Urinalysis questions for pain management

[sleepwell]

Urine Analysis - Questions Newbie here. PM patient
Hello all...

Just was accepted in to my pm program. So my questions are this....Do they test the levels of Norco (my current script) ? Will they see the other opiates in my system ? would it work to crush up a norco and put it in some fake pis ? lol doubt that works.

Anyway....just want to be prepared. possible UA first couple weeks of Feb. and working my way through a handfull of 30mg little red wammies :)

Don't know much about urinalysis so any info would be useful.

Thanx kidz.

be safe !!!!
nod on

[youwonhundred]

The best answer to that question isn't really going to be much help. It depends. Some PM clinics do pee tests, others (mine for example) have never asked for one in almost 3 years. Chances are good that they won't ask for one right off the bat, but I could be wrong, so don't count on it 100%. As far as putting crushed pills into your pee, that would probably not work so well, since we are talking about a docs office and not probation, where they generally use the cheapie five panel ones. Most drug tests, iirc, test for end metabolites now, and not the actual drug itself (I might be wrong on that, but I do remember thats how the methadone clinic used to do it, and I assume a PM clinic would use the more accurate method. Again, this is just from personal experience, but unless they want to establish a baseline of what you've been self prescribing, to know where to start you, I can't see the PM clinic kicking you out because your first wizz quiz was dirty. For all they know, you are in intractable pain (you may be, and if you are, you ain't alone, and I;m sorry you have to go through it too) without adequate medication, and hey, you gotta do what you gotta do to live. Constant pain is no kind of life, I know all too well. Anyway, I just got up to pee and smoke a cig, but decided to pop on here for a minute.. Hope my 3am ramblings were at least somewhat helpful. I might think of something better after sleep. Also, I don't think I know you yet, so welcome to opiophile, your home, on the web *something like that. we need a catchy slogan, right?*

[Levity]

Some PM clinics will send your whiz out for a total evaluation to see how much of what you have in your peepee. Others will just a ten dollar Wal-Mart special to make sure you're not on meth, heroin, weed, and drain cleaner. Others will never test you, others will don't won't care.

Most PM docs just do it to cover their asses if the DEA hits the fab or they think you're diverting or abusing your meds. Best bet... Don't do anything bad a week before the pee test and take your meds as recomended two days before ans until the cup comes out.

[ACDF2Pain]

I agree with youwonhundred and levity. It seems to depend on the practice and (my thinking) their fear/distrust level. My previous PM practice made me sign a contract that among other things said I had to submit to urine tests (which they did) and pill counts (which they did not do - to me).

I thought it would be interesting to list the tests they billed for on the last urine test. I'll list the items right off the invoice:

Creatinine
PH
Specific Gravity
Fentanyl
Alcohol
Soma
Buprenorphine
Meperidine
Amphetamines
Barbituate
Benzodiazepene
Cocaine
Methadone
Opiates
Oxycodone
Phencyclidine(PCP)
Propoxyphene
Methadone Metabolite
GC/MS

I assume that they searched for each drug (the first three and last items are tests or measurements) because each line had a dollar amount associated - and it totaled over $1,000. Yes, you read that correctly - over one thousand dollars.

[minor rant] It's unbelievable what they put us CP patients through to try to get a small increase in our quality of life [end minor rant].

[sleepwell]

Thank you all so very much. My god they can test for everything. So I see on that list oxycodone but not hydrocodone....does hydro come across the test as opiates ? or can they test specifically for hydro ? I forgot to add that I was wrongfully placed in the chemical dependency dept. some months back so of course...my pm team included my former CD doc in the loop for appts....which is where I'm sure all the urinalysis is done.

So only a week for the opies to get out of your system ?? one week of my 'scribed meds will test me good ?

You are all so helpful and greetings to you as well.

I do suffer from chronic pain and it is a serious bitch...so take care of yourselves all of you. Be well.

[resorcinol]

Thank you all so very much. My god they can test for everything. So I see on that list oxycodone but not hydrocodone....does hydro come across the test as opiates ? or can they test specifically for hydro ? I forgot to add that I was wrongfully placed in the chemical dependency dept. some months back so of course...my pm team included my former CD doc in the loop for appts....which is where I'm sure all the urinalysis is done.

So only a week for the opies to get out of your system ?? one week of my 'scribed meds will test me good ?

You are all so helpful and greetings to you as well.

I do suffer from chronic pain and it is a serious bitch...so take care of yourselves all of you. Be well.

oxycodone is a metabolite of hydrocodone so it would show up even if they don't test for hydrocodone specifically

[JonnyMohawk]

oxycodone is a metabolite of hydrocodone so it would show up even if they don't test for hydrocodone specifically

That isnt right at all.

Hydrocodone metabolizes into hydromorphone.

Oxycodone metabolizes into oxymorphone.



Careful with your info buddy.

