Pain Management Community
Pain Management Doctor Drug Screenings
About This Community:

This patient support community is for discussions relating to pain management, chronic pain, arthritis, back pain, cancer, headaches, movement disorders pain, and muscle pain.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

Pain Management Doctor Drug Screenings

Hi everyone,

I just joined this forum and have been reading through many informative posts from many people like me.  I apologize if this question has been answered before.  About a year ago I was diagnosed with degenerative disc disease, and found out I had suffered from 2 severely herniated discs, sciatica and muscle loss in my foot.  I've been in pain ever since.  I've been to a few different doctors looking for help with my chronic pain.  After seeing my MRI's, doctors are more than willing to prescribe me pain medication, but then they refuse to refill, leaving me stuck without answers.  I finally just found a pain management doctor who is actually willing to help me with my chronic pain by prescribing pain medication.  I had my first visit with him a few weeks ago, but since I've had so many bad experiences with other doctors, I lied to him about how much medication I needed to help with the pain.  I told him that 3 pills 3 times a day is what I was used to.  Anyway, I obviously ran out of the medication sooner than I was supposed to because I was really taking 4 - 6 a day instead of 3.  I had a leftover precription of Norco from an old doctor's visit I had, so I've been taking those for the past few days.  My next appointment is coming up and I'm nervous that me may drug test me as stated in his contract.  Though I want to say that he seems like a very easy going doctor, he wasn't too invasive in his questioning and didn't treat me like a drug addict like other doctors in the past did.  His office is literally made up of a tiny office and a small waiting room with one assistant... there's no real medical room that you'd see in a standard doctor or medical office/clinic.  It's just really an office.  So I'm wondering if he's really even going to drug test me or not.  Anyway my main question is if he does decide to test me in my next visit, will he be able to tell which kind of pain medication I have been taking, and in what amounts?  I've read that urine tests can't test the concentration of the drug, just whether it's there or not.  I'm not too concerned with explaining to him the truth, since I did mention to him in my last visit that I had some left over Norco's from another visit.  I'm just more concerned with him being able to see the levels.  I don't want him to kick me out of his practice over this, because I feel so lucky to have finally found a doctor who can help me.  I really want to be more open with him and tell him I need a higher prescription, but I'm nervous as to what he may think.  Does anyone have any experience with this?  

Thanks for reading...
Related Discussions
10 Comments Post a Comment
Blank
Avatar_f_tn
Well, IMO you are going to have to come clean with him.  It's never a good idea to be less than honest with your doctors.  I understand your frustration and fear but you have to be totally honest with him BEFORE he finds this out through a urinalysis.  Maybe you could just tell him that you were really afraid and hadn't been honest about what you've been taking and that you didn't tell him out of fear.  Hopefully, he'll be very understanding and can reevaluate what you really need.

Personally, I won't take an extra pill or take anything even one minute early.  If my pain is so high the meds don't help, I call and talk to them and try to figure something out.  My pain clinic isn't as strict as some but I still don't chance things.  And I also have a fear of sliding from dependence into addiction, though that's my own fear based on seeing too much addiction in my ex and his family.

My boyfriend has his pain managed by our primary care doctor.  She is excellent but she is extremely strict.  She wants to be called, even after hours/weekends, if you need to change things even slightly.  We all came down with stomach flus in May.  I wound up in serious withdrawal as I couldn't take my medication for days.  I wound up in the ER (and had a terrible experience there.)  When my boyfriend started with the stomach bug after me, I called our primary care doc BEFORE he reached the point I got to.  She said she was glad I called and that even if he was throwing up his medication, he was never to take anything extra without calling her as it violated his pain contract.  She did tell me to give him an extra one and also gave me ways to keep him hydrated and told me what to do if his vomiting lasted more than the day.  Luckily, his only lasted 12 hours and he was fine.

But IF he had taken even one extra pill, she would have had to stop his pain management according to the policies in her office.

As hard as it may be for you, you HAVE to tell your doctor about this.  If you don't, you may lose him.  Most doctors seem to be very empathetic and understanding IF you tell them beforehand.

Trust is an integral part of pain management, on both sides.  You need for them to trust you.  A good pain management doctor/team can often be very hard to find so if you feel this is a good doctor, you don't want to lose him.  (Though in my personal opinion, a doctor that ONLY prescribes medication, especially initially, raises a red flag.  In a lot of cases, pain management consists of a multi-faceted approach.  They may have you try procedures, a pain psychologist, physical therapy, occupational therapy, etc., in addition to medications.  Some people only do medications but it seems to me that's after they've tried other things in addition to the pain medication.  Of course, at a certain point, the doctor may feel they've tried everything they can and pain meds are the only thing helping, and that's fine.)

