Aa
Aa
A
A
A
Close
Avatar universal

reasons for FALSE negative hydrocodone results

In 2000, I was in a car accident and broke my hip and tailbone.  The tailbone never healed correctly and is now "hooked" which causes me a great amount of pain when doing daily activities such as laundry or bathing my daughter, cleaning, etc...I was also recently diagnosed with scaitica.  I have been seeing a doctor for 8 years for this pain.  I always liked this doctor and got along with him great.  Although he was much more interested in my personal life than he was my pain.  Anyhow, he prescribed me hydrodone to take 4x per day.  I most certainly was taking my medication as prescribed for the last 8 years.   My doctor has never tested me to see if it was in my urine.  When I was out of medicine between appointments I would call them and go pick up a script.  Well the last time I did this, (June 24), they sent me to the lab for work.  He had been testing my liver levels by bloodtests.  Anyway that day they askd for a urine sample.  My doctor told me it was to make sure I was taking the medicine and not selling them.  He said that they are really getting on him for being a "lax" doctor, which he definately is.  He didnt even start testing my liver until 5 years after I had been on the medicine and I am the one who suggested it.  Anyhow, I wasnt worried about a thing because I have been taking them.  I actually took one before I went in that day.  So a few days ago, I called to get my medicine refilled and the pharmacy told me that the dr had cancelled my refill.  I called my doctor and he told me that I wasnt taking my medicine and I insisted I was and asked to be retested and he wouldnt even listen to me, AFTER 8 YEARS... I am a college graduate, studying for my LSAT to get into law school and work 2 jobs to support my daughter.  He knows all of this, yet would not even speak to me and told me to call my primary doctor, which I did.  I then sent him a fax and told him how disappointed I am in how he wont talk to me or retest me.  He had his nurse call me back and she told me that its nothing personal and its standard procedure, blah blah.  She said she cant retest me because it has to be a surprise test.  If he was a real doctor, dealing with a patient after 8 years, you would think he woulda called me when he got the results back and have me come into to be retested.  That woulda been a surprise.  He didnt even call me in to discuss the test or anything.  He just cancelled my refill.  Anyhow he told me to discuss my results with my primary doctor (who is in the same building) and stated he had talkd to her.  When I arrived in her office, he had not given her my results, but she was able to view them on my computer file.  She stated that the "point in fact" portion actually tested positive but it was confirmed negative, but said that she didnt understand the results and referred me to a pain management doctor.  However, my appointment isnt until Aug 24.  How am I supposed to go that long without the medicine after being on them for 8 years???  My primary doctor gave me a script for tramadol which is not doing a damn thing for the pain.  Anyway Im wondering if anyone has had this happen to them and how did it get resolved or did it get resolved?? Should I be contacting an attorney?
10 Responses
Sort by: Helpful Oldest Newest
1301089 tn?1290666571
Hi again from Sara.  You may want to start a new thread on this as well.  The older threads don't get a lot of attention.  Sorry!
Sara
Helpful - 0
Avatar universal
hello, this happened to me, i go to pain management, do you drink alot of liquids? i do because of other meds. the dr told me that is why, my urine was so diluted because of my liquid consumption. so they gave me another test the month after and all was fine--i made sure i took one on the morning i arrived at the dr office!
Helpful - 0
Avatar universal
i too have had the same problem. i have had 2 major back surgeries one was a fusion for L1 to L5 and my leg rested in one position for 9 hrs and lost the blood flow causing femoral nerve neuropathy. i then had the hardware removed 8 months later and they found a screw loose laying on a nerve. i started on lortab and now am on percocet. when i was on lortab it was expalined to me that the DEA required urine tests to make sure u test positive for your medicine. i tested positive for lortab but have never tested positive for percocet. i have even taken my percocet in front of my dr and waited 3 hrs to do a urine test and still tessted negative after a lot of researching my dr told me that some people have a enzybe in their body that prevents them from testing positive for certain opiates. thank god my dr went out of his way to find this out because i would be in serious trouble if he hadnt. maybe your dr needs to go out of his or her way and do more research on this matter. evidently the DEA is aware of this because i still get my percocet[90 a month along with soma and xanax] good luck to u and my heart goes out to u
Helpful - 0
Avatar universal
Unfortunately clarity sometimes goes AWOL :-( when I write at night.

While there are a number of reasons for a drug test to return a false negative, one reason that is still rather neglected is the variation in an individual's metabolism and extraction of the drug and its end-products. If an individual differs from the typical case, say in regards to liver metabolism, then they may repeatedly fail tests that they are "expected" to pass.

To quote from Hutchison et al, [Mark R. Hutchinson et al, British Journal of Clinical Pharmacology, 57:3 287--297 (2003)]:
"Approximately 7% of the Caucasian population have inactivating mutations in the gene encoding CYP2D6 or have complete deletion of the gene..."
This means that one in fourteen Caucasians has a dysfunctional or completely missing CYP2D6 gene. To continue:
"These subjects are classified poor metabolizers (PM) and are distinguishable from extensive metabolizers (EM) by their impaired ability to metabolize compounds that are substrates for this enzyme. The clearance of drugs metabolized by CYP2D6 can be 10--20 fold lower in PMs than EMs..."
An extensive metabolizer (EM) is the typical individual. This means that people who are PMs may have as low as 5% clearance (ie extraction of end-products via kidneys as urine) when compared with the typical (ie EMs), and for all practical purposes are way below the threshold for tests designed on the assumption of a typical person.

Apologies if this is still confusing; in very short form it means that a small but significant fraction of Caucasians may fail a standardised drug test repeatedly, simply because of the genes that Ma and Pa gave 'em. The 7% is about one in fourteen people. That's a lot of potential false negatives, and a lot of upset people.
Helpful - 0
356518 tn?1322263642
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’
http://www1.va.gov/hsrd/about/national_meeting/2004/abstracts/2047.htm

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.

