negative result despite taking meds and patch was currently on

[mindysu3]

I was on oxycodone 5mg and a fentanyl patch 12 mcg per hour my doc had me give a urine sample which i could have refused but thought I had nothing to hide.  2 weeks later I went in and he told me that my results were negative for both meds and my anxiety med that I take 1-3 times daily he said he had to discharge me. i begged him to give me another test and showed him that I had my patch on. they let me give another urine sample which again was negative.  they said they could not prescribe me any more but did find a place that would take blood for a serum drug test.  what withdrawls symptoms will occur  and why would they not show up in my urine.  after 7 years I finally found the right meds that did not make me sick and now they are taken away.  I understand on their end why they can't but I don't understand the negative results. any ideas why this happened or any one who has experianced this would help.

[sandee1818]

It really depends on the type of test you were given and also the results coming back negative twice is cause for alarm. I would make SURE you get the blood serum test as soon as possible so that the results can be put in your file and the doctor then can say okay we have proof so lets find out why your urine test are testing negative.
We have seen alot of this happening here and it is very hard to find a new doctor that will prescibe these meds for you after a negative test result and you have two so it is very very important you get this blood work done pronto!
Mollyrae has an article in her journal about this take a look at it too.
There are reasons your test could have come up negative such as mistakes at the office or lab but with two thats a rare occurrence to have happen twice. There are 13 drugs that will interfere with these test and I have posted them many times , I will find them again and post them for you too.
Normally i would doubt you were even taking your meds with a negative test result twice but with having the patch on and showing the doctor and I tend to believe you I think you may have some problem that your meds just are not showing up.
Did you ask the doctor for reasons he/she thinks this could happen?
Please get the blood work soon and I also think with the doc giving you a second test which is really never done and then ordering blood work I think the doctor believes your taking your meds too. There is also a hair follicle test you can buy online that will show the drugs you have taken in the last 90 days you can look in to.
I am sorry this is happening to you.
Get the blood work and then ask the doc if he will refer you to another PM doctor since I am assuming it will show your meds. If it is not in the blood work then your not taking the medications. I am not accusing you of anything mind you I am just saying there is no mistaken what drugs are in your blood work.
It is in your best interest to have this blood work done immediately and then get with your doctor about what options he can offer you at that point.
Let us know how it goes:)

[mindysu3]

During the visit he told me that this urine test goes back 30 days  so if i had taken it the last 30 days it would have showed up.  Is this true b/c from what I understand most drugs are out of your urine in 72 hours.  Also if I am taking the smallest dose available for fentanyl that should still show up in my blood?  I placed my last patch on , on tuesday june 9 and I did get the blood test done on friday june 12, I should have nothing to worry about?  I also took a 5mg oxcodone that morning at 8:45am I saw him at 9:30am took the urine test   somewhere between 10:00 - 10:30am.  They then told me it was negative and tried to find a place that would do a blood test.  I cried and had to blow my nose from the time he told me it was negative until 11:15am when I left and then it continued almost all day until my head started to hurt and my vision got blurry then after    that i woke up about every hour during the night and could not sleep.  Before I left they could not find a place that would do the blood test and the nurse told me they would continue to see me and do the injections but would not prescribe anything.  I then called them back to schedule my next vist and she told me  they found a place that would do it. the nurse said that they would contact me to set the test up.  I then asked her if they would do it today because next week ther would be even less of a chance it would show up.  She then called me back and said I could go now.  It was  almost an hour drive but hopefully it was worth it.  I am also taking seroquel 25mg, Lamictal(lamotrigine) 250mg, alprazolam .5mg 1-3 a day, bupropion 300mg plus the pain meds.  Also I have been given vicodin percocet narco darvocet oxycontin and fentanyl 25mcg per hour which all of them made me sick and called them and asked for something different b/c they made me sick  .  Also the first couple of days of the 12mcg/hour patch i was also sick but rested and got through it b/c that one did help the pain and those symptoms stopped.  I do get very costipated on these patches and some is probably due to the oxycodone too.  Also when i went to pick up the script for the lower dose , the nurse asked for the 25mcg patch's so I went out to my car and got them and gave them to her.  as far as the rest that I never used I dissolved in water and poured that  into a little ziplok bag of cat litter, which I learned is the best way from working for hospice.  These doctors have told me how strong these meds are yet I take them and they do not show up in my urine?  I thought I had nothing to worry about so I signed the paper and gave them a sample  and now I have no faith in the health care system. I did ask him why and he said the test goes back 30 days so I must not be taking them.  This is th worst month I have ever gone through, being on short term disabilty and finding out june 15 it was going to go to long term disability and I will lose my 24 hour a week status and go to casual position and not knowing if I will have a job if i do get better and now this.  sorry this is so long but maybe writing my thoughts down will help me sleep better tonight although my back hurts pretty bad right now.

