Yale H. Caplan, PhD, D-ABFT
Director, National Scientific Services
"Amount of Drug Taken: At this time, there is no scientifically validated relationship between the amount of drug taken and urine drug concentration. Therefore, a UDT cannot indicate the amount of drug taken, when the last dose was administered, or the source of that drug.1-5 Recently, some laboratories have offered technology to compare a patient’s UDT
result to an expected range for a drug—they claim that comparing a normalized test result concentration to the expected range can measure compliance with the prescribed dose (reporting: in range, low, or high). Although their protocol may calculate a normalized value based on the patient’s height and weight, the specimen’s pH and specific gravity, and prescription dosage, many other factors can influence the absorption, distribution, metabolism, and elimination of a drug. These include genetic polymorphisms (eg, enzyme deficiencies), renal and hepatic function, disease states, body surface area and muscle mass, cardiac output, drug-drug interactions, drug-food interactions, and age. Therefore, at this time, UDT measurements should not be used to extrapolate backward and make specific
determinations regarding dose and compliance with the prescribed drug. Software and laboratory products have not yet been fully validated scientifically and peer reviewed in the medical literature. Interpreting a UDT beyond the current scientific knowledge may put
healthcare professionals and patients at medical and/or legal risk." Is this an exact science?
Drug test are not an exact science by any means. There have been numerous members here alone that have had false negatives.
There are test that can validate a drug screen but they are expensive. Also there is blood work which is far more reliable but most doctors depend n the UA screens which are not exact.
I have been the victim of a false negative so I know the pain and anger one feels when the doctor says well none of your medications are showing up in your UA screen. It is very hard as your taking your medications as prescribed and you just want to scream. The idea of being seen as a person who would divert drugs is very hard to deal with. Although my doctor knew I was taking my medications it is very embarrassing.
I have some information in my journal that shows the VA did a study where their Pt's on narcotics were coming up negative too. Mollyrae also has some information in her journal on this.
What upsets me about these tests are the Doctors expectaions. These patients are taking their prescribed medications and sometimes might not necessarily need the entire dose for that day (or may need an extra dose) so they take what they feel is going to help in the moment. Not every day is the same when Chronic Pain is involved. So a patient takes what they feel is appropriate for them...within reason (sometimes I may need an extra pill or one less, depends on the day)........
The Doctor looks at this test and expects the prescribed amount. How can one person judge what another needs for that day. We are all different and have different needs. I think these tests need some give and take space adn the Doctors of all ppl should realize this.
Now I can see if the patient wasn't taking their meds and NOTHING, nada, zero was found. That might be grounds for termination but not when there are the prescription drugs found no matter what the level.
I feel that these tests need to be re-evaluated so that the chronic pain paitent doesn't need to suffer or worry anymore.
The fact is that at least one medication (oxycodone) is notorious for false negatives, and depending on a variety of factors (metabolic, time/amount of dose/genetic) a zero amount is possible regardless of how many times the specimen is tested. While the technology used has come a long way, no UA is infallible for the aforementioned reasons as well as chain of custody/lab errors. Either use two methods to begin with and one follow up before termination of medication, or find another way. These physicians are acting either on fear, profit or both. I have observed detailers selling them on medications that relied on slick presentations, and/or a 'perk'. The recent case of one large pharmaceutical corporation offering perks for another medication even while paying out for doing the same on another one demonstrates the level of corruption. Many of the physicians are no different from anyone else in falling for sales presentations from intentionally attractive sales people who don't know an analog from an isomer.
I would never divert my medication for these reasons: I need it for the pain; it goes against my moral/ethical beliefs; if I didn't have those beliefs I would sell something far more profitable, like coke (if I was taking the risk, I'd make it worth my while). I have far too much to lose, both in coping with the pain and getting caught. I am all in favor of stopping those who do divert (and I mean sell--if my wife ran out and she needed one since she's on a similar medication I would give it to her) because if they are not taking it they don't need it and are making it difficult for legitimate intractable pain patients. One UA alone should never be grounds to end patient care. A series of random follow ups using blood tests should be enough to take care of this. They also have the option of asking a patient to bring their meds in at a random time if they suspect diversion. It is true that there are times that we simply don't need to take it (depending on the problem). If I don't need it, I won't take it (although for me at least, I am open to sudden breakthrough which takes awhile to subside). Ameritox for example has a terrible reputation, their RX Guard is called 'snake oil' by many insiders, and they are being investigated for Medicare fraud and paying kickbacks per patient tested to physicians. Their RX Guard system appears in no scientific papers/journals which are peer reviewed, only advertisements with testimonials (subjective and suspicious IMO). This is not ethical in any way, shape or form.
I must add this observation. Intelligence is to wisdom what stupidity is to ignorance. Physicians are intelligent, but can act without any wisdom at all. There are still physicians refusing to provide adequate pain relief to terminally ill cancer patients because they may become addicted. They're not going to 'withdraw' or exhibit drug-seeking behavior from the grave I suspect. If I were dying from bone cancer (nothing treats that severe pain), I would rather end my life than have my last days spent in such agony watching some ignorant fool 'bravely' keep me from becoming (gasp) an addict.
I agree. I was reading some articles about Kevorkian and began to understand some of these peoples pain that were so under treated for pain they chose to end heir lives.
I really never understood one wanting to end their lives as life is life but when I read about the pain they were in I began to understand a little bit where they were coming from. Not that I advocate this by any means.
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