Hello and Welcome to our Pain Management Forum. I'm glad that you found us and took the time to tell us about your pain and situation. I'm very sorry that you too have a Chronic Pain condition.
Many of us worry about unjustly having incorrect results from a UDS. However I'm not certain that's what your UDS is revealing.
Our member and resident "Sheep Doc" has much more knowledge than I about the chemistry and metabolites of specific opiates - and knows more about how to interpret UDS. He checks in often. Hang tight.
I do know that even a physician not well versed or educated in UDS can misread the results. It can be very complex and is not always an easy interruption. I also know it depends on the UDS that is utilized. I assume yours was not the usual initial immunoassay - which is not as accurate as the confirmatory (gas chromatography-mass spectrometry [GC-MS]).
Chemistry was/is not my strong suit - and I'd be uncomfortable trying to answer your question with any accuracy. I can encourage you not to be overly concerned at this point. Your Chronic Pain provides you with more than enough concern.
Hang in there. We'll all do our best to help. Please keep us posted. I wish you the very best.
speedy27CeeDee, I know little about the metabolites of cocaine, or why it would be found in a urine drug test (UDT).
I will refer you to a document published in 2013 by an organization that help state medical boards define 'standards of practice' in for doctors within their purvey. (FSMB).
The title of this document is Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain.
Within it you will find a section that covers "Periodic Drug Testing" and from this I quote:
"Physicians need to be aware of the limitations of available tests (such as their limited sensitivity for many opioids) and take care to order tests appropriately . For example, when a drug test is ordered, it is important to specify that it include the opioid being prescribed . Because of the complexities involved in interpreting drug test results, it is advisable to confirm significant or unexpected results with the laboratory toxicologist or a clinical pathologist [59-60]."
Most physicians, unless they are specifically trained in the pharmacology of opioids, are unfamiliar with UDT results, and therefore accept them as fact, as if they would a blood sugar result, knowing well that a simple blood glucose level can have false readings depending whether or not the patient was fasting for 12 hours prior to the test.
This is also from the FSMB document:
"Test results that suggest opioid misuse should be discussed with the patient. It is helpful to approach such a discussion in a positive, supportive fashion, so as to strengthen the physician-patient relationship and encourage healthy behaviors (as well as behavioral change where that is needed). Both the test results and subsequent discussion with the patient should be documented in the medical record ."
Any good doctor would question a blood glucose level above normal limits, and talk with the patient -- were you fasting? Did you have coffee that morning? Do you use sugar in your coffee?
It is a sign of our times that doctors do not have these discussions with patients who fail a UDT.
Your result, positive for cocaine, is what is known as a "false positive" result.
The -caines are a family of anesthetic medications used in dentistry, surgery, and even in simple procedures in a doctors office. A false positive for cocaine, especially when detected by a simple polyscan UDT using immunoassay (a strip that turns a specific color in the presence of a substance), may be caused by such an injection.
I'm not an expert on UDT analysis, but I have a colleague who is. He's developed an app for iPhone and Android that helps doctors interpret UDT called UrineTel (or UrinTel -- I don't recall.)
His website is Remitigate.com. But UrineTel or UrinTel is for doctors and may be beyond the scope of anyone unfamiliar with medical practice.
So, I suggest that you talk with your doctor and set the record straight -- you do not use illegal drugs and never have. You wouldn't know how to find them. If you need it, ask that a more sensitive test be done -- a blood test for cocaine metabolites. This may cost you, but it will prove that this test result was an anomaly.
But don't be surprised by a suspicious doctor. A couple of years ago a conscientious pain doctor I know, a man whom I respect as a doctor and as a pain patient advocate, once reported his astonishment over finding UDT results that were positive for cocaine in his patients who are now in their 70s. When this man tests, he does a full chromatography for the metabolites of substances, not the simple immunoassay technique.
I reminded him that Keith Richards is now in his 70s.
Oh, one more thought.
If you really aren't 'doing' cocaine, you might consider changing your MedHelp moniker.