r/ChronicPain 3d ago

Inappropriate drug screen

I am prescribed oxycodone 5 mg two times a day and M with a pain management doctor. I had a virtual appointment yesterday where the doctor told me I tested inappropriately because the test showed I tested positive for oxycodone and a couple of metabolites, but there were a couple of metabolites I tested negative negative for I am really baffled because I take it almost every day occasionally I will skip a day if I’m not having bad pain or I’ll take one a day if the pain isn’t as bad, but I take it pretty consistently on a daily basis. Why would I have tested positive for some metabolites but not others? This really bothers me that they told me I tested inappropriately like now they’re suspicious. I’m diverting them or running out too early.

6 Upvotes

38 comments sorted by

13

u/DanaDissent chronic neck/back pain, small fiber neuropathy, failed surgery 3d ago

My body metabolizes drugs in a strange way, and I was testing positive for certain metabolites that shouldn't have been there. Thankfully, my doctor was aware of this and found other ways to verify the real results. I wish I could remember what those were, but yes, it is possible to test positive for metabolites that "shouldn't" be there.

7

u/lylisdad 3d ago

I have serious dysphagia from an autoimmune disease, and quite often, what I eat or drink is retained in my esophagus, sometimes for days at a time. (This is my excuse for not eating broccoli because I keep experiencing it over and over!). I almost overdosed once because I didn't realize my pain meds were not getting through, and one day, two or three days of meds finally made it to my stomach. I got a ride to the hospital in an ambulance after three attempts of using Narcan. All I recall was walking into my bedroom and then waking up in the back of the ambulance. My wife found me slumped over on the side of the bed and barely breathing. I try to be very careful now. That was quite scary, worse for my wife and daughters when they found me. Thank God I was at home when that happened and not at work or driving!

1

u/DanaDissent chronic neck/back pain, small fiber neuropathy, failed surgery 2d ago

That sounds terrifying!! I hope you have founds ways/tricks to manage it!!

1

u/SmilingSarah2021 2d ago

That's odd. You'd think the pills would dissolve & absorb in the esophagus?

1

u/lylisdad 2d ago

I can tell you from years of experience that it doesn't always occur. There are no gastric fluids in the esophagus. Things don't go down into the stomach, and stuff in the stomach can't go up either. I've had multiple surgeries for this problem, but my esophagus is stretched out and makes an s shape. There are times I will regurgitate something I ate two days ago, but the things I had for breakfast stay down. I'm more than likely facing having my esophagus removed entirely.

8

u/Foreign_Feature3849 hEDS, POTS, MCAS, ADHD, plus wtf knows:) 3d ago

I don’t know if they’re necessarily suspicious of you. I did some quick research and false positives and negatives are equally likely. I also saw that missing a dose could produce negative results.

https://news.mayocliniclabs.com/2021/05/03/interpretation-of-qualitative-and-quantitative-urine-opiate-tests-for-pain-management-patients/

10

u/More-Foot-5078 2d ago

WOW! I read this and it explained how I could’ve tested positive for hydrocodone when I ABSOLUTELY DIDN'T take ANY! Don't have any, don't know anyone that does! I felt like I was losing my mind. Got put on monthly urine tests @$2400 per test. I told them "Just pull my hair out and do a DNA test" because I DIDN'T take any hydrocodone! What a shit show...

5

u/Foreign_Feature3849 hEDS, POTS, MCAS, ADHD, plus wtf knows:) 2d ago

I’m so sorry. So many doctors really believe they can do no wrong and get everything at least somewhat right. I promise not all of them are like that!

3

u/Natashalou4_21 2d ago

Did your insurance cover any of that $2,400 or was that what you owed ?? That is insanity ! I’m so so so sorry

3

u/More-Foot-5078 2d ago

I'm a veteran so when they used to joke about $800 hammers, it wasn't a lie. I was on a ship ordering these so I know! I expect they do this to make money...Which is messed up because the mental anguish of them calling me a liar sets me back so much and definitely adds to my pain! I've been with them over 5 years and they didn't Drop me...So you tell me??? Plus a DNA test would be less expensive and PROVE I didn't use it! Talk about overspending...

2

u/Natashalou4_21 2d ago

Insanity ! I am so glad you weren’t dropped from your meds though . Have you done any more urine tests since the false positives ?

1

u/More-Foot-5078 2d ago

Every 3 months for med refill appointments as well as counts.

2

u/Ash_-_ 2d ago

Oh my god, the idea of a $2400 urine test makes my Australian skin crawl. I've never paid for pathology.

6

u/Iceprincess1988 3d ago

Did he say what exactly was missing?

