Methadone detection

[wrangler14]

I am in a PM program that I have been in at UVA for over 7 years and also have a spinal cord stimulator.  I am 61 yo.  I have never had any problems till last week.  I had went in the month before and gave a urine sample but asked for some water beforehand......I drank three smal cups and produced a urine sample that was good.  I went back last week and they requested another urine sample.  I didn't have to go and was cut off at two cups.  After that the Dr and nurse were really pressuring me to give a sample.  It had been an hour and the Dr told me I had one last time to try or they were going to take me off the methadone.  I tried and did not produce.  I came out of the bathroom and requested the Dr do a catherization and they said they couldn't do it.  It took me back in the office and told me a threw up a red flag and that they have patients who are selling their drugs and taking a methadone when asked to take a test and then drink water till it is in your system before giving a sample.  I did not urinate until 805 pm.  A lot of the time I don't urinate much and I think constipation has something to do with it.  As soon as I can get the
stool to move a little bit three or four times I can usually urinate but have to sit down......I am a male.  Does anyone know roughly if you took a 5 mg methadone lets say at noon when would it show up in the urine?  Thanks for the help!

[remar]

Did they release you from pain management?
You did tell them they could use a catheter so to me that says you have nothing to hide.
I don't see why there would be a problem with you sitting there until you had to urinate. Was the office getting ready to close or something?
You have a perfect record so if I were you I would ask for another try at a urine test as soon as possible.  

[Wobby65]

It shouldn't take long at all for methadone to show up in your urine...most meds taken in pill form are dissolved within 45 minutes, so I would think it would show up by then if not even sooner. It's too bad that so many people misuse/sell medications and then try to scam doctors...legit pain mgt patients are the ones who usually pay the price.

[philnoir]

I would imagine methadone metabolites would have a chance to appear in an immunoassay UDT within 6 hours after taking even this small dose.

As far as the other story goes, I'm appalled, and seriously question your doctor's calling to the medical profession. From his attitude, he seems better suited for a career in law enforcement. Instead of relying on scientific evidence based on fact, as we were taught in medical school, he chooses to base his assumptions on deductive logic -- you can't urinate, therefore you are hiding something, therefore you are selling your medications on the black market.

Frankly, I don't know why some people pursue pain medicine as a field when they do not trust their patients own reports of compliance with medication (after 6 years of a history of compliance with treatment plan), and treats difficulty in urination, not as a medical problem that could be indicative of prostate disease in a 61 year-old male, but as a sign of criminal behavior.

I suggest you forward a copy of your letter to the head of medicine at UVA, the state board of medicine, and your state medical society governing this practice.

Sorry to be so harsh in my comments, but I am fed up with a pain management system of medicine in America that exhibits more interest in preventing the diversion of pain relieving opioid analgesics and lowered overall doses than in the physical well being of patients trusting their health to people calling themselves physicians and sanctioned by regulatory agencies that seem to share these priorities.

With practitioners like yours, it is no wonder tht America's medical ethics vis-a-vis pain treatment standards of practice  is the laughing stock of the international pain community.

[wrangler14]

Thanks for the input.  No they were not getting ready to close.  Yes they released me from the program.  I did go to my urologist yesterday withe my xrays showing I had a large amount of stool down to my rectum.  He wanted a small urine sample but I could not provide one although I did drink a 12 oz coke an hour before I saw the Dr so I could give urine.  We talked and he did an ultrasound on my bladder and there was NOTHING in there.  I asked him where it went to and he said other parts of my body needed the fluid.  He also said constipation will cause pressure on the bladder and block the uretha.  Sitting down moves the bladder which me make it easier to rinate.  I have to add miralax to my diet and increase the fluids.  I am going to try to use this information to get back in the program.  I do not Dr shop and I want to prove them wrong.  I think it is very hard to get into another clinic after you have been dismissed from your old clinic.  Am I right?

[wrangler14]

Hi!  I really appreciate your input.  This is what I have done.  Had an xray of the lower GI to prove constipation.  Noted a large amount of stool in colon to rectum.  I am on several meds that contribute to that.  I went yesterday to see my urologist.  He was shocked by what I told him.  I had drank a 12 oz coke before I went so if they wanted me to give them a sample I could but then again I couldn't.  He did an ultrasound on me and found NOTHING in my blader.  I asked were did it go then and his response was that other parts of my body must need the fluids.  He did a DRE and my prostate was fine.  I was told to increase my fluid intake and add mirilax to my diet also and he did say constipation could put pressure on the bladder and block the urethea.  Also sitting down may make it easier to urinate because it repositions the bladder.  I have seen the same urologist for a long time 4 times a year for low testosterone.   I have had my PCP write a letter to vouch for my reputation and also another Dr I have seen for many years.  I do not Dr shop and I know if I don't resolve this getting into another clinic will be hard.  I will have all the written information the first of the week which will be submitted to UVA.  I am stunned and want to clear my name so I am fighting this all the way.  Meanwhile I am going through withdrawals and a huge increase in pain.   I do not understand this at all.  I am going to quote you on some of the things you said if you don't object.  Thank you again kind sir!

[philnoir]

Again, a real doctor would be more interested in why you're having such trouble producing a urine specimen rather than dismissing you from the practice for being unable to do so.

And to cut off a patient on COT w/o a weaning program is both immoral and unethical. Some courts would consider it medical malpractice.

Opioid abstinence can be a serious problem in a 61 year old man. See your PCP and ask for help, either with substitute prescriptions or support in weaning. Bring the reports from your urologist.

Finally, consider involving a medical malpractice attorney. The consult is free, you are certainly being mistreated, and this action on the part of your former pain doctor should be challenged.

Best wishes.