I need help and or advise, I have been taking prescription vicodin for several years, I have severe arthritis in my hips and neck, I have had one hip replaced, waiting for the next one. Any way I have serious pain. I went to refill my prescription, and the Doctor wanted to see me first, I was asked to take a drug test, which I did, I had taken my last pill about 24 hours earlier, the test showed no drug in my system, the Dr. Said I should have it in my system, I have no idea why I don’t, I did not realize it was a big deal, she gave me my prescription, 30 days later, I needed more, I was asked to have another test, again no vicodin in my system, this time it had been about 36 hours. Now very big deal! I have basically been acused of selling the meds. I asked for a blood test, she refused. She says there is no way the test is wrong! And the drug should stay in my system for weeks. I am living proof that is not the case. I have asked twice for a blood test, I have been denied that test. Of coarse I can not get any more vicodin, I can’t leave this stand, the Doctors office says I have no choice, I have to let it go. That there is no way I can prove my case. I had been taking the 500 strength, 1 a day sometimes 2 never more than that. I really need advise! I feel I am being acused of something, that I know I am not guilty of. please. Help?
Get a second opinion.
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Welcome to the SDMB, Nanners.
Questions seeking advice and opinions, especially those of a legal or medical nature, belong in our IMHO forum. Please keep in mind that the responses you receive are just the opinions of some online folks, and shouldn’t be taken to be the equivalent of professional legal and medical advice.
Moving thread from General Questions to In My Humble Opinion.
They are really making it hard for people with chronic pain to get the medicines they need…
When I get to work, I shall look in our test kit, and see what it says about false negatives for opiates.
My best guess is that you may have been drinking way too much water that day (diabetes?). But other possibilities exist. Interfering substances, you metabolize the drug weird, ect.
Your doctor is very silly saying that the test can be wrong. All lab tests can be wrong. I hope she does realize this…
Taking 1-2 daily should leave with no possible way of not coming back positive unless the sensitivity of the test was very low. The halflife of the drug is such that taking one pill would mean its detectable for 2-3 days, but since you take it daily it builds up in your system. I’d ask what the test conducted “level of detection” was. Usually an early test is performed at a higher sensitivity, if that comes back positive than mass spec is performed to get the precise level.
Ask for a hair analysis. That will show drug use over time rather than right now today. Don’t know what it costs though.
. I had drank nothing except a cup of coffee, I do take a lot of meds, I was told that none of them would influence the results, I confirmed that with my pharmacist . Thanks
When you say “500 strength”, to what are you referring?
Vicodin (and all other drugs containing hydrocodone) is mixed with another drug - in the specific case if vicodin, it us acetaminophen. The name ‘5/500’ is 5 mg hydrocodone (the opiate) and 500 of acetaminophen.
I have used both 5/500 and 10/325 - have never seen anything approaching 500 mg of hydrocodone.
They don’t make the */500 any more it’s all */325.
Nanners, did your doctor prescribe anything else for pain? Perhaps tramadol?
Continued…after more time to think.
So, I strongly suspect your doctor does not understand the nature of this drug test that she ordered, or what the results really mean. She just sees a big NEGATIVE. But in her defense, most doctors do this kind of stuff. (I strongly feel that they should be required to pass a competency quiz on each laboratory test, before they are allowed to order said test.)
Here is a breakdown of urine based drug tests in general, and yours in particular.
- Immunological urine drug tests were approved by the FDA to aid in emergency situations, and to be the the first step in evaluating drug use in non-emergency cases. If the results may have a significant impact on the patient, then the test MUST be followed by a more reliable test which uses a different methodology. The literature that comes with the test kit my hospital uses states:
Caps added for emphasis.
- These tests were approved for emergency situations, and to help determine the PRESENCE of drugs in patients who ARE NOT supposed to be taking them. They were not designed to determine the ABSENCE of drugs in patients who ARE supposed to be taking them.
This is how they they work. There is a specific cut-off level for each drug metabolite detected. If amount detected is below the cut-off we call it negative, if above the cut off we call it positive.
These levels were determined by the Substance Abuse and Mental Health Services Administration. The agency was concerned about the impact of false positives (people getting fired, imprisoned, losing their kids). But they were not too concerned about false negatives when the concentration of the drug was not life threatening. So they made some of the cut-off levels fairly high. Again, a quote from the test literature;
- Hydrocodone (Vicodin) has a high cut-off level. Meaning a false negative from hydrocodone is more likely than a false negative from most other common drugs. Cut-off levels used in my test kit (a sampling)
-
Urine is a variable substance. The darker, the better, and first morning samples are always the best. Urine with a specific gravity of less than 1.005 is not suitable for testing. Did anybody test your samples for specific gravity?
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Vicodin is not particularly strong to start with. Mostly Tylenol. Because the government does not want you abusing opiates unless you destroy your liver in the process. (Hopefully this is changing soon)
Conclusion. These crazy regulations that require doctors to drug test their poor crippled patients are fairly new. And I realize that there is a learning curve.
