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Test results for urine test


I have severe chronic back pain.  I've had chronic back pain from an abusive relationship 13 years ago and two car accidents. I'm on Long Term Disability from work. I've had a total of 13 different injection procedures that last maybe for 3 months along with back pills.  

My Pain Management center changed my medication about 3 months ago at my request because my body became immune to the meds. and needed something else.  They removed my morphine but increased the Oxycodone.  I've been seeing this Pain Management since 1999.  I checked my lab results on line, when I read them from the urine test it showed cocaine on my lab results. The medication I'm taking now is - Oxycodone 20 mg taking 5 times a day; Amitriptyline HCL 50 mg 1 a day; Lexapro 20 mg taking once a day; Triamterene-HCTZ; Nucynta ER 50 mg twice a day; Flexreril10 mg 3 times a day; Gabapentin 300 mg once a day; and Xanax one time a day for panic attacks.  I have a severe chronic back pain.  I've had a total of 13 different injection procedures that last maybe for 3 months along with back pills.  I've had chronic back pain from an abusive relationship 13 years ago and two car accidents.  I take fluid pills I listed above and depression pills Lexapro.  My question is have anyone's urine test from pain management have cocaine with the pills I take on lab results?  I have never taken cocaine in any form and I feel they will dismiss me from the center saying I'm taking cocaine with all these meds!  I would surely die if I'm taking cocaine with all my prescription meds!  My return appointment is the 28th and I'm trying to make sure I have information to give them protecting myself.  Some of the PM doctors are so nasty,  I feel bad enough for having to take pain meds for my back problem of 2 pinched nerves, 2 bulging dics, 2 annual tears, Scoliosis; and arthritis in my hip sockets. I really want to be ready before they try to throw me out the practice for something I've never taken.  I probably would fill must better if I did take marijuana and cocaine, what a joke, I'm a 53 year old woman that wouldn't even know where to go and do something like that.
Help with an answer from the medication I take that cocaine would show up because it is in the meds I take!

Thanks in advance for any information you could give me!
3 Responses
547368 tn?1440541785
Hello and Welcome to our Pain Management Forum. I'm glad that you found us and took the time to tell us about your pain and situation. I'm very sorry that you too have a Chronic Pain condition.

Many of us worry about unjustly having incorrect results from a UDS. However I'm not certain that's what your UDS is revealing.

Our member and resident "Sheep Doc" has much more knowledge than I about the chemistry and metabolites of specific opiates - and knows more about how to interpret UDS. He checks in often. Hang tight.

I do know that even a physician not well versed or educated in UDS can misread the results. It can be very complex and is not always an easy interruption. I also know it depends on the UDS that is utilized. I assume yours was not the usual initial immunoassay - which is not as accurate as the confirmatory (gas chromatography-mass spectrometry [GC-MS]).

Chemistry was/is not my strong suit - and I'd be uncomfortable trying to answer your question with any accuracy. I can encourage you not to be overly concerned at this point. Your Chronic Pain provides you with more than enough concern.

Hang in there. We'll all do our best to help. Please keep us posted. I wish you the very best.

Peace,
~Tuck

7721494 tn?1431627964
speedy27CeeDee, I know little about the metabolites of cocaine, or why it would be found in a urine drug test (UDT).

I will refer you to a document published in 2013 by an organization that help state medical boards define 'standards of practice' in for doctors within their purvey. (FSMB).

http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/pain_policy_july2013.pdf

The title of this document is Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain.

Within it you will find a section that covers "Periodic Drug Testing" and from this I quote:

"Physicians need to be aware of the limitations of available tests (such as their limited sensitivity for many opioids) and take care to order tests appropriately [54]. For example, when a drug test is ordered, it is important to specify that it include the opioid being prescribed [53]. Because of the complexities involved in interpreting drug test results, it is advisable to confirm significant or unexpected results with the laboratory toxicologist or a clinical pathologist [59-60]."

Most physicians, unless they are specifically trained in the pharmacology of opioids, are unfamiliar with UDT results, and therefore accept them as fact, as if they would a blood sugar result, knowing well that a simple blood glucose level can have false readings depending whether or not the patient was fasting for 12 hours prior to the test.

This is also from the FSMB document:

"Test results that suggest opioid misuse should be discussed with the patient. It is helpful to approach such a discussion in a positive, supportive fashion, so as to strengthen the physician-patient relationship and encourage healthy behaviors (as well as behavioral change where that is needed). Both the test results and subsequent discussion with the patient should be documented in the medical record [53]."

Any good doctor would question a blood glucose level above normal limits, and talk with the patient -- were you fasting? Did you have coffee that morning? Do you use sugar in your coffee?

It is a sign of our times that doctors do not have these discussions with patients who fail a UDT.

Your result, positive for cocaine, is what is known as a "false positive" result.

The -caines are a family of anesthetic medications used in dentistry, surgery, and even in simple procedures in a doctors office. A false positive for cocaine, especially when detected by a simple polyscan UDT using immunoassay (a strip that turns a specific color in the presence of a substance), may be caused by such an injection.

I'm not an expert on UDT analysis, but I have a colleague who is. He's developed an app for iPhone and Android that helps doctors interpret UDT called UrineTel (or UrinTel -- I don't recall.)

His website is Remitigate.com. But UrineTel or UrinTel is for doctors and may be beyond the scope of anyone unfamiliar with medical practice.

So, I suggest that you talk with your doctor and set the record straight -- you do not use illegal drugs and never have. You wouldn't know how to find them. If you need it, ask that a more sensitive test be done -- a blood test for cocaine metabolites. This may cost you, but it will prove that this test result was an anomaly.

But don't be surprised by a suspicious doctor. A couple of years ago a conscientious pain doctor I know, a man whom I respect as a doctor and as a pain patient advocate, once reported his astonishment over finding UDT results that were positive for cocaine in his patients who are now in their 70s. When this man tests, he does a full chromatography for the metabolites of substances, not the simple immunoassay technique.

I reminded him that Keith Richards is now in his 70s.

Best wishes.
7721494 tn?1431627964
Oh, one more thought.

If you really aren't 'doing' cocaine, you might consider changing your MedHelp moniker.
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