We have all been seeing the post about the false negitive test and what happens as a result.
I am all for supporting chronic pain Pt's but I also want to share the doctors prospective on this too.
I am not a doctor but I do understand why they tend to release the Pt after a negitive drug test too. they spend years and years working to become a doctor and they work hard and usually have long hours as well. They also have the DEA breathing down their necks and while they want to help their Pt's they too have to look out for their practice and their well being and their families too. The doctor is usually the bread winner in the family and if they were to believe everyone who had a negitive test result and then continued to give the their narcotic medications then that puts them at risk as well as their families.
I know no one wants to hear this but it is true, these doctors do want to help those in pain or they would have never went in the pain management practice to begin with.
They do have those Pt's who use them and decieve them and abuse their trust and when they have been "burned" once that puts them in a postion of questioning all of their Pt's. is this fair to the legitimate Pt's, NO.
But what would you suggest they do? if they do trust the wrong one then they are risking everything they have worked so hard for and their families finances and maybe evn their own freedom.
I do agree we as Pt's have a right to fair treatment and the right to have a doctor who will satnd up for us but we also have to remember they have a lot at stake too.
I hope this helps us realize that it is not so simple when there is a false negitive result and we need to look at all angles and not just our own.
What are your feelings and what do you think could be done to make things better for us and our doctors?
I appreciate your input:)
Please excuse my spelling errors, my spell check is not working properly.
I agree with you sandee, it is hard on both sides. The doctor's are risking their career and livelihood to work in the profession of pain management. There is always the risk that the person in front of them is lying to them. They do need to be careful and it is sad when someone has a negative test done and they have done nothing wrong but, i do see both sides of it.
I am thankful for the doc that i have and tell her everything and keep her updated on what is going on. I feel like I have built a trusting relationship with her and would never do anything to damage that. It almost cost me my life being in that accident of mine and because of her, i have somewhat of a life, no where close to where i used to be but, I can function as somewhat of a normal human nowdays because of her.
Everyone needs to be careful with their meds, guard them with your life basically and take them as prescribed and if something like false positive or false negative should come up than i would hustle my body to the closest lab and have another test taken or do what i needed to do to get help. It is really hard on people when this happens to them, i understand that but, you are right - the doctor's are trying their best and even though i complain from time to time i am still eternally greatful for the help that i do get cause i could be getting no help. We all need to remember that we are lucky to get help and not take that for grantid.
take care everyone - i hope i did not say anything to offend anyone, i am just stating my opinion and that is all it is - is my opinion.
If the proof is out there that these tests can be up to 44% incorrect, then I think it's the doctors responsibility to have another option available,ie the blood test. As an example, imagine at an endocrinologist's office they were dueing blood glucose tests with a machine that was wrong 44% of the time. They certainly wouldn't tell the diabetic well your numbers are off, your dismissed.
If the pain patient comes up negative on the ua then they should have the ability to take the blood right there and then so if the patient is diverting they will have no opportunity to take some meds and if the patient is not diverting the blood tests would reveal that.
I find it completely unfair that with a negative ua you can be dismissed on the spot with no meds to withdrawl from. If the tests are this inacurate then there should be another test. We sign our lives away with these contracts,we have no choice but to follow them or we will be dismissed. What is there to hold the doc to the contract if even anything in the contract applies to the doctor. In addition, many of us have to go through shots, blocks,etc. in order to get the meds and very few people have success with these procedure. No other group of patients must sign similiar contracts and go through painful procedures in order to get their meds. We are afraid to say what we think and feel because what if we tick the doc off and he no longer will prescribe the meds. Anyone seeing the pattern here?
I completely understand the doctors needing to protect themselves, but how are we protected. Someone may be thinking that if the doc dismisses us then he must prescribe 30 days worth, not if he thinks you're diverting. You can be dismissed without meds. You can also be dismissed on the doctors whim. They have all the power.
It's a difficult choice to make here. I can definitely see both sides. I have 2 wonderful doctors that I see every month, I get pain meds from both and I do not have a contract with either one. My internist does blood test me every 3 months, but only to make sure that my liver and kidneys are ok. I have never given either one of them any reason to doubt my word.
I do understand why doctors refuse to take a chance on patients, most of them have been burned more than once I'm sure. I do understand that signing a contract is for your safety and the doctors, and I agree that a false negative should be able to get blood work done right then, it might make the biggest difference to all.
