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Random Drug Urine Test and Norco Metabolites timelines?

I have been on a pain management contract for three years with my PCP for 10mg of Norco to be taken 3x per day. I was given a random urine test on Thursday April 2nd at 2pm. I told my doctor that I took my last dose of 5mg Norco on Monday March 30th at 7am. The truth, which I should have told him, was that I ran out earlier than that by a few days.

The urine test was done at Lab Corp which I believe the method most likely used was the 12 drug panel followed up with confirmation by way of the GC-MS (Gas Chromatography Mass Spectrometry). My understanding is that this test will show the Norco metabolites Norhydrocodone and Hydromorphone.

Based on the timelines above that I told my doctor of my last Norco use, that would be 80 hours since I took my last dose of Norco of 5mg prior to the test.  Would he expect to see the Norco metabolites on my test results? And if he will, are there any factors that play in my favor that he may consider for the negative test if no Norco metabolites are shown in my urine?

I am very concerned about this, mostly due to the fact that I have a very good relationship with the doctor. I don’t want to lose his trust.

I am also having two surgeries done as soon as hospitals in my area allow them.  Due to the Coronavirus only life threatening emergency surgeries are being allowed. I don’t want to lose my pain management agreement prior to these surgeries taking place.

Two side notes, I have already discussed with my doctor that I would like to go on Suboxone but he wanted to wait until after my surgeries are completed and I am recovered. I got the sense he is not keen on Suboxone. Secondly, I don’t know if this matters but in the three years I have been on the pain management contract I have not failed a drug test.

I’m sorry for the long post. This is keeping me awake with worry. Thank you in advance for any help with my question.
2 Responses
20803600 tn?1546262537
COMMUNITY LEADER
Shebee,
Unfortunately, it is very likely there will be a failed test result. And the gs/ms metabolites testing will also show no metabolites .
The in office screenings typically show positive/negative. The urine is then sent out for confirmatory and actual level testing using either go/ms or immunoassay testing. These tests show exactly how much of the drug you are taking/have been taking over time. They reveal if the patient is taking too much or too little.
Since you told the doctor you took half your dosage on Monday but ran out days earlier, odds are not favorable for even trace metabolites to be present. Telling the doctor you took half a dose on Monday, then having negatives results is going to set off many alarms I’m afraid. Trying to create a cover story/explanation NOW is  only going to make a bad situation worse.
You had to have been taking more than prescribed more often than you may want to admit, but running out of meds is a no no in pain management, period. Your running out 5+ days early is a huge red flag.
Maybe this is a time to reassess your ongoing need for pain medication honestly, and find other means of managing pain aside from relying solely on opiates.
Not trying to be harsh, but being honest with the situation you are in, and your non compliance can open the door to addiction, and I hope you don’t go down that road.
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1 Comments
Thank you for answering my question. I suspected that no metabolites would be found and you thoughtfully confirmed my concerns.
I have several chronic pain issues (cervical and thoracic spinal stenosis, prior torn rotator cuff surgery from which continued pain has been an ongoing issue, ulnar nerve lesion/Cupital Tunnel, adult onset scoliosis, bone heel spur with plantar fasciitis and osteoarthritis). I have been able to manage the pain from these conditions with a Hydrocodone dose of 10mg 3x per day for the three past three years, without overtaking.
I have not heard from my prescribing Doctor yet but based on your comments, I have prepared myself for the consequences of a failed urine test. This is most upsetting as I have likely ruined the trust he has put in me.

Unfortunately where the overtaking of my medication (the past two months) began was with a broken ankle and torn ligaments and bilateral inguinal hernias. My scheduled surgeries for these have been postponed due to the Coronavirus and hospitals allowing only live threatening surgeries to be conducted at this time,
I agree with you that it I do not want to go down the road of addiction. I have seen a few family members and friends become addicted to opiates due to long term prescribed use and the suffering that has resulted from it.

I spoke with one of my doctors about this issue and we both agree it is my best interest to cease taking opiates for a period of time of at least six months, and perhaps for the long term, due to how highly addictive opiates can be.
Due to the likelihood of physical dependence, he prescribed low dose Gabapentin for pain, a two week prescription of Clonidine and Xanax to aid me in the opiate withdrawal process. His protocol also calls for drinking a lot of water, vitamin supplements and a plant based food plan.
I am anxious and a bit scared of what to expect during the withdrawal period, including how to manage the daily pain I have (most notable is the broken ankle/torn ligaments and inguinal hernias).

Would you have any suggestions or feedback on the medications he prescribed for the withdrawal period or any knowledge you may have when one stops using pain medication?
Tomorrow will be my last day of taking the opiate pain medication.  
I would greatly appreciate any thoughts on this you may have.
Thank you for your prior response and I apologize for the long post. This whole situation has been weighing heavily on my mind.
Kind Regards.
20803600 tn?1546262537
COMMUNITY LEADER
Shebee, I answered this the other day, but apparently it didn’t post. My apologies.
I would avoid using the Xanax if possible. The clonodine typically helps quite a bit in managing most of any withdrawal symptoms. There are a few over the counter meds that seem to help- hylands Restless Legs for muscle spasms, anti diarreheals to manage any stomach/digestive upset, and Gatorade to replenish electrolytes.
Most withdrawal symptoms start to ease off quite a bit day 3, and improve from then on out.
I personally would avoid suboxone, that becomes an issue when it is not used for short periods of time (under 2wks or less) to get someone off opiates completely, and then immediately off suboxone. Too often, in my experience, drs like to keep people on it far too long, at stronger doses than necessary for someone with chronic pain, who wants or needs to stop opiates. Suboxone is geared toward managing long term addiction, not so much for chronic pain patients who want off opiates. In most of our situations, if it used at all, it should be minuscule doses, for just a couple days, then stopped.
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