This is a great forum and I hope you keep posting and let us know what happened.  Please call your doctor on Monday and explain things to him.  The sooner you do this the better, and you'll feel better when you don't have to worry about it.
Blank
Avatar_f_tn
I'm sorry you're having so much pain and finding it difficult to manage it with the meds your PM doc has prescribed.

My first question is - the medication that your new doctor prescribed - is it Norco like the prescription from your old doctor?  Or was it something completely different from what the new doc gave you?

Unfortunately, the results of you having taken ANYTHING other than what your new doc prescribed - in the dose he prescribed - IS a violation of the pain contract - so I fear either way, you may have some issues to deal with.  However, if what your new doc prescribed is a completely different med than the Norco, the problems could be even worse.

As mellie said, you NEED to be 100% honest with your new doc NOW - before your next appointment and let him know what you've been taking and exactly how much.  DO NOT wait until you are there for your appointment and possibly getting tested.  If you are open and honest with the doc now, before them possibly handing you a cup to pee in, it should be looked upon much better (even with this error you've made) and not like you've been trying to hide the fact that you took more (or different) meds than what you had been prescribed.

Be honest with the doc about the reason you originally told him that 3 pills 3x a day was enough was because of how you had been treated/looked at it in the past by other docs and you were afraid that if you told him exactly how much meds you required, he may think badly about you.

I'm also a big confused on the dose that you were saying.  When you say 3 pills 3 times a day - what is the dose of each pill?  5/500?  5/325?  7.5/500? etc., etc.?  And when you say 4-6 a day, is that ONLY 4-6 pills a day or 4-6 pills THREE times a day?  My concern with this question is the amount of acetaminophen that you could possibly be ingesting.  Even at a 5/500 dose - taking 3 of them 3 times a day, you are over the maximum daily amount of aceteminophen (which is 4,000 mg and you would be ingesting 4,500 at that dose)  Taking more acetaminophen (tylenol) than the max daily amount can be VERY dangerous and damaging to your liver and could potentially cause more damage and problems than the narcotic portion of the med itself.

So PLEASE do call your doctor first thing Monday morning and talk to the doctor.  If you aren't able to talk to him directly on the phone, most definitely make an appointment to have a face to face with him.  

Best of luck and please keep us posted on what you find out and how you're doing.
Blank
Avatar_f_tn
Thanks for your responses everyone.  I want to clarify that my doctor had prescribed me Percocet 10/325, 1 pill 3 times a day.  I called him to inform him I was going to move up to 1 pill 4 times a day as the 3 weren't working.  He said that was fine.  Therefore the 90 pills he prescribed me will obviously have run out before my  next appointment which was scheduled 30 days after my first.  So either way, I will have run out of his prescription whether I was following it the way I was supposed to or not.  I also did tell him on my first visit that I had a left over prescription for Norco which I was taking when I initially visited him.  He did not drug test me on that visit.

So I know I should be totally honest with him that in order to really control my pain I need to be prescribed 4-6 pills per day as opposed to 3-4.  So the only thing I really have not been honest with him about is the dose I've been taking per day.  I guess my concern is that if he drug tests me he will see that I've been taking Norcos for the past few days as opposed to having just run out of Percocet and moving to Norco more recently.  

The real thing I am wondering is that do typical pain management doctors give urine dip tests?  Or do they send the tests out to a lab?  I've read how a lot of other pain doctors seem very strict... mine did not seem strict at all.  I did sign the contract which stated not to get other prescriptions from other doctors, but that couldn't include other doctors I had seen in the past.  And I did tell him that I had another prescription left over.  He also did not go over the "rules" with me in my consultation.  He did not seem, at least to me, as strict as some of these other doctors seem.  Or maybe I'm wrong..
Blank
82861_tn?1333457511
The UA is the least of your problems.  You say you're worried that this doctor will treat you like a drug addict as others have done previously.  What behavior made those doctors suspect you were an addict?  

Self-medicating (taking more than prescribed whenever you feel like it) and maintaining additional supplies of narcotics is a big red flag for addiction.  Much depends on why you take your meds this way -  to treat increased pain or to escape from it?  Is this a case of addiction or pseudo addiction where addictive behaviors present but because of untreated or under-treated pain?  

There's a reason doctors are careful about prescribing and following patients on opiate therapy.  Visit any drug rehab facility and you'll find a whole lot of people there whose addictions began in just this way.  They have legitimate pain just like you and me but at some point the meds controlled them instead of them controlling the meds.  

