Negative Test - False Accusations

[think4u62]

I hope I can get some assistance with this dilemma.  I am currently assisting a person dealing with PTSD , neurological and physical truama and a lot of the pain associated with being a victim of a gay hate crime.  For the past year and a half, he has been on several medications for depression, pain, sleep and for symptoms associated with PTSD anxiety and nightmares.  Recently, he was asked to submit a urine sample, and his test came out negative for the vicadine that he was taking "as needed", and was accused by the nurse and the doctor for "selling his medication" and not taking it as prescribed.  Now, 6 months earlier, this same man being accused of selling his medications, returned 3 prescriptions to the previous Dr. (she no longer works there) because the medications were not working with the other medications he was on.  The Dr. informed him that he was a liar, and that he was not going to treat him because if he was taking the medications, then he would test positive.  I saw this person approximately 1/2 in my office, shaking, crying and wondering "what he did wrong?"This doctor does not realize that this victim of a hate crime who suffers from PTSD, was just re-victimized, and sees nothing wrong with what he did.

Now, my question is, I know that this person takes numerous medications, and I informed him that he should go to his primary and discuss the situation and ask for both another urine and blood test.  He managed to do so the following day, and was administered the tests, but was denied another referral from his primary doctor for another pain management specialist.  The Cl is on disability, so does he have a choice, or can he seek another clinic/doctor without the referral?  Second, I know that this Cl takes his medications, but for some reason, the vicadin, anti-depressants and sleep meds did not show on either test, or than the "obvious" of not taking them, which in his condition is not likely, could there be a reason for this?

Any assistance in this matter would be greatly appreciated, as I would like to assist this CL in the best manner possible

Respectfully,
Think4u62

[sandee1818]

I had done some research on this issue a few post down. If you will look for false negative results you will also find some other member's post on this. In my research I found that there are several 12 I believe medications that will cause a false negative urine screen. I will find them and re post them for you. These urine test have cutoff levels and depending on the type of test you get it may require a trace amount of the drug to be present for a positive result and then there are the test that require a much higher cutoff point or level of medication that has to be present for it to come out positive. The VA has done extensive studies on this matter and I will also point you to that link too. I am so sorry this happening to your friend, it is very hard to deal with his kind of thing and I would imagine even more difficult when it is treatment for a violent crime committed against him. He certainly has my sympathies and I do hope and pray he can find another PM that will treat him. I know that a lot of Pm's require a referral but some do not you can check in your area to see if you can find one. I would suggest getting a copy of his records and sending them to some Pm's in the area and explain the situation and see if one of the Dr's will agree to a consult. My PM is great and I did not need a referral I referred myself and their are many that will accept him with the proper records. When you get a copy of his records also get a copy of his pharmacy records too for the Dr's. I will post the above things as soon as I can. I urge you to get started on these things right away if that is what you choose to do as the longer you wait the more difficult it will be. Don't give up hope there are Dr's out there that are sympathetic and have compassion, although they are few and far in between they do exsist.

[sandee1818]

I forgot to mention that if he is out of his meds he should go to the ER and try and at least get his antidepressant meds as stopping them abruptly is not good. Labs and lab techs can make mistakes after all no one is perfect. Is there a possibility the Pm will re do the test? If he has been out of his meds for over 72 hours though this will not do him any good.

[sandee1818]

It seems that these test have cutoff levels as in some are very sensitive while others are not sensitive enough to detect the drugs.

A drug screen is a complex thing and the higher tuned (more sensitive)
it is the more complex it becomes. You see, drug screens can be
adjusted to detect various trace amounts of many different types of
drugs. Some test react positively for the presence of drugs
(substances or derivatives) only if those traces appear in the test
medium in certain volumes. For example, a person on parole may be
given a test for marijuana (cannabis, hash, etc) that will respond
positive if the test medium contains traces above  a certain “cutoff
level” where the cutoff level is very low (10ng/ml possibly) . Whereas
a person applying for a job may be given a test for marijuana
(cannabis, hash, etc) that will respond positive only if the test
medium contains traces above a certain “cutoff level” where the cutoff
level is very high (50ng/ml possibly).

There is some recent history with false results as is evidenced by
studies conducted by the Veteran’s Administration (VA). For example,
the VAGLAHS Outpatient Pain Program (OPMP) utilizes a standard Drug of
Abuse (DOA) immunoassay and Biorad High Performance Liquid
Chromatography (HPLC) Remedi-HS. These tests are used to monitor for
medication compliance. In 2004  as many as 44 % of patients tested
were found negative for opiates despite patient prescribed opioid
medication. The VA concluded that the DOA test was not sensitive
enough (in other words the cutoff was too high to detect the presence
of opioids commensurate with what the VA considered minimum
requirements)
.‘Result of Urine Toxicology in VA Patients Treated In a Pain Clinic’

This is an article of the VA study......

http://www1.va.gov/hsrd/about/national_meeting/2004/abstracts/2047.htm



I think my above post is saying that the test these Dr's are using are not the best for our situation. In order to test positive for our meds we have to have the required amount in our system that the test requires in order to test positive. If one test requires only trace amounts then surly there will be no problem, if one test requires that a high level be detected then we will have to have that level in order to test positive. Now to me this is outrageous that the Dr who orders these test can order the test that requires higher levels of the drug to be present in order to


These are the drugs that will cause a false negitive.....

The reactivity of 13 quinolones (levofloxacin, ofloxacin, pefloxacin, enoxacin, moxifloxacin, gatifloxacin, trovafloxacin, sparfloxacin, lomefloxacin, ciprofloxacin, clinafloxacin, norfloxacin, and nalidixic acid) was tested in 5 commercial opiate screening assays from September 1998 to March 1999. In 6 healthy volunteers, we confirmed the cross-reactivity of levofloxacin or ofloxacin with these opiate screening assays. be positive, therefore some will and have failed these test. There is a member here that is a lab tech and can answer far more questions about this I will see if we can get him to reply.

