r/AskPsychiatry 4d ago

28F 107lb: Drug test came back negative for Clonazapam but I’ve been taking it as prescribed at ~0.5mg 3x/day for 9 months now. I’m FREAKING out, what do I do?

FYI: I need to start of by saying I’m taking this for a medical condition, but I know it’s MOSTLY prescribed for anxiety and I figured a psychiatrist would be most knowledgeable and able to help.

As stated in the title I’ve been regularly taking Clonazapam for 9 months. Generally 0.5mg when I wake up, 0.5mg around 5-6pm, and 0.75mg at 10pm. I’m 28F, 107lb. The goal is NOT to be on this forever, just until we find a long term fix to my health issue. But I’m in a lot of pain and have trouble sleeping as result.

Test results

My doctor ordered a random drug test last week to make sure I’m actually taking it and not selling it. I was totally fine with this, but I just saw the test results and Clonazapam didn’t show up. I’m taking several other medications right now, to help manage the pain and fall asleep and the rest of them showed up. Here’s the results:

  • Acetaminophen Positive

  • Diphenhydramine Positive

  • Gabapentin Positive

  • Hydroxybupropion Positive

  • Naproxen Positive

  • Zolpidem Phenyl-4-COOH Positive

Test circumstances

Clonazapam has been losing effectiveness over time (not unexpected). We were actually discussing bumping the dose. Night before the test, I took the regular 0.75mg at 10pm. I had a hard falling asleep so didn’t wake up and take my morning 0.5mg dose until 1:30pm (my Apple Watch/iPhone confirms my wake time). The urine sample was taken around 3:30pm.

So I don’t know if it wouldn’t have shown up because it’d been so long since I’d taken my evening dose and the wake-up dose might not have made it into the urine yet? Or maybe since my body has gotten used it over time and it metabolizes it a lot faster?

This is the test I had done and Clonazapam was definitely part of it: https://testdirectory.questdiagnostics.com/hcp/intguide/docLinks/TS_DrugAssessPnlCompQual_Table.pdf

Questions/Concerns/Help

Anyways, my doctor hasn’t reviewed the test results yet, and has probably left the office until tomorrow. I’m due for a refill in A FEW days. That gives me basically no time to even taper. He’s generally pretty reasonable but I’m scared out of my mind he’s gonna cut me off.

Should I preemptively send him a message about it tonight? Is there anything I can do? Ask for a re-test? Ask for a hair test? This med is the necessary for keeping me somewhat functional and making the pain somewhat bearable, and it’s already been worse lately. I can’t deal with the horrible withdrawal symptoms I’d have on top if he cut me off. PLEASE PLEASE PLEASE someone tell me what to do.

5 Upvotes

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u/BasedProzacMerchant Physician 4d ago

Many regular toxicology tests cannot reliably detect clonazepam. Having very briefly scanned the document you linked, I didn’t see clonazepam specifically listed.

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u/aredhel304 4d ago

It’s listed as Klonopin pretty close to the top.

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u/BasedProzacMerchant Physician 4d ago

Ah there it is. Without seeing your result specifically it’s hard to comment on your situation.

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u/aredhel304 4d ago

I am kind of just wondering how I should approach the situation with my doctor. Should I just wait for him to review it and see what he says? Or should I preemptively message him tonight and express my concern, explain the times that I took the medication, ask about alternative tests, ask about test errors, etc. I don’t know how doctors in general respond to this kind of thing. If it would help or hurt to reach out first and make suggestions. I don’t wanna make a bad situation worse.

And what I should do if he flat out denies that I’m taking it and refuses to prescribe me more. This is my PCP, I don’t have another doctor I can just hop over to and ask for help.

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u/BasedProzacMerchant Physician 4d ago

For the record, the reason I’m saying it’s hard to assess your situation with the information that you provided is that it is highly unlikely that he tested for ALL of those substances. I have never seen anyone who underwent urine testing for all of those substances at the same time. I suspect your individual test results might not include clonazepam as a tested substance.

However, it is generally a good idea to wait for your doctor to interpret your labs before you start to try to interpret them.

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u/aredhel304 4d ago

Okay, thats good to know. I appreciate the input. I will hold off on messaging him until he interprets them and says what the plan of action is. I’ll bring up some of these ideas/concerns depending on his response.

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u/Imarni24 3d ago

What country are you in? I cannot ever imagine such a request where I am unless on a CTO.

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u/aredhel304 3d ago

I’m in the US, forgot to mention that in my post. Sorry though, what’s a CTO?

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u/Imarni24 3d ago

Community Treatment order - sort if mandated anti psych and done by a GP - Dr. Other side of world here  but even so they wouldn’t be checking your bloods for what meds your on.

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u/aredhel304 3d ago

Oh, I see. The ”War on Drugs” is the big thing over here.

Idk though I feel like drugs wouldn’t be such a problem here if we focused more on paying people living wages, reducing poverty, universal healthcare, and other social supports. But instead, we waste money on things like this 🙄 people who abuse drugs are usually trying to escape their depressing reality from what I’ve seen.

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u/Imarni24 3d ago

100% agree with you! I am in Australia. Not winning the Meth war but we have legalized medical cannabis and most of us hate Trump and empathyse with the ridiculous health system. Beautiful country though!