I'm NOT saying you're an addict.  I just want you to keep certain behaviors in mind so you can avoid the heartbreak and destruction that come with it, as well as to illustrate some of the reasons doctors have to maintain a somewhat paranoid medical practice.  Urinalysis is just part of the business.  Not all doctors test the same way.  Most use a general panel unless there's a problem.  It's cheap, fast and easy.  The more in-depth testing to narrow down specific opiates is more expensive and takes longer to perform and I believe also requires blood rather than urine.  Most clinics don't have sufficient lab capability to do more than the UA.  Having nothing show up on a test is just as bad as having something show up that shouldn't be there.  Many people sell their drugs on the street, so having a clean test can also get you thrown out of the practice.

You may simply need a long-acting medication rather than short-acting meds like percocet and norco.  If you have pain every day, all day and all night, it makes more sense to go with a long-acting medication.  There are plenty to choose from so have a chat with your doctor about that.  It would also help to talk with him about your goals for pain management.  I think all of us initially expected to have our pain cured, or something close to it.  PM doesn't work that way.  It's all about "management" rather than cure.  You can avoid a whole lot of misunderstanding and difficulty if both you and your doctor have the same goals.
Blank
Avatar_f_tn
Even though your doctor did not specifically tell you not to take the Norco from yoru previous doctor anymore, when you signed the pain contract and got the prescription for the Percocet from the new doc, that was most definitely intended for you not to take the Norco and DOES include scripts that you had previously gotten from other docs.  Even though they had been prescribed by a previous doctor and you told your new doc that you had them, it still does not give you carte blanche to use them - especially wihout your PM docs knowledge and approval.  By doing so, you have definitely violated your pain contract with the PM doc and could suffer dire consequences.  If you are drug tested, the test more than likely WILL show hydrocodone in yoru system (norco) as opposed to oxycodone (percocet).  I believe most PM docs do send their urine tests out to a lab for examination, although I might be wrong and it may differ from state to state.  

Realistically (although a moot point at this time) what you should have done when you called him and got his approval to increase your dose from 3 per day to 4, was to at that same time, remind him that the prescription he had given you was for 90 pills - enough to cover 3 per day for 30 days, but that by increasing your dose, it would mean that you would be running out prior to your next apointment and ask him what you should do in that case?  Did he want to make your appointment for sooner or should you call him when you were getting ready to run out and see about picking up a script for enough to cover you until your already scheduled appointment.

I would definitely call him first thing Monday morning and be honest with him - tell him you believe you may have made a mistake by taking the Norco that you had on hand from a previous doc.  As I said, being honest with him NOW as opposed to waiting until you see if you're going to be tested, could go a long way in how he reacts/treats this.

I do hope that you keep all this in mind in the future - I know you certainly do not want to violate your PM contract and risk the possibility of losing your pain management.  That's why it's so important to check with your doctor before adjusting ANY medication, whether it's over the counter or prescription.  Some pain contracts even state that before taking even an over the counter med, it has to be approved by the doc.  this is for your safety, as well as the doctor's safety and licensing.

Also please keep in mind that while your doctor may not seem as strict as some other docs, he still has rules that HE has to go by also (remember that he is under great scrutiny from the DEA), and that typically does include randomly drug testing his patients.  Some PM docs are a bit more lenient when it comes to violations of the contract - some will give their patient's a second chance, depending on the circumstances, however, others will not.

Please do take my advice on contacting your doctor Monday and also please let me know what you find out.  In the meantime, PLEASE do not take any more of the Norco until you can talk to your doc and see if he will clear it.
Blank
547368_tn?1332173665
Hi marzbarz999,

Welcome to the Pain Management Forum. I am glad that you joined us and took the time to post in detail. I am sorry to hear about your high pain levels.... we all know how significantly uncontrolled chronic pain can disrupt our lives.... and my heart goes out to you.

Our members have responded with excellent comments, concerns and suggestions, as usual. Much of what I have to say will just reiterate most of what has already been said.

I am happy to hear that you have finally found a compassionate PMP. They can be difficult to come by and we must treat them as we would want to be treated, with respect and honesty. Right off the bat per your admission you "lied to him."  This concerns me.

Don't get me wrong. I do understand your fear of not receiving long term and proper pain management..... most of us have experienced those same concerns. However you've already put a wrench in the system by not being forthcoming. Building a good Doctor/Patient relationship is imperative, especially for those of us that have Chronic Pain. I don't think you have burned this bridge but you will if you don't begin again and be completely honest with him.