[sandee1818]

I do not know what your doctor is saying when he states that the urine test goes back 30 days. There's no urine test that I am aware of that will show these medications after 30 days. The oxycodone will show show up depending on your metabolism anywhere from 24 to 72 hours after taking the pill. the fentanyl will show up considerably longer.
Are you sure he was not referring to the blood serum test? Even then the short acting oxycodone would not show up after 30 days.
It does not matter what amount of the fentanyl that your on it will show up in your blood work if your using it. When you had the test done had you taken any oxycodone within 3 days?
I assume you have not gotten the results back yet for the blood work.
Ask the doctor what he meant by the test goes back 0 days because that is not possible with a urine test.

A drug screen is a complex thing and the higher tuned (more sensitive)
it is the more complex it becomes. You see, drug screens can be
adjusted to detect various trace amounts of many different types of
drugs. Some test react positively for the presence of drugs
(substances or derivatives) only if those traces appear in the test
medium in certain volumes. For example, a person on parole may be
given a test for marijuana (cannabis, hash, etc) that will respond
positive if the test medium contains traces above  a certain “cutoff
level” where the cutoff level is very low (10ng/ml possibly) . Whereas
a person applying for a job may be given a test for marijuana
(cannabis, hash, etc) that will respond positive only if the test
medium contains traces above a certain “cutoff level” where the cutoff
level is very high (50ng/ml possibly).

There is some recent history with false results as is evidenced by
studies conducted by the Veteran’s Administration (VA). For example,
the VAGLAHS Outpatient Pain Program (OPMP) utilizes a standard Drug of
Abuse (DOA) immunoassay and Biorad High Performance Liquid
Chromatography (HPLC) Remedi-HS. These tests are used to monitor for
medication compliance. In 2004  as many as 44 % of patients tested
were found negative for opiates despite patient prescribed opioid
medication. The VA concluded that the DOA test was not sensitive
enough (in other words the cutoff was too high to detect the presence
of opioids commensurate with what the VA considered minimum
requirements)
.‘Result of Urine Toxicology in VA Patients Treated In a Pain Clinic’
http://www1.va.gov/hsrd/about/national_meeting/2004/abstracts/2047.htm

In order to test positive for our meds we have to have the required amount in our system that the test requires in order to test positive. If one test requires only trace amounts then surly there will be no problem, if one test requires that a high level be detected then we will have to have that level in order to test positive.

These are the drugs known to cause a false negitive.....

The reactivity of 13 quinolones (levofloxacin, ofloxacin, pefloxacin, enoxacin, moxifloxacin, gatifloxacin, trovafloxacin, sparfloxacin, lomefloxacin, ciprofloxacin, clinafloxacin, norfloxacin, and nalidixic acid) was tested in 5 commercial opiate screening assays from September 1998 to March 1999. In 6 healthy volunteers, we confirmed the cross-reactivity of levofloxacin or ofloxacin with these opiate screening assays. be positive, therefore some will and have failed these test.

I copied the above from an old post when a member had the same problem your having.
When you do speak to the doctor ask him about the 30 days and also if he is aware that some medications will cause a false negative.
Did you sign a contract with your doctor?
Your doctor ( according to your state laws) has to treat you for thirty days or until you can find a replacement doctor. this means treating you with the medications he has been treating you with. You can sue him for patient abandonment. Unless you signed a contract with him of course..

[Tuckamore]

Hello Mindysu,

I am so sorry for all you have had to endure with these false drug tests. I am not as familiar with these as my astute colleague Sandee. I hope to be up to speed soon.

I am about to take a continuing education course on opiates, addiction, chronic pain patients, drug screening, etc. My sister (also a nurse) is taking this course now. I have reviewed the information and accompanying workbook. I was extremely surprised at the percentage of false negative and positive drug screens and why and how they fail. There are several reasons that this occurs and in a small selection of patients they can not accurately explain the results.

Some things I do know. Such as unfortunately the general medical population has viewed and treated these tests as if they are basically infallible. As you know there are policies set forth in a PM Program. If you fail one of the drug screens you are dismissed from the 'opiates for pain control' portion of the program. It is out of the PMP hands to reinstate you.  

I encourage you to begin looking for another PMP, asap. It will take you time to find another physician/clinic that will admit you to their program. You may want to consult with your PCP to see if he/she will prescribe for you until you are able to locate another PMP that will accept and treat you.