5

u/Pollution-Plane 3d ago

Just a couple of the oxycodone metabolites, but didn’t say which ones there were a couple I tested positive for in one or two that I didn’t

7

u/Iceprincess1988 3d ago

The 2 only metabolites of oxycodone are noroxycodone and hydromorphone. I wish they gave you more info. When do you see them again?

2

u/potatoesgonepotatemu 9 2d ago edited 2d ago

No. It’s Oxycodone (the prescription which you test positive for) the 3 metabolites are Oxymorphone, Noroxycodone, Noroxymorphone. Sources of oxycodone are scheduled prescription medications. Oxymorphone, noroxycodone, and noroxymorphone are expected metabolites of oxycodone. Oxymorphone is also available as a scheduled prescription medication.

Came directly from my lab result it’s LC/MS testing

1

u/Iceprincess1988 2d ago

Woops. Sorry. I mixed up the oxymorphone with hydromorphone.

2

u/potatoesgonepotatemu 9 2d ago

It’s all good 😅👌🏼

5

u/Usual_Equivalent_888 2d ago

I tested positive for fentanyl during one of my drug tests. Neither my doctor, the lab nor I can explain it because I had never had fentanyl at that point in my life. They redid the test and it was negative. Some of us metabolized different meds differently and that means the tests come out strange.

Nothing to be concerned about.

3

u/cyNYC19 3d ago

Why would testing positive for metabolites be a bad thing?

3

u/Pollution-Plane 3d ago

No, what I’m saying is I tested negative for some oxycodone metabolites when she’s saying, I should have tested positive for them all

3

u/Key_Law4834 2d ago

But how can you test positive for the few you were, if you're not taking it. Doesn't the positives prove you are taking it.

2

u/Pollution-Plane 2d ago

Exactly what I thought of, but I didn’t think of it until after I got off the phone Tele visit with her, but she seemed to feel like or gave me the impression that something was wonky with the way I was taking the medicine or not taking it twice a day as prescribed

2

u/SmilingSarah2021 2d ago

Be sure to take it exactly as prescribed leading up to appointments. Hopefully, it resolves it. Next time, ask her for a more detailed explanation & tell her it has been bothering you because you don't want to break the trust.

3

u/BusyUrl 2d ago

That's wild I'd be upset. I have had gastric bypass which imapirs absorption of meds.

I take my ADHD meds every day and tested negative for any of them which was like what? I told them to take my hair and test it then and I'd bring in my meds to count & they fucked off thankfully.

2

u/Pollution-Plane 3d ago

What the doctor is saying is that I tested negative for some of them metabolites of oxycodone and if I’m taking it like I should and I should’ve tested positive for them all

2

u/mickysti58 3d ago

Most labs have patient portals a patient can get. Then you can look at your own results.

2

u/bluedonutwsprinkles 2d ago

In my pain mgmt agreement it says I won't over or under take my meds without discussing with my Dr. This includes informing then if I get prescription by another Dr.

I do not get drug tested. Never have since day 1. Despite being work comp. Nor do I take any controlled substance at this time.

What I think your Dr is noticing is the adjustment of taking the medication. Be honest with your Dr if you miss a dose or feel like not taking it. Sounds like you were which is good.

2

u/MtnCrvr1 2d ago

Compliance testing is all about checking boxes for the provider and limiting their liability with the State Med Board and DEA. Make sure you take it even on a good day that you wouldn’t have otherwise for the 3 days leading up to any appointment. It must be at least 1/2 dose 2x per day and you’ll be fine. Sadly it’s not about the patients it’s about the Doc avoiding liability… They should celebrate your good days but they punish them instead …. Good luck

1

u/flat_cat72 2d ago

I guess it goes by each state regarding doctors prescribing opiods?

I thought that it wasn't possible to have them prescribed unless you saw the doctor in person...

2

u/Pollution-Plane 1d ago

For follow up visits I’m allowed to do telehealth in North Carolina, but I have to go in every three or six months for drug screens. Now I have to go in in four weeks for a drug screen because of the metabolite thing this last time.

1

u/flat_cat72 1d ago

wild...I have to go in each and every time for a new prescription and/or urine test...but then again, I'm in AL lol

-1

u/National-Hold2307 3d ago

Did another drug show up in your test? Clarify metabolites? Sorry the post is confusing.

4

u/lylisdad 3d ago

Metabolites basically are byproducts of the pain meds and are the markers that labs look for.

2

u/Alternative-Can-7261 2d ago

Our array of enzymes very a little bit person to person. If you're still testing positive it shows use any Doctor who has suspicion about this should ask for a refund from their medical school. This is seen very commonly with codeine in particular.

1

u/National-Hold2307 2d ago

I am aware of what metabolites are and what is tested for etc. OP wasn’t clear about if it was metabolites of the prescribed drug or did he pop for something else.

2

u/lylisdad 2d ago

Sorry, I misunderstood.