I did take a blood test 6 hours after taking a 5mg oxycodone and did not think I gave him a reason to doubt me. I tried a 25mcg fentanyl patch and returned them when I recieved the lower dose. That made me sick so then I tried the oxycontin for a month with no relief. So then Iasked for the lower dose fentanyl 12mcg and the oxycodone 5mg(which did not work w/o the patch) and that worked it took my pain down to where I could tolerate it and function. It did not make me sick after the first patch or make me feel euphoric or high or whatever some call it. If it is too much, just like with alchohol I got sick. I completely understand the doctors point of view and we feel terrible without our meds, bt their liscense to practice is not worth breaking any rules. I would not want to lose my job for breaking a rule to help someone else. It is human nature to put ourselves before others. If we did nothing wrong then hopefully the truth will come out. They do have the power but they also went through many years of school and time to get where they are.
I have to agree with Boxerluver. If the drug screens were 100% accurate that by all means dismiss the patients when they fail. They would absolutely deserve it. But we all know they aren't even close 80% accurate.
So you sign a contract that really says when you are doing everything right and the test comes back wrong...you're gone. I do not see the justice in this. The physician has ALL the protections and rights and the CP patients have absolutely none. How does this contract protect the CP patient?
Inaccurate drug screen? You are assumed guilty without even being able to put up a defense. Guilty as charged! Is this democracy? I'm not asking any PMP to put his liscense on the line for me. I just asking to be treated fairly. Even someone accused of manufacturing and distribution of a controlled substance or committing murder is entitled to a lawyer and a jury trial before his peers. Fail a drug test and you are guilty!!! Am I the only one who sees something wrong with this picture?
No! You're most definitely NOT the only one who sees something wrong with this picture! It's VERY unfair to the CP patient!
I can absolutely see the attempt to protect the doctors, the odds are against everyone with a negative test being on the up and up, but not even an 80% accuracy rate on the tests makes it unfairly biased toward the doctors in the extreme! I think that they should at least mandate a second test after the first one is failed before they are allowed to just turn a patient out. If they cut a patient loose because of a failed drug test, that patient not only has to now find another doctor, he stands almost zero chance of finding that doctor because of being released by the doctor who administered the failed test. So now someone who is legitimately in pain suffers, the doctor looks like the fair-haired boy for being good and not dealing with someone who "wasn't truthful" about how they were taking their meds, and the drug addict who is taking the drugs just to get high STILL manages to get them ANYWAY from somewhere else. The addicts always manage to get what they need, by WHATEVER means necessary, and the CP patient who has always been honest with the doctor now goes through hideous withdrawal symptoms because of a test that is accurate less than 80% of the time. Ridiculous!
Something needs to be done, or new tests devised or something. Like I said, I had a doctor ready to boot me out the door once "We found opiates in your system, we can't treat you" and I forced him to read the paper I handed him BEFORE the test, and I listed what I had taken!
Doctors are under tremendous pressure, I understand that. However being paranoid and ready to dismiss everyone as an addict is not the way to do it. Doctors and Patients need more protection, if a doctor prescribes adequate pain meds and the patient abuses, he should not get in trouble. If he prescribes way more pills than he needs, okay then that's wrong.
I had an appointment this coming Monday for my regular monthly visit to my doctor up in Houston. Then, because of all the hoopla and problems with oxycodone and Ethex, for the first time since the nonsense started, my entire prescription did not come through and I was shorted two bottles of the oxycodone liquid by my pharmacy. Rather than overnight me a prescription for two days worth of pills to replace the missing liquid, my doctor asked me to come in on Friday morning instead, and we would start my new month three days early.