We are here to support you. You may vent or ask questions at any time. Sometimes just knowing that someone is listening, cares and understands can be helpful. We can offer you that and I hope you will take advantage of our comforting community.

Hang in there. Please keep us updated. We will look forward to hearing from you. I hope you will become an active member of our community.
Peace,
Tuck  

[ChronicPain1]

Are they actually checking for Fentanyl? I've read that it won't show sometimes on a standard opiate test, but that could be wrong.

I had a test once where the doctor came in and goes "Well you tested positive for opiates, so we can't continue". I shook my head and said "Look at the paper where you asked me to write down what I took..." of course "Oh it says Percocet 5mg, I'm sorry about that".

Doctors are extremely fallible and seem to believe in these tests above all else, I believe you had the patch on and it should've came up. As sandee said maybe that's the issue or perhaps the test is wrong, I mean it must be. Keep trying, plead your case.

[Mollyrae]

Because you were on the 12 mcg patch and you initially changed the Patch on the 9th and then had your test on the 11th, it's possible that the amount in your blood stream was too low to register. As you know, the 12mcg patch is the lowest available and with it needing to be changed the day you had the test, it's possible that there was not enough in your system.

As for the Oxycodone, I do not know why that wouldn't show up. When you have the blood test, it will show up and prove that it was in your system.

I have heard a lot of this going on too. I think it's because opiates are so widely used these days. Everyone's system is different and I think the way Doctor test for the drugs has to be changed. I'm not sure how but evidently it's not working for many ppl who are honest.

I feel for you and hope that with the blood test, everything gets straightened out. It's a crime to loose the one thing that helps many of us and Doctors are so hard to come by.

Please take care and good luck with the results.
Mollyrae

[sandee1818]

I posted some of the article above about the amounts and the cutt off levels. So Mollyrae may be correct that you did not have enough to register on the test.

[mindysu3]

Okay it has now been 7 day and finally this afternoon I called the lab and they said my results were in (blood serum) but could not tell me what they were.  They said they faxed to the main office and the local office.  the main office said they didn't get it and later said if they did they send it to my local office and then shred it.  My doc is at another place on fridays so I called the lab back and gave them that fax #.  No call from the doc so I called the main office and they said that they must be done for the day.  I told them that I really needed my pain meds if the test showed that I was taking.  No phone call back not even from the on call doc.

[mindysu3]

Well I got a hold of the lab again and she called and got a hold of my doctor and read him the results. He called me and told me they were the same as the ua.  I don't understand how taking a 5mg oxycodone at 8:30am friday and having the blood test done at 2:00pm it could possibly be negative?  Will this stop me from going to a neuroscience center instead of a pain management clinic. Well I guess at least my pychotherapist believes me and understands that if I were selling them I would have stuck with the oxycontin or the 25mcg patch. Hopefully she can help me.

[scaredmom330]

This is so common. I take morphine 60 mg twice a day and have had a couple of negative ur test. I am lucky my doctor believes me and know I can't surviive without my pain meds. As you will read, this has happened to so many. I am very confused why the fentanyl didnt show up in the blood test when you had the patch on. This is all very confusing. I think the doctor's need to trust their patients and allow a couple of false/positives knowing how unprodictable this ur test really is. I am so sorry you are going through this, and pray everything works out for you.

[sandee1818]

Unfortunatly the pain management doctors have the Pt's that do sell their meds they have to be dilligent in keeping those at bay because they threaten the doctors practice and their families welfare as this is their job that they worked very hard for and some look at it like they will not risk everything they have worked for for one Pt who may or may not be telling the truth. I know this is a two way street as the doctorsshould stand up for their Pt's but you have to look at it from their prospective too.
With things like they are today with the DEA breathing down their necks they have to be extra careful.
I do think that some people abuse their doctors trust and when they do this is what happens the doctor is reluctant to trust anyone else as they may have been burned before and refuse to let it happen again.

[wildwoodone]

If had run out a few days early and only saved one for the morning of your dr. visit you could have had too little to show up because they would expect a certain level on a daily drug.

