Help! I am very concerned about a drug test!

[SockMonkeyPro]

I am very glad I found MedHelp, if for no other reason that it helps to know there are others out there who suffer from chronic pain and may be able to give me insight into managing mine better.  Unfortunately, I do have a question I hesitate to ask because it sounds as if I am a drug abuser or trying to trick my upcoming urinalysis.  I assure you this is not the case, but I am afraid I messed up and need your help and/or assurance. Please bear with me...

1.  In 2004, I was run over by a commercial snow plow.  I eventually recovered, but was left with moderate to severe pain in my right sciatic nerve and throughout my cervical spine.  My doctor prescribes Oxycodone, 10 mg, 4 times daily prn AND Oxycodone, 5 mg, 4 times daily.  His goal is to keep a constant level of medication in my system to keep the pain from becoming unbearable which is accomplished with the Oxycodone 10 mg, 4 times daily.  If the pain is exceptionally severe, I take one 10 mg pill and one 5 mg pill about 15 - 30 minutes later if I've not gotten relief from the 10 mg.  On other occasions, I take the additional 5 mg table for break through pain.  That, along with lidocaine patches, meditation, warm compresses, etc, makes my life bearable. Having said all that, here are my two questions:

1. During the last week of July, I contracted some sort of bug which caused much nausea, vomiting, and diarrhea, along with a low grade fever for about a week.  On two occasions, I took my 10 mg oxycodone, but immediately threw up (one time I could see the pill and one time I did not, but I was certain I threw it up the second I got it down.  Not wanting to be in anymore pain than I already was in, I took another 10 mg tab.  In about 30 minutes, I began to feel woozy and realized with horror that I may not have actually thrown up the second pill.  I have been so diligent about taking my medication as directed, and have always been in compliance according to my drug screens, but I am mortified that I have messed up big time.  My doctor has put his faith in me to take the drugs as directed and I am so distressed that I may have let him down!  I am scheduled to have my next drug screen on August 18.  Is there a chance that the test will not cover the period at the end of July?  I am not sure what type of drug screens they run, but I assume it's just a routine drug test.  I really dread having to admit that I took that second pill, even though I did it in good faith.  Could you share your thoughts with me?  I am almost in tears!  Thank you.

2. I noticed several months ago that my doctor had changed the directions of my meds from "take one every six hours prn" to "take one tablet 4 times daily prn."  I asked my friend who is a nurse how she would interpret the "4 times daily."  She said I should take one around 8 am, 12 pm, 4 pm and 8 pm if needed.  Basically, take the 4 tablets within a 12 hour period.  I keep forgetting to ask my doctor, and all my drug test results have showed I'm in compliance, but is this correct?  Thanks again for whatever help you can provide me.  I promise my next question will not be so lengthy!

[Tuckamore]

That's not true in all substances, in all tests - but it is true in this instance. Some drugs leave trace metabolites.

Thanks for your input.

~Tuck

[GreenLeafyNothing]

You have absolutely NOTHING to worry about.

There is NO SUCH THING as a drug test in August that is going to show how much or what you took in July.

Not even if they hired NASA rocket scientists to invent such a test.

Period.

[philnoir]

Hi SockMonkeyPro -- thanks for explaining. That's a great story.

Perhaps you've heard the term, 'sock-puppet', which refers to characters like Shari Lewis' Lambchop, but also is applied to internet 'trolls' -- people who disrupt online forums through abusing its participants. The sock-puppet is the name behind which a troll appears.

Enough of that. Let's address your question.

Back when Shari was playing with Lambchop on those little B&W televisions, doctors would write PRN on an Rx.

For instance,

Take one tablet every 4-6 hours PRN pain.

PRN means, 'as needed.'

Today, there is too much risk surrounding the use of opioid medications. I wont discuss who's at risk, but will explain that due to this risk, a doctor writes QID or every 6 hours, instead of as above.

Then he may instruct his or her patient to take them as you describe for BT pain. Be flattered -- your doc is respecting your intelligence. She may also add: don't take more than 4 a day.

In this case, it is wise to follow your doctor's directions, regardless of what it says on the bottle.

By the way, that sharp pain as you turn -- do you have a diagnosis of lumbar spondylosis?

If so, that pain is caused by arthritic facet joints, and there is an interventional pain treatment that can remove that pain for 250 days or more. It's called a medial-branch neurotomy, or commonly, RF Ablation.

Best wishes.

[Tuckamore]

I have heard that phrase before, "Pain is inevitable, but suffering is optional." - but I've not heard it come out of a Physician's mouth - plus his addition of  "We'll get through this together."  You are blessed to have such a caring and compassionate physician. Hang tight to him!