But, for the purposes of pain management; urine drug screens (either rapid or analyzer based) should only be used to determine which patients require more expensive blood work. And, the ONLY test that should be used to justify taking away needed medication is gas chromatography/mass spectrometry (GC/MS) of plasma or serum. Available from Mayo, ARUP, and scores of regional laboratories.
I hope this helps you and others (my mother once went off a cliff in a Volkswagen).
Take care of yourself.
Fishtar - Medical Laboratory Scientist
I hope this isn’t the case but is it possible someone could be switching your Vicodin with something that looks similar?
I have seen this with my grandparents. My cousin or one of the neighbors stole the Vicodin and replaced it with generic tylenol. It looks very similar to some generic vicodin.
Prescription pain medicine is abused all the time and by all types of people.
This is a good point - although I doubt it is the case here.
Anyone getting any abusable drug - heck I check all my drugs I get - should look up the code on the internet (that is on the pill).
Generic Tylenol pills do look very similar to the hydrocodone/acetaminophen combos (same with oxycodone/acetaminophen). It is not uncommon for addicts that work at pharmacies - or addict friends of people who have scripts to do this.
The first reference I checked on line for how long hydrocodone could be checked in urine listed 1-6 days. It only has a half life of 3ish hours. Meaning that if a test has a cutoff at 12,000 - and you are at 20,000 now - you’ll be around 10,000 3 hours from now - and around 5,000 - 3 hours after that.
Doctors are getting more pressure put on them by DEA and state licensing boards for opiate prescriptions. Many rules now include drug testing - and doctors do not get much if any training on this in medical school. They are mostly guessing based on what others have said about the tests. Different tests have different levels.
FWIW - your doctors office is right - you are screwed - it doesn’t matter what you say - they won’t believe you until they get 10 old people telling them the same thing.
I’ve never been tested by a doctors or a drug of abuse, but I have had my level checked for other drugs - one of which was not abusable at all. It came back a zero (well below detectable limits). We had both known this was part of the plan (take the drug for 30 days - see where the level was - and adjust it from there.
My doctor knows I deal with data for a living - I had been seeing him for probably ten plus years at that point. So we had the following conversation:
I had even asked him on when I should take the test - should I take it at my low point (right before I normally take my daily dose - or another time - and made sure I was taking at almost exact same time each day as test got closer)
Me: “So did you get the number back on drug A?”
Him: “Yeah - it came back below detectable limits.”
Me: “That’s odd - any idea why it would say that? (I was assuming perhaps type of diet or something)”
Him: “No - unless you weren’t taking it. (Detected slight accusation - very slight)”
Me: “So wait a minute - you think that I - that could have picked anyway I wanted to go to get my blood drawn - picked a day where I hadn’t taken any at least several days before? I mean you know that I know if i didn’t take any it would come back a zero?”
Him: “yeah - that doesn’t make much sense - let me give you another slip”
This is why those tests are so stupid - if someone is diverting their drugs - it only gets rid of the stupid people - unless they do complicated testing - all someone diverting their drug has to do is take the drug the day of the test - and say a day or two before hand to be sure.
You can still sell 27 out of 30 of your doses and they will think you aren’t selling your drugs.
In the mean time - use your brain if it ever comes up again - if you have already tested low for Hydrocodone - make sure there is Hydrocodone in your system next time.
You can get single drug urine tests off amazon for like $1 or less a piece if you buy like 15 at a time or something. Is it stupid to have to test yourself to make sure your doctor doesn’t fuck up? yes it is.
Welcome to the War on Drugs 2.0
Possible the doctor is lying to you to get you off Vicodin?
My state legislature and medical board, in separate but related acts, recently created a truly Byzantine set of regulations for prescribers of chronic narcotics. Those regulations require drug testing on anyone receiving chronic narcotics, and goes as far as to say how often testing should be done based on the doctor’s perception of abuse or diversion risk (from yearly in low-risk patients to monthly in those at the highest risk).
However, it makes no mention at all of what the doc is supposed to do with the test results. Do I have to stop prescribing narcs if a cancer patient tests positive for marijuana? What about the little old lady who takes a Vicodin once a week or so when her shoulder acts up and hasn’t taken it for a week when she comes in? IMO, you just have to consider the test results thoughtfully and document your decision-making process thoroughly and you’re going to be in the clear, but most docs fear having to explain that sort of thing to an auditor (and they’re probably not wrong to do so), so they’d rather make the rule hard and fast even if it isn’t fair.
Also, it can be really hard to get the test paid for. Our Medicaid system sent a letter to the state board after the guidelines came out essentially saying that just because the board required it didn’t mean they were going to pay for it. The initial drug screen isn’t that expensive, but the confirmatory tests can add up to hundreds of dollars. So most offices have a policy that the cost of drug testing is the patient’s responsibility and that if they can’t pay for confirmatory testing, the results of the screen have to stand. That sucks, and it undermines the whole point of having a screening test to begin with, but it’s what we’re left with.
Wish I had some real advice.