prevalence of three mutations *3, *4, and *5 in about 10% of the general population (22). In fact, 95% of individuals classified as poor drug metabolizers have one or more of these mutations. They are more likely to experience severe toxicity or therapeutic failure. Thus, pharmacogenomics, in the near future, might become an integral part of pain management to individualize oxycodone and other drug therapy with minimized adverse reactions.

    References
    1. Baselt, R.C., Disposition of Toxic Drugs and Chemicals in Man, Fifth Edition, Chemical Toxicology Institute, Foster City, CA, 2000, pp. 644-645.


    Continued on next post, Shore

    Last edited by Shoreline; 03-30-2004 at 09:58 AM.

     
    Old 03-30-2004, 10:15 AM   #4
    Shoreline
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    Re: Shoreline... Can you advise me here... plezzzzzzz

    Here is some more basic drug testing info.
    But I know they did not do a GC-MS test on your urine, If they did, ask to see the results. Take him a copy of tha first article and expalin you understand OxyCodone is inherently difficult to accurately test for and you understand Morphine is much simpler to confirm and thus easier for him to cover his ars by doing a simple UA designed to detect Morphine.

    Laboratory Methods
    Laboratory detection of morphine and codeine is performed by immunoassay. Confirmation is by gas chromatography/mass spectrometry (GC/MS).

    Cutoff and Detection Post Dose
    The detection limit of the initial screen is 300 ng/ml, with a sensitivity of 20 ng/ml. This is sufficient to detect heroin use for approximately 24-48 hours post dose and codeine for somewhat longer. Positives are confirmed on GC/MS at a cutoff level of 300 ng/ml.

    OXYCODONE
    Classification: Opiate-narcotic analgesic

    Background: The milky residue collected from the opium poppy plant (opium) is the natural material from which opiate compounds are extracted or synthesized. Oxycodone is a semi-synthetic opiates derived from opium. Oxycodone, like other opiates is characterized by its analgesic properties, and the tendency for users to form a physical dependency and develop tolerance with extended use. It is a commonly prescribed analgesic taken orally, frequently in combination with acetaminophen or aspirin. OxyContin, the time-release form of oxycodone, is supplied in 80 mg doses and is often called “hillbilly heroin”. When the pills are crushed, the contents can be snorted or dissolved in water and injected. Its use as a “Club Drug” is reported as on the increase.

    Street Names: Oxy; OC; hillbilly heroin

    Detection in Urine: 1-3 days

    Physiological Effects: Analgesia (pain relief), respiratory depression, constipation. Long time use leads to dependence and tolerance so that a dramatic increase in dose is necessary for the same analgesic effect. Tolerance begins after the initial dose but is usually significant only after the second week of chronic use. A 35 fold increase in dose may be necessary for the same effect. Withdrawal symptoms may begin 6-8 hours after the last dose and reach a peak at 36–72 hours.

    Toxicity: Respiratory depression/failure is the greatest risk associated with opiate abuse aside from the risk of infection associated with illicit intravenous drug use.

    Psychological Effects: Sedation, euphoria, mental clouding

    Cutoff Levels: ImmunoAssay screen test: 500 ng/mL
    GCMS confirmation test:
    300 ng/mL


    Office of the Armed Forces Medical Examiner, Armed Forces Institute of Pathology, Washington, DC 20306-6000.