[sandee1818]

I hope this helps if you need anything else please let me know.

Good luck, your friend is lucky to have someone who cares so much about his well being and I really hope things work out for him.

[extrmeski]

I as well had the same probelm.  I was taking fentanyl patches 100mcg every 2 days, and percocets for break-through as needed.  My tests came back positive for Fentanyl but no oxycodone (active ingredient in percocets)  they kicked me out of pain management.  So no big deal right I mean I just my monthly supply and a week later they inform me I'm out.  So I make an appointment at another pain management place, things are great.  Well I get to teh new place get treated like I am some untouchable addict and the doctor tells me that I am on such a high dose he doesnt want to touch me.  Great, then he gives me a list of doctors that will treat such a high dosage of drugs (I never asked to be on them in the first place mind you).  Well can't get in until July 28th  this was the beginning of June mind you.  So I go back to the pain mgt place and was told too bad.  So I went to my primary and he said the same thing!  Do not trust doctors.  Oh I forgot to mention that my 30 day pain mgt appt due to scheduling problems was on day 34.  I got a 30 day supply you do the math!

[Toomanyadvil]

Hi Extrmeski


          I'm so sorry this has happened to you also.
It seems lately so many people are having this problem.
Did you sign a pain contract with the PM DR?
The contract will usually say that either the DR can terminate treatment without tapering the medication for certain reasons or that upon termination the DR must either perform a taper to get you off the medication or refer you to another DR.

The urine tests are supposed to be done a second time to make sure there wasnt a mistake using a more sensative test. Did your DR do a quick in office test or send the sample or you to a lab?
I'm sorry you got discharged without any help and are having such a difficult time.
If I understand you correctly you have a 30 day supply and will run out 4 days before a new app?
Have you tried calling the DR you have the July app with and explaining that you only have a 30 day supply and will be out before you can see them.
I know your in such a awful situation and up against a rock wall.
Remember you always have the DER if the pain gets out of control or you start going through withdrawls. The ER may be able to help if you explain that you have a app with a new PM DR but cant get in early and dont have enough medication to get you to that appointment.

You may also want to get a copy of your records from the past PM DR. The new DR will be sent them. But it's always a good idea to know what is written about the urine test and if it lists what test was given.
It may help not to go in blind to what the DR was thinking and wht this really happened.
You also may be treated faster if you can give the DR your records the day if your forst app.

I hope your able to find help with this new DR and they will be willing to stabalize your pain.

TMA

[Toomanyadvil]

I wanted to metion also, that make sure at this new DR if they ask you to sign a contract to make sure you get a copy to have yourslef so that if something like this ever haooens again(knock on wood) that you know what is expected from the DR regarding being tapered off the medication or referred to amother DR.

TMA

[babydm29]

your friend is in the same boat that I am in. I no longer have a PM either cause my Urine drug screen also came back negative. When in fact I did take my meds all the time, on time. My PM dr didnt even concider any reason that it could have been negative. He ASSUMES that I am not taking them and selling them. Im NOT.. But now Im going threw withdrawls and have NO PMdr cause mine disowned me after the test came back negative. I cant find anouther dr cause of what he wrote in his reports. My PCP will not deal with chronic pain, So like your friend IM SCREWED too. I hope that your friend has better luck then I am having. Im out of my meds and cant get anymore. withdrawls s**k. So your friend isent alone in what he is going threw Im right there by him. Except that this has never happened to me before. I dont C Y he just wouldnt do a blood test just to double check. NO he assumes things.

[MajorDose]

I was told at my lst visit that I could no longer receive meds due to a negitive blood serum test. I have not returned to the office but have an appointment July 1st. here is what i done.
I called the lab doing the test. I did not ask for the results but I asked to speak with the pathologist. Asking him how do some ressearch on drug testing before you call to be familiar with the concepts. I found that the blood serum test that was done was not checking for oxycotin so negitive results is on the part of the doctor or staff that did not order the correct test. I have had other negitive urine test while taking oxycodone but what got the pathologist's attention is a urine sample taken on the day that the cath was removed at the end of a pain pump trial did not detect what daladuid leaves. He verified that it would have been detected with the 10 panel test that they had done. Now he is looking at my other negitives and has doubts. Either there is something keeping detection from happening or their tests are flawed.
So back to the doctor and demand monitored testing. Check to see if the process was wrong the blood serum test should have never been done then held against me, as well as the urine test that did not detect what as any reasonable doubt should have been there...... human error.
Followup and get proof if not their clerical mistakes and office help will not get it right and someone else will be ousted

[sandee1818]

I am glad you were diligent and found the problem. I hope that your doctor will now order the proper test for you. This does happen alot and it is terrible!

[Babs1469]

It is so harsh how some doctors seem to only see black and white and not consider other possiblities!  It is not safe to cut you off like that without giving you the benefit of the doubt and at least helping you ween off safely. The doctor cannot ignore the symptoms of withdrawl I mean you don't need a lab test to see that right? It makes me so mad that the reason we all have such a tenuous control over our lives is because some people think it is fun to get high or easy to make a quick buck.

When I read posts like this I remember to be grateful for the wonderful, caring, trustworthy doctor and PA I see.  My heart goes out to all of you who have suffered needlessley because the doctor was covering his/her a$$

[ChronicPain1]

Something absolutely needs to be done about this, it's infuriating that people are suffering because of inaccurate tests. I can't believe this is going on, doctors need to be made aware and bring it up at national conferences.