There are thirteen drugs known to cause false negatives in these test.


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.
Helpful - 0
535089 tn?1400673519
Hi:

I am very sorry this has happened and like others have said, it's happening a lot. OtisDaMan's comments are confusing and hard to understand....Sorry Otis. In my journals I have listed different reasons why you might have a false-negative drug screen. I feel that it is written in Lehman's terms (somewhat easier to understand).

It does sound like there was Hydrocodone but not enough. Your levels were too low. If you took your pill that day but it was the only one you took in a while, the test will show that you have not been taking them on a regular basis and that to some Doctors is reason enough to let you go. If you have been taking them on a regular basis, then it has to be caused by you metabolism.

Please feel free to check out my journals. You may find them helpful. Please take care and I wish you luck in the future.
Mollyrae
Helpful - 0
Avatar universal
The July issue of Mayo Clinic Proceedings looks at individual opioid metabolism and pain management issues around that. Howard Smith's article looks particularly interesting.
It is located at the URL: www.mayoclinicproceedings.com/content/current

The Mayo Clinic are of high repute.

Regards,

OtisDaMan
Helpful - 0
Avatar universal
An awful lot of people seem to get tripped up by these drug tests, through no fault of their own. I personally think it is a tragedy that doctors immediately put up the barriers once a failed test occurs. Anyway, here is a bit of information that may at least give you some ideas as to what avenues you could explore.

False negatives (and false positives) may occur for many reasons; the most likely being a) test was too insensitive, ie your concentration was below the threshold for the particular test assay that was used; b) you take other medications that interact with hydrocodone's pharmacokinetics, so that it doesn't "behave" in accordance with the assumptions behind the test assay; c) the lab stuffed up the test - it sometimes happens; d) your liver metabolism differs from the norm; e) you didn't take the medication and this is a true positive - I'm assuming that isn't the case in your situation.

Liver metabolism of a number of opioids depends upon a set of genes (strands of DNA that encode for different proteins, enzymes, and other molecules) collectively referred to as CYP450. The CYP450 super-family has one gene in particular, called 2D6 (or CYP450-2D6). This gene, which is just a particular strand of your DNA, has several different variants, ranging from super-efficient versions to virtually non-functional. Hydrocodone, codeine, tramadol, and several other opioids are oxidatively metabolised by the enzyme encoded in the 2D6 gene. Hydrocodone also needs the 3A4 gene as part of its metabolic pathway.

The point of all this is that someone with the rarer variants of these genes, particularly 2D6 - of which there are several dozen known variants, may vastly alter the rate at which a drug is metabolised, and that in turn may affect the quantity of metabolites of hydrocoden in your urine. Other medications may also interfere with the function of various CYP450 genes, blocking or accelerating the rate at which they metabolise drugs. Many antidepressants inhibit 2D6 for instance; common proton-pump inhibiters - used for stomach acid and reflux problems - may inhibit several CYP450 genes.

Given this is a demonstrated set of facts, available from articles stored in PubMed, the NIH USA national database of medical research articles, it still stuns me that the DEA and doctors could rely on the results of an isolated test. A negative result should be further investigated, say by taking several blood and urine samples over a course of several hours, giving you a known quantity of the drug after verifying that you don't have any in your system, to see how your body processes the given medication. They should also perform a microarray gene test to see if you have the normal genes or some variant; current tests can discriminate on 2D6, 3A4, and several other CYP450 genes.

Perhaps a lawyer could assist you in at least establishing the details of the test assay. They should know the most effective way of getting hold of the details. BTW, in some countries the labs keep the original urine and/or blood samples for a week or so after they have been tested. This is just in case they are required to retest or perform a new test. Perhaps you could see which lab did the test and whether a sample is held.

All the best,

Regards, OtisDaMan
Helpful - 0
954005 tn?1304626605
Hi.....I can't necessarily help you with the drug testing...but I just wanted to reach out as a fellow tailbone sufferer...I broke mine, and after almost 2 years of not healing at all, I had a coccygectomy (excision of coccyx and exploration) where they removed the broken (smashed together/crooked) part of my tailbone.  I am still in recovery, and it's questionable whether we had success with the operation, so I am looking at life long pain.  I just thought I would let you know that I know how horrible the pain is with this type of injury, and I totally sympathize.  I'd love to talk more, since ours is not a common problem that is talked about...if you need to...
Will your PCP bump you up to anything else temporarily until your pain mngmnt appt? It's worth a try...especially with the amount of pain you are in...
I look forward to talking with you!
Helpful - 0
210982 tn?1280983895
Hello! I am so sorry you are dealing with this issue. I have never hadthat happen to me, but I have heard of ithappening before to others. I agree with you, after 8 years you would think he would at least talk to you or retest you or call you in to get more info. I have heard that doctors who prescribe narcotics are really becoming strict because of the pressure they are getting from the DEA. And because they are so addictive and they know people sell them because they can charge outrageous prices. But anyway, I would think it would be worth asking a lawyer if you have any recourse. Good luck!!
Helpful - 0
Have an Answer?

You are reading content posted in the Pain Management Community

Top Pain Answerers
Avatar universal
st. louis, MO
317787 tn?1473358451
DC
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Find out how beta-blocker eye drops show promising results for acute migraine relief.
Could it be something you ate? Lack of sleep? Here are 11 migraine triggers to look out for.
Find out if PRP therapy right for you.
Tips for preventing one of the most common types of knee injury.
Here are 10 ways to stop headaches before they start.
Tips and moves to ease backaches