[mindysu3]

I am very thankful for the counsler that I have. I have seen many over the last 9 years, and never felt comfortable with any.  She made me feel like there is hope that there is someway to prove that I was taking them.  She knows ua do not go back 30 days and some people have a faster metabolism or maybe one of my other meds is affecting it.  I don't know if it is possible but she mentioned something about going to the hospital and have them watch me take my meds and then give me a test. Hopefully if it comes down to it she could help me find a way to do that or prove that my other meds are affecting the test.  I totally understand why these docs can't believe everyone and can't help everyone figure out why this is happening.  If he didn't believe he wouldn't have let me take another ua or the blood test.  It doesn't help though that nurse has been a pain about getting the info to my work and disability insurance that pays me. It has been a week and my work has still not recieved my fitness for duty form.  I don't understand why it is so hard to check some boxes,sign and fax it.  Plus my restrictions have been the same since March. The disability insurance requires my record of the last visit and every month she has been sending all of them.   This has to be done once a month and she tells me she has never had to do this before for anyone and makes it seem as though it is a very time consuming thing.  She has been short with me, my work and the disability people.  I have had two epideral injections done 1 between c7 and t1 and another between t1-t2.  The first one was pretty quick and painless but the third was terrible  and after 3 weeks my spine is very sore in that area in the morning.  He wants me to have a third but I feel like that would make it worse.  That is why I am hoping to get into a neurospine center.  Will this false negative stop them from taking me??  I also hope that I will not get fired because of this or lose my disabilty payment??? Maybe I should get my psyciatrist involved?? I worked as a hospice home health aid and was liked by everyone and requested by some patients.

[sandee1818]

I was just doing some further research on false negitive results and found this.....


http://pennfm.pbworks/f/drug.seeking.patient.nguyen_20090528.ppt

it has alot of things there but the thing that caught my eye is that short acting meds such as oxycodone will not show up on a UAD test, neither will fentanyl.

The refrences gven were....
Levy S 2006/ drug testing in adolescents in ambulatory medicine, physicians practices knowledge.
Savage SR 1999 opoid use in management of chrinic pain

This is documented proof that these test results are  not always correct.

[mindysu3]

Thank you for the information sandee butwhen the nurse called me this morning with final test result she said I had 10mg of oxycodone and cocaine metabolite in the blood serum test, I have never in my life tried cocaine. They still will not prescribe my pain meds. I told them when I first started the stuffI told her what I had found on the internet from you she didn't seem to care.  I saw him on june 12 and after he told me my test was negative i asked to be released to work.On june 16 I was moved to casual status. the doctor still has not sent my fitness for duty form I gave the on june 15 and apparently now after a week he decided to release me to lift 50 lbs which is what my job requires. I don't know why he wouldn't on the 12 but now he will b/c they said I asked for it. Which I did before june 16 and not since.  There has been no improvement w/ 2 epideral steroid injections, but since the first I now get tingiling in my R hand sometimes.  I told them I did not want another injection, the t1-t2 area from the last one is still sore in that region after almost a month.  What is the point of still seeing him if he will not give me meds and I don't want any more injections?  I am thinking about going to a nerospine center?  Should I see another doctor or stay with him?

[mindysu3]

I messed up something in last post I was trying to say that during my next visit after  I started the meds. I told them it didn't last as long as they should 5mg oxycodone only about 4hr's and 12.5mcg fentanyl only lasts a little over a day after it takes almost 12 hr's to work.

[Tuckamore]

If I recall correctly some opiates will metabolize and break down as cocaine.

Sandee has more information on this subject than I do. She can respond better to your concerns than I. Sorry.

Tuck

[sandee1818]

I was looking for the article about how some pain meds can metabolize as cocaine.
I will keep looking and post it for you.
This is a documented fact.
I had just posted in the post by me about false negitive results that most doctors are not sufficently educated on this subject, and on drug testing in general.
I would definatly find a new doctor if I was you. You need to have the proper treatment and he obviously can not provide it for you.
I am sorry your having to go thru this:)

[mindysu3]

Thank you for all your help.  I did get in to a neuroscience center this wednesday.  Should I be upfront with them about what has happened or wait to see if they request documentation from the pain doc about my injections.  Even though the pain is unbearable most of the time I don't know if I want to go through all this again. I did print out some of the info you gave me and also found another spot on the internet

http://www.thatspoppycock.com/library/opiate_drug_testing.htm

Its always a little scary for me to see a new doc but this place has neurologists neurosurgeons, associate practitioners (I will be seeing one of these first), physical therapy and chiropractic care all in the same building. They also have a neurosurgeon who does medical-legal services (Independent Medical Evalutions/Liability/Record Review/Expert Opinion) What does that mean?

I also spoke with my psyciatrist today and he was going to check if my bupropion that I am on has anything to do with my test results.


Again thank you so much for everything

[sandee1818]

ALWAYS be totally honest with your doctor. They wwil find out and then they will know you lied to them and that will be the end! I can not stress this enough, you have to be honest with the doctor do he can treat you properly and having a trustful relationship with your doctor is VERY important!