You may require a long acting opiate in addition to short acting ones for break-through pain. I don't know the amount of pain you are experiencing or your history so I cannot guess what would be the best approach, that's why you have a PMP. Trust him to help you and he can only do that by your honest appraisal of your pain levels and the effectiveness of what he is prescribed for you.

I won't suggest you have an addiction tendency, again I don't know you or your pain. Reliable statistics reveal that 4% or less of true Chronic Pain patients ever become addicts. Those are very low numbers and should reassure us and the medical professionals however it also means that there are 4% that develop an addiction. I always give ppl the benefit of the doubt and tend to think that rather then a problem with opiates they just haven't found proper pain management. Many of us look(ed) like addicts, it's called pseudo addiction until by trial and error with a good PMP we found the right combination of medications to control our pain.

Your PMP may not seems as "strict" as other PMP but don't think for a minute that he isn't watching his license. He has to abide by the "rules and regulations" as outlined in his PM Contract. If he doesn't he can be in huge trouble with the DEA and risk sanctions or worse.

It doesn't necessarily matter the type of urine drug test he does in office, many send them out for further, more detailed analysis. You can't beat a test and you shouldn't try. In the long run and/ or sooner or later if you are not following the rules you will be caught. So please take only what he prescribed and how he prescribed it... or you risk losing this PMP and future PMPs and more importantly pain management period!

So fess up and admit that you pain is not properly controlled on the current regime. You can tell him you were frightened and afraid that you would be looked upon unfavorably if you told him the amount of pain you were in. Maybe something like you felt that no one listened to you in the past and you were concerned with that now but realize that is not the case with him. If you've had issues in the past you may only get one shot at this so don't blow it. The amount of acetaminophen you are taking in my opinion is not excessive.

According to what I have read and been told the FDA is lowing the guidelines due to the fact that so-ooo many things have acetaminophen in them. Due to that fact ppl are exceeding the recommendations as they are not taking those additional sources into consideration.  So add up ALL the acetaminophen you are consuming not just what is added into the opiates.

I wish you the very best and hope that you will keep in touch with us... be active in our community. We are here to support one another and exchange information. I'll look forward to your updates.

Peace,
~Tuck
Blank
Avatar_f_tn
Hi everyone,

Thanks for all your support.  I called my doctor and told him the honest truth about the whole thing.  I explained the reason I ran out of my prescription was because I was taking 4 a day as opposed to 3 a day which he approved two weeks ago, so I was taking my other prescription in the mean time.  He was not upset with me and was glad I kept him informed.  He's going to increase my medication per month so that I'll have enough for my pain level.  Thanks everyone!
Blank
Avatar_m_tn
i would love to know who your doctor is, i to have has such an incredibly hard time finding a doctor who is not afraid to actually help someone in pain out. i have been to 2 different ones and have been through injections, physical therapy, accu puncture, chiropractic. All with no relief. can anyone here give me advice on where to find a doctor who is not afraid to perscribe pain medication. i am located in central pa, but am willing to travel. my next step is surgery, however i am still fairly young and hate the thoughts of the possible ill  effects that surgery could have.  please help
Blank
Avatar_m_tn
i would love to know who your doctor is, i to have has such an incredibly hard time finding a doctor who is not afraid to actually help someone in pain out. i have been to 2 different ones and have been through injections, physical therapy, accu puncture, chiropractic. All with no relief. can anyone here give me advice on where to find a doctor who is not afraid to perscribe pain medication. i am located in central pa, but am willing to travel. my next step is surgery, however i am still fairly young and hate the thoughts of the possible ill  effects that surgery could have.  please help
Blank
Avatar_m_tn
hi tuck, sorry i am new to this forum, well new to looking to the internet to help me with my problem. so dont know if i posted in the right way or not. I am at my wits end though and just dont know where else to turn and read your poste about people being here to help one another so thought maybe i could actually find some help here. my email address is ***@****. please respond either on here or thru email. thank you
Blank
Post a Comment
To
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
Pain Management Community Resources
RSS Expert Activity
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
Top Pain Answerers
535089_tn?1400677119
Blank
Mollyrae
WI
7721494_tn?1408157057
Blank
philnoir
Four Corners, CO
Avatar_m_tn
Blank
trixy71
1855076_tn?1337118903
Blank
marycarmel
MA
1326416_tn?1370930601
Blank
shinty
Just south of Boston, MA
9501656_tn?1404652987
Blank
Diamond_Dixie
Somewhere in NorthFL, FL