    Opiate testing for morphine and codeine is performed routinely in forensic urine drug-testing laboratories in an effort to identify illicit opiate abusers. In addition to heroin, the 6-keto-opioids, including hydromorphone, hydrocodone, oxymorphone, and oxycodone, have high abuse liability and are self-administered by opiate abusers, but only limited information is available on detection of these compounds by current immunoassay and gas chromatographic-mass spectrometric (GC-MS) methods. In this study, single doses of hydromorphone, hydrocodone, oxymorphone, and oxycodone were administered to human subjects, and urine samples were collected before and periodically after dosing. Opiate levels were determined in a quantitative mode with four commercial immunoassays, TDx opiates (TDx), Abuscreen radioimmunoassay (ABUS), Coat-A-Count morphine in urine (CAC), and EMIT d.a.u. opiate assay (EMIT), and by GC-MS. GC-MS assay results indicated that hydromorphone, hydrocodone, oxymorphone, and oxycodone administration resulted in rapid excretion of parent drug and O-demethylated metabolites in urine. Peak concentrations occurred within 8 h after drug administration and declined below 300 ng/mL within 24-48 h. Immunoassay testing indicated that hydromorphone, hydrocodone, and oxycodone, but not oxymorphone, were detectable in urine by TDx and EMIT (300-ng/mL cutoff) for 6-24 h. ABUS detected only hydrocodone, and CAC failed to detect any of the four 6-keto-opioid analgesics. Generally, immunoassays for opiates in urine displayed substantially lower sensitivities for 6-keto-opioids compared with GC-MS. Consequently, urine samples containing low to moderate concentrations of hydromorphone, hydrocodone, oxymorphone, and oxycodone will likely go undetected when tested by conventional immunoassays.
    You have done nothing wrong suzie, They didn't run the right tests and there is no way your insurance would pay for GC-MS and you would get a bill for several thousand dollars for having this test done.

    Explain you understand why he would want you to switch to a drug thats easier to detect but it's a shame to give up a med that's effective just because we presently don't have an easy and inexpensive way to detect OxyCodone in Urine.

    Good luck, Shore
    PS let us know how it turns out.

    Last edited by Shoreline; 03-30-2004 at 10:19 AM.

     
    Old 03-30-2004, 08:30 PM   #5
    susiek
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    Re: Shoreline... Can you advise me here... plezzzzzzz

    Ya know Shore... I just want you to know that though I have never met you, know if your male/female or your age, that I love you.... I truly love you. Sometimes, I just read others ups/downs rather than write mine (walk a mile ... ya know that saying) but through and through, you always go above and beyond to help each of us and I just want you to know that I think you are an extronardinary person.... God Bless you.... as he has us for having you in our lives....

    Thanks~

     
    Old 03-30-2004, 08:40 PM   #6
    wastefulltick
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    Re: Shoreline... Can you advise me here... plezzzzzzz

    i agree with all due respect shore you are always so helpful to everyone on this board and you devote so much time and energy to getting and giving information to us you are always there to support everyone with kind words of wisdom kudos to you and may you be richly rewarded
    bob
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    chronic pain sufferer from pinched nerve in c67,disc protusions in c2,c3,c4 osteophytes in c3,c4

    Last edited by wastefulltick; 03-30-2004 at 08:42 PM.

     
    Old 03-31-2004, 07:43 AM   #7
    Kayley
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    Re: Shoreline... Can you advise me here... plezzzzzzz

    I totally agreee! I've learned so much vital information from you, Shorline. Info that I would not have known otherwise. Thank you!!!
    Kayley

     
    Old 03-31-2004, 09:55 AM   #8
    surgicaldisaster
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    Thumbs up Re: Shoreline... Can you advise me here... plezzzzzzz

    I totally agree with everyone...you are a God send to us all....thank you for all you do for each and everyone of us .You are an Love, Surgical Disaster

     
    Old 04-01-2004, 12:43 AM   #9
    chriztene
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    Re: Shoreline... Can you advise me here... plezzzzzzz

    Quote:
    Originally Posted by susiek
    Ya know Shore... I just want you to know that though I have never met you, know if your male/female or your age, that I love you.... I truly love you. Sometimes, I just read others ups/downs rather than write mine (walk a mile ... ya know that saying) but through and through, you always go above and beyond to help each of us and I just want you to know that I think you are an extronardinary person.... God Bless you.... as he has us for having you in our lives....

    Thanks~
    Wow, the article Shore posted doesn't apply to me but was an informative read. I am amazed at Shoreline's writing capabilities and the time it must take to post some of his/her messages.

    I have learned so much valuable information since joining this forum. Chronic Pain is a life altering experience and it is so wonderful to be able to come here for support/information. Especially, nice when someone is knowledgeable and is quick to help.

    Thank You

     
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