[mindysu3]

I recently got a copy of my drug screen results and in blood serum tests and the uad there is no positive result for cocain or amphetamines so I do not know where they saw this. my oxycodone did show up as <10.0 and normal is between 10.0-40.0 it also says elevated reporting due to nature of specimen (what does that mean?). My fentanyl showed up as<.5 and therapeutic range is 1-3 ng/ml. Would this be due to my low doses that I was on 12.5mcg/hr and 5mg oxycodone also the patch had been on since tuesday and needed to be changed the day the test had been done. Also in the uad result it shows negative for both and cutoff levels were 100ng/ml for oxycodone and 1ng/ml for fentanyl.  In the result explanation it does say that they were not detected but this could be due to individual metabolism or not taking it. The doc also had told me that if I had taking it at all in the last 30 days it would have showed up yet on the results explanation it says detection time approximately 2-3 days* for oxy and 1-3 for fentanyl.  Why did they lie about the cocaine metabolite and why didn't he pay attention to everything this report said. It did also show positve for carboxy thc, what does that mean? Also in his dictation they said they wanted to due the epideral steroid injection due to escalating amount of pain meds even though I had asked for a lesser amount of fentanyl because the 25mcg patch made me very sick and asked for the oxycodone insted of the oxycontin. It also says he prescibed me oxycodone 5-325 even though it was only oxycodone 5mg because when they are mixed with acetamenaphine I get sick. The other thing that doesn't make any sense is when they did and injection in my R hip for pain they wrote I had immediate relief but yet I remember hardly being able to walk out of the office because it initially made the pain worse And I asked them how long it would take for the shot to work.
Another thing they wrote was that I denied and weakness in my R arm and hand yet I did tell them that b/c this has been a problem for many years.  My new nuero doc would not treat me b/c of the carboxy thc and told me to go back to the pain doc and get a referral from him to somone else. I will not go back to the pain doc especially since I read all these notes and there were many things they said to me or put in the dictations that were not true.  There are not many docs that will prescibe pain meds around here for chronic pain especially the oxycodone w/o acetomenaphine.  Why is plain oxycodone so much worse than when it is mixed w/ acetamenaphine.  If the combo did not make me sick I would take it but it does so now the alternative is no pain relief at all.  The new nuero doc also said everyone has bulges in discs and it does not cause pain.  B/c of that they again have labeled me as having fibrmyalgia and say opiod pain meds do not help that kind of pain. They would prescribe vicodin or perocet yet those make me sick and will not listen that plain oxycodone does not make me sick. What do I do now???

[Mollyrae]

Hi Mindysu3:

I have some information in my Journals that light be of some help to you. Opiates can breakdown to Cocaine Metab's. I feel that the Doctor was looking for a reason to let you go. I don't know for what reason but he may have had one. Doctors can be very uncomfortable in prescribing pain meds. It's the DEA that has scared many of them right out of practicing pain therapy.
My advise to you is to find another Doctor altogether. Start fresh...they are out there if you look. It may take a while but be assertive. It's your comfort of life that you are dealing with.
Please take a look at my journals. It explains why you might have a false-negative or positive drug screen. The information is proven in may medical journals across the nation.
I hope that you can straighten things out. We are here for you......
Mollyrae

[sandee1818]

Mollyrae is correct in thinking the doctor was just looking to dismiss you.
Try and find a new PM doctor. I know it is frustrating but hang in there.

[pitbull4u]

Here are more references to help you. Please write a brief (as possible) letter to be included in your medical records. Include references to the sources you've found.
This will help you with current/future doctors.
Urine Drug Screening: Practical Guide for Clinicians — Mayo Clinic ...
most sensitive for adulterants causing false-negative results.15 Normally, urine ...... False-positive results in urine drug screening in healthy volunteers ...
www.mayoclinicproceedings.com/content/83/1/66.full - Similar -
by KE Moeller - 2008 - Cited by 11 - Related articles - All 7 versions
http://www.mayoclinicproceedings.com/content/83/1/66.full

Jul 22, 2009 ... The “False Negative Immunoassay Screening Results in Pain Patients” ... Millennium Laboratories is rapidly becoming the Urine Drug Testing ...
www.businesswire.com/.../menuitem.8819818c238b6a7dd84adb8be6908a0c/?... - Cached Millennium Laboratories Research Study Reveals Lower Opiate Cutoff Levels Identify Higher Percentage of Patients Taking Illegal Drugs

Keep fighting for your rights! Dee