MSW, I've worked with many and have several friends with that degree. I am also very familiar with Sock Monkeys. In WI you can also get them with blue thread in the toes too. I love your story. Early in my career I worked with  developmentally disabled adults. They can be challenging but they are a much more rewarding group of individuals. I have awesome memories, similar to what you shared with us - that I cherish to this day. I'm certain you do also.

Do you also take sometime to treat the actual nerve pain? I didn't see that in your initial post when you listed the meds you used. Neurontin (gabapentin) or Lyrica (Pregabalin) are the two primary drugs used to treat the type of nerve pain you describe. I have it also. It works wonders! I was hesitant to take it. I had tried Neurontin some years ago and it was not effective. Maybe the dose wasn't high enough but I didn't like the side effects - so when a new PMP suggested Lyrica I dragged me feet. Wow! It does wonders for my nerve pain. You may want to investigate it's possibilities with your physician. It's only a Schedule V and Physicians are Not reluctant to prescribe it. Anyway that's my two cents -  for what it's worth!

Blessings,
~Tuck

[SockMonkeyPro]

Good morning, Tuck.  Again, thanks for the information.  Please read my reply to Philnoir for the update.  You guys have really eased my mind about the extra pill(s) I took when I was ill.  Past that, I am not going to worry another minute about the somewhat confusing issue of having two different dosages of Oxycodone with the same directions on both bottles.  Technically, I could have taken the 10 mg and the 5 mg simultaneously four times a day and still have been compliant with my contract.  But my issue is not to "beat" a drug test, nor is it to make my physician look incompetent.  I thank God every day that he has treated me compassionately and has done everything within his power to give me a better quality of life.  As he told me once, "Pain is inevitable, but suffering is optional. You and I will get through this together."

[SockMonkeyPro]

Thanks for the insight.  My doc used to write my prescriptions "Oxycodone, 10 mg, 1 tab every six hours."  In response (I think) to the amount of breakthrough pain I was having, he changed it to four times a day.  I believe his intent in prescribing the additional 5 mg tabs 4 times a day was to address break through pain and/or if the pain had become so severe that the 10 mg dose was ineffective.  (Both my sciatic and cervical pain are exacerbated with movement.  I'm sure you guys understand that something as simple as reaching over to the toilet paper holder can bring me to my knees.  Sometimes it calms down on its own, and other times nothing on earth helps.  The only alternative is to endure it until it's time to take my next dose of medication.  Nonetheless, I will not leave his office on the 18th until I have a better understanding of his intentions.

A sock monkey is a stuffed animal, usually made from work socks.  The heel of the socks are red, which make for great big ole lips.  I am an MSW, retired, and much of my work was done with developmentally disabled adults.  One of my individuals loved sock monkeys and carried one with him wherever he went.  Alas, he left it at a bowling alley one day and it was gone by the time we went back to retrieve it.  He was inconsolable! There happened to be three other workers with our group and one of them said "Here is Diana and here is Theresa and John and Michelle.  I want you to choose the person that would be the best sock monkey to hang with you today."  After much deliberation, my individual decided I was soft and - his words - "would keep me safe and could beat up the a*hole who stole his monkey." For the next 27 years, the nickname stuck.  I eventually made another sock monkey for him and he carried it with him until he died of natural causes at the age of 72.  Life can just be really good like that. :)

[Tuckamore]

Very interesting - In my "world" QID meant four times a day - not every 6 hours. If a Doc meant every six hours he wrote it out. Of course that was "Back in the day".  I wish I had a quarter for every script I transferred in what they use to call the Medix - which was a list of the patient's medicine, when it was to be given, what it was, what it was for, etc.  I wrote out MD's orders and they signed them. I'd be wealthy if I had that quarter. :0)

I guess it depended on the area you lived in - or maybe how a particular facilities interrupted QID. So the clarification may have been needed if it meant different things to different ppl.

You're so right. There was much more latitude. Nurses and Pharmacists for example -  were allow to use the education and brains they possessed. Those days are long gone. I think mistakes and misunderstanding were less than - but I have no statistics to prove my thoughts. It was a simpler, kinder world - or so it seemed. :0)

[philnoir]

Back in the good ole' days of medicine, a pharmacist had more latitude with his prerogative in writing out instructions. I wish I could include an image here of how docs used to write Rx -- we used a lot of obscure symbols we were taught in clinical rotation (working in the hospital during medical school). These symbols were developed from the old apothecary system, where pharmacists made most of the medicines (before Big Pharma).

So we could write something like

Sig: T tab QID #120

and that T had a dot over the top. I have no such character on my keyboard. I guess I need an Apothecary font.

