VA urine test false negative for hydrocodone

[FighterPilotswife]

I have been in pain management for 14 years and recently have a new VA doctor due to my previous doctor of 10+ years retiring.  I signed a contract for my hydrocodone and my prescription is for 1 tablet every six hours not to exceed four per day AS NEEDED.  I always try to take 1/2 tablet at a time and if that doesn't give me just enough relief to function I take another half.  On my scheduled lab day I took 1/2 tablet at 8 pm the night prior, fasted and did not take another dose until after my urinalysis (I don't take on empty stomach as it makes me nauseous).  So my total for the day prior to my lab would have been had a total of two pills (4 1/2 doses 7 am; 12 noon; 4pm and again at 8pm, test was done 8-9 am the next morning.   This means I had 1/2 tab of 5/325 over a 12+ hour period.  I had voided prior to going to the clinic (they are an hour away) and drank a large glass of water so I could void again when I got there.  When I went for my doctors appt she spent 20 minutes of my 30 minute appt accusing me of not taking my meds (negative urinalysis).  She called the pharmacy and the pharmacist accused me of lying... No one bothered to call the lab to verify if a false negative could occur with the dosage I had taken. I told her the lab test was wrong and she said the test is not wrong.  I told her I have been taking on average 2 tablets per day and an extra one or two on the days I need them.  She cut my prescription in 1/2.   Why would I come up with a negative result, I NEVER miss a day with out my medications?   What can I do to support the fact that false negatives do happen.  If my last test was negative on 2 tablets a day and now I am FORCED to only two tablets a day, what is to say I won't have another false negative?  I am so angry that my INTEGRITY was questioned and worried that my meds are cut in half.   I am determined to challenge the current policy, maybe followup with a blood test if a negative urine test occurs.  For those of us who are honest chronic pain sufferers, we are being punsished for those who sell or abuse their medications.  I told her that this needs to be looked into (false negatives) not only for me but for all the other chronic pain suffers.   Also are there any other pain medications that could work for me if she takes me off the hydrocodone.  I have had tramadol in the past and was taking up to six tablets a day for relief.  I will go back on that if needed.   Again I thank you for any help you can give me or direction you can lead me to to help build a case that false negatives do occur!  

[philnoir]

Actually, you want them to increase the cutoff level -- so that lower levels of opioid metabolites are detected.

There is also a simple opioid test done with a dipstick. It simply checks for the presence of opioid. If you are a poor metabolizer, this may satisfy your physician that you are indeed taking your medication, and perhaps he.she can find another opioid analgesic that your body can better use.

Best wishes.

[FighterPilotswife]

Thank you Cathy, that is great advice, I will try this too.  I have never lied about my medication and my husband is also a witness to my taking it.  I just hate being accused of lying and treated like a criminal.  I try so hard to take the minimum so I can function with my head on straight.  The days I take my full dose of four full tablets a day, I do not go anywhere or do anything mechanical.  It just isn't safe.

They are making it harder and harder on those of us who follow the rules....

[FighterPilotswife]

Thank you, I am going to see if they will lower the cutoff on the test, right now the cutoff is 300 (I am not sure what that means).  I have come back presumptive positive and then the second time they did a Mass Spec test and kept the cutoff at 300.   Does anyone have any idea what a cutoff of 300 is?  Is it a high number?  I see where the THC cutoff was 50.   I am sure this is where my problem lies.  If I take a full tablet four times a day (which I do on a very bad day), I get an upset stomach and feel loopy which I do not like at all.  I try to take the lowest possible dose there is just so I can function.  In addition I have an hour drive to the clinic, I can't afford to take too much medication and risk imparing my driving.

[cathy5841]

Always go to the bathroom before you take your full prescribed dose when being tested. When given the test void a little the use the catch container to catch the rest. I was having false negatives and my Dr knew I was taking as prescribed because my hubby or parents dispense it to me.  I have not had a false negative since following her advice. She told me I have an extremely fast metabolism when it come to processing the medication which caused her to change up my meds cuz they did not last as long as they should. Good luck to you.

[philnoir]

There are many posts here about false negatives. Please search.
Too often a lab sets its detection level too high, so a small amount of hydrocodone goes undetected.

Everyone metabolizes opioids based on their body's ability to create certain liver enzymes, called CYP450.

Generally, these tests check opioid metabolites. If you are a poor metabolizer of hydrocodone, you're going to have less metabolites in your urine. Also, people with kidney disease under excrete these metabolites.

Ask your doctor to work with you on this. Perhaps you can find another lab that will give you the proper result, or use a simpler test that looks only for the presence of opioids in your blood stream instead of checking their metabolites.

Best wishes.