[kramorph]

You cant really hide anything these days, they can test for virtually anything, just ask professional athletes. When I was taking alot of codeine to help with arthritis pain,( as the 'done does f'all) my doc didnt beleive me(as codeine is converted to morphine in the liver and so is heroin), so they measure morphine, conjugated morphine and the various metabolites of morphine. All these simply give a positive on a general opiate test.Further urinalysis is required to determine exactly which opiates were taken, and my doc found out I was telling him the truth.Why would I lie anyway.I no longer see that doc. There are many drinks available that apparently mask various drugs etc, but I dont know how effective they are and they can probably detect that too.The other option is to buy either dry synthetic urine powder, or actual urine(just make sure urine came from same gender as you).And there is also a product called the whizzinator, an appliance you where and use the plastic penis conected to synthetic urine, rather than your own, for observed cup filling, not sure about female whizzinators though.

[resorcinol]

That isnt right at all.

Hydrocodone metabolizes into hydromorphone.

Oxycodone metabolizes into oxymorphone.



Careful with your info buddy.

whoops, I actually know that.

Don't know WHAT the hell I was thinking.

Hope I can still edit that

I know my stuff, and I know it well, I really have no idea what I was thinking there. Perhaps the alcohol in my system played a part but usually i'm more lucid than that even drunk.

[JonnyMohawk]

whoops, I actually know that.

Don't know WHAT the hell I was thinking.

Hope I can still edit that

I know my stuff, and I know it well, I really have no idea what I was thinking there. Perhaps the alcohol in my system played a part but usually i'm more lucid than that even drunk.


Haha its all good, we all make mistakes sometimes.

[sleepwell]

Thanx for the replies....but I'm still confused on the hydrocodone.....it will come across/test as opiates ? so if SWIM is prescribed Norcos and they are going to test for legitimate levels of that prescription....will SWIM be s.o.l. from chewing up 30mg MS tabs ? I don't understand if that scenario would just have one total amount of opiates or whether the two can be identified seperately and by amount. Never really got an answer on how long it takes opiates to get out of your system or how long I should be on my prescribed amount before the UA.

Thanx again.

[sleepwell]

Think I found what I need.

Let me know if anyone objects to this info.
http://www.byedr.com/medicine/2346-byedr-1.html

Sounds to me.....as long as SWIM stops taking unprescribed opies 3 to 5 days before a UA and only takes the prescribed medication and prescribed amount....all will be well for SWIM.

[LayinLow]

Never really got an answer on how long it takes opiates to get out of your system or how long I should be on my prescribed amount before the UA.

Thanx again.


It takes around 3 days for opiates to get out of your system. I think you were talking about hydrocodone or morphine and both of those will be out of your system in about 3 days. To answer your other question, you only need to be on your prescribed meds for about a day for the level you want to show up on your UA. (Probably even less, but to be safe) And yes, hydrocodone will defiantly show up as an opiate in your UA.

[kramorph]

Alot of these modified morphine optiates are actual metabolites of morphine and codeine. Thats how we discovered alot of these compounds. Just like temazepam is a metabolite of oxazepam, which is a metabolite of Diazepam. I studied all this shit many years ago, I dont remember all the details, but these days they can almost tell u what you had for breakfast last week from ya urine. It just depends on how much money they are prepared to spend to try and catch you out.
P.S. As most (all?) opiates and opiods are basic(alkaline) acidification of your urine may well help you excrete unwanted subs out of your body in time. And drink lots too, the more ya wee the more crap goes with it.

[Young Professor]

I'm not a veteran of this board, but I am a veteran of PM. In most case, yes the drug test will give the Doc levels of the narcotics. But, this isn't exact science by any means. The test will show the rough amount, so if you just took a dose in the last 10-12 hours, your level will be fairly high. You can do a simple internet search on this subject and you'll easily find charts that tell you how long a particular drug stays in your system & etc.

Additionally, they will break the narcotics down by type....Hydro, Oxy, fentanyl, & etc. So, if you're Rx'd Hydro, but Oxy shows up, your in big trouble. The test also scans for the illegals like pot, coke, meth & etc.

The test also picks up certain cursors or enzymes in your body to ensure there aren't any routine masking agents...Or that you've added something (like water, spit, or whatever) to your urine in the bathroom. The test will measure the correct ratio of your urine in regards to it's chemical structure (creatine for example). Do not tamper with your urine in any way, or it's OVER.

The tests used are basically the same as what employers use for pre-employment...Meaning that there is a "threshold" that you have to have in your system before the test picks it up....Thresholds are used b/c employers don't want to falsely accuse someone, so they set the threshold off the bottom somewhere. For example, it's been speculated that poppies on bread may show up as very small levels of pot. So, they set the threshold much higher so there isn't any way possible for someone to eat poppies and test + for pot. However, this concept may be problematic to PM patients