While I was there, rather than continue with possibly not being able to get part of my prescription (until they finish ironing out the wrinkles with the oxycodone liquid) my doctor just decided to switch me to Methadone 10mg (1 tab every 4 hours) with oxycodone 15mg (2 tab every 4 hours) for breakthru pain. When my doctor first began his practice, he used to moonlight down here at our local hospital, so whenever I have my appointment, we spend time talking about my town and what's new here, etc. We have developed a very friendly relationship over the years and it's nice to sit and chat with him as a friend. I take his advice very seriously, even the non-medical stuff. And this visit, we also talked about how expensive it is each month for me to come to Houston for my appointment. He knows that I don't drive, and that I pay someone to drive me there each month. I had seriously thought about getting my license, but after reading about the problems that some people have had because of having their meds not only in their systems, but also with them, I'm not so sure now that I want to go through with it. He told me "You know what you should do? Now don't get me wrong, I am not trying to get you to find somewhere else to go because of anything other than it's so monstrously expensive for you to make this trip each month. You should find yourself a family practice doctor down in B**C*** who isn't afraid to write prescriptions. They can consult with me and I can help them prescribe pain meds for you, and all you'd have to do is go to their office right there in your town." I thanked him for being concerned with the large outlay of money each month on my part, but I told him that, while it's great now that literally HUNDREDS of dollars will be saved each month now that I'm on Methadone instead of the oxycodone liquid, even if the price of gas went up again I wouldn't consider switching to a family practice doctor who would write scripts because there is no such animal in my town, number one, and number two, I don't trust them to just turn me out for something stupid somewhere down the line because of something absolutely nonsensical.
The part I love best about my doctor is that he doesn't "do" knee-jerk reactions. He doesn't overreact or underreact to things. He weighs things out slowly and deliberately, looks at all of the "what ifs", and then plans his mode of attack from there. Some things are worth more than money to me, and one of them is my relationship with my doctor. I would rather spend more money to make the trip to see him than have a doctor right in my own town who could get an attack of the heebie jeebies over writing narcotics prescriptions because of something they read in a magazine or saw on the news. I'm not up for that kind of trade off or that kind of worry, that every visit could be the one where the doctor decides that they're a family practice doctor and not a pain management doctor, and that writing prescriptions for narcotics is something that is best left to the specialists. I've got my specialist, I'm sticking with him.
I do agree with the point made about us CP Pt's not having enough right's. We can and some have been kicked out or fired because of one false negitive test result and that needs to be stopped. I totally agree with that!
When I posted this my intention was to have other see both sides. We often see the CP Pt's side as there has been many posts where a member has been fired due to one false negitive result but we do not see the doctor's side of it often.
Believe me I understand the anger and humulation that's invovled when one is fired unjustly.
We need to think of a better way to kick the ones who divert to the curb w/o affecting the true legitimate Pt's.
I do not have the answer other than give the Pt the benifit of doubt and ask for a second test when a false negitive result is given. There ARE too many mistakes made to assume the first test is correct. I have done a lot of research on false negitives and there is just too many varibles and when your dealing with humans there is always room for error. It is just reality that human beings do make mistakes and to base someones health care on that is rediculious to me.
We do have to do something though other than post our feelings on the subject, something that will bring forth change.
Any suggestions on how we can accomplish this?
Yeah Ghilly my current Pain Mgmt. clinic is now moving, another 15 minutes away and that kind of irks me. Since they can't fax prescriptions for opiates(Never understood this, wouldn't that be safer? Doctor to Pharmacy, bypassing the patient?) I now need to go all the way out there. It's a pain, and I do drive. I hope you find a closer place.
sandee, I'm not sure how we could accomplish this. I'm not sure contacting our representatives would do much, but there needs to be a petition or something. Having your name blacklisted in your file forever because of a faulty test is just wrong.
Actually I have proposed that we all do some thing in the past. I have not been successful in obtain answers or group support as to what to do.
So I have personally written my state and local representatives in the past on Pain Management and the difficulties we experience. One person hasn't made a difference although I do beleive that one person can.
Obtaining a valid test result is a complex process because results are affected by several factors including the subject of intrest, test methodology, pharmacokinetics, chain of custody, procedures of intentional and unintentional tampering.
Unless proper procedures are used in collecting , analyzing and interpreting laboratory testing for drugs there is a substantial risk of error.
Many doctors lack an adequate understanding of the complexities of UDT and the factors that can affect the test results.
These factors include metobolic conversion between drugs, genectic variations in drug metabolism, the sensitivity and specificity of the analytical method for a paticuliar drug or metabolite. Also the effects of intentional and unintentional interferants.
This is from sharon Levy MD, MPH
There are many articles I have found on this subject of false negitive test results. the ones that stand out to me are from levy and those of SR savage.
\There is some research being done on this. So there is hope ahead:)
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