The instructions mean: Take one tablet every 6 hours.

The #120 is a note to the pharmacist -- put 120 pills in the bottle. That's what we called a 30 day supply -- and we did the math in our heads~!

If you guessed that QID means "four times a day" then you'd be a good guesser.

Back then we were allowed to think. The pharmacist knew that the doc didn't want the patient to take the 4 tablets all at once or every couple of hours. When a doc writes QID, he means every 6 hours.

And the pharmacist, smart fellow, knew this. So we could write QID, and that smart partner in your medical care, your pharmacist, would patiently type out his label:  

"Take one tablet by mouth every 6 hours."

These days, most Rx are written by computers where the doc puts in a number 4 in the correct screen, and the computer prints on the Rx: "Take one tablet by mouth every 6 hours"

But some docs still like the feel of that Rx pad in their lab coat pocket. It balances the weight of the stethoscope.

I know that I did, even though through most of my career, I never wore a lab coat -- I would hang up on the picket-wire fences I had to cross.

So these docs with pads may write QID on the paper script. They mean "Take one tablet by mouth every 6 hours."

But, the pharmacist can no longer use his brain to translate this message. I guess there's a lawyer looking over his shoulder, and like the rest of us, he doesn't want any trouble with that lawyer.

That's what we now call the "medical business."

And take that pain medication every 6 hours. Most docs think this keeps the pain low so it won't get a foothold toward making your life miserable.

What is a Sock Monkey?

Best wishes.

[Tuckamore]

You're very welcome. Maybe because of my background your doctor's rational and order makes sense to me - though I rarely see it written this way.

I think what he is saying is - take 10mg, if it is not effective in a certain time frame - (usually it's an hour) than you may take an additional 5mg. I don't find that confusing - though I can see how it might be.

Four times a day is usually your choice of time frames. Let's just talk about the initial 10mgs. It's four times a day. You may take one at 4AM a second one at 11AM, your third at 5PM and your fourth at 11PM or however it best suites your situation. In facilities the times are usually 8-12-4-8 or there abouts. Some facilities in may be 7-11-4-8. Just because that's what's usually done in a medical setting doesn't mean that those are the hours you must keep.

Rule of thumb, at least four hours apart. I take my 4th med at 10 or 11PM, it will hold me till about 3-4AM when I take my first of four meds for the day. My PMP knows that's the way I take my meds and he says, "Whatever works."  Why would they care if that fourth or first dose is very late at nite or early morning hours. It's the four a day that counts.

Thanks for responding to Remar's and my replies. Ppl don't often do that and we're left wondering if we were of any help - or if they even read our replies. So your responses are very appreciated. :0)

I look forward to hearing more from you. Good luck our friend in pain.

Peace,
~Tuck

[SockMonkeyPro]

Dear Tuck, I appreciate you and Remar both taking the time to address my concerns.  What you've both said makes a lot of sense and, for the first time since I made the error, I feel like I can breathe a little easier.  I will let you know what my physician said about giving me two prescriptions in different dosages but with the same exact directions.  I've since found out that the protocol for taking meds four times a day is they are to be taken during waking hours unless otherwise directed.  If the label said take "every six hours," then they are to be taken six hours apart, no exceptions.  As I told Remar, I'm so grateful for your input.  Good luck to you in all your endeavors.  - Diana

[SockMonkeyPro]

Thanks so much for taking the time to respond to my question, Remar.  You've given me real peace of mind.  I'll follow-up with getting clarification about the need for two different prescriptions when I go for my drug test on the 18th.  Again, I greatly appreciate you sharing your insight with me.  Wish me luck!

[Tuckamore]

Oh Sweetie,

It's a sad commentary when we Chronic Pain Patients feel we must be concerned, and risk losing PM (Pain Management) when we've been ill - or may have made a mistake in our meds.

You'll be fine. An extra tablet or a missed tablet is not going to mess up a drug screen weeks later - if it was a chronic procedure yes but not an occasional error. Honest, that one day a few weeks from the Urine Drug Screen isn't going to change the results.

Please let us know that my statements are correct. None of us should have to worry like this!! We all need to know that something like this won't jeopardize our PM (pain management).

Keep in touch - and try not to worry. It'll be okay.

My Best to You,
~Tuck


  

[remar]

Your concern is about taking the two extra pills because you know for sure you vomited one pill, possibly two. If that's your concern then you have nothing to worry about. I would think  your Dr will understand that you were sick. You didn't take 3 pills in a short amount of time for no reason. It was because you were vomiting the pills back up.
I'm wondering why your Dr has you on two different doses. He must have his reasons. You need to know why though and also need to know when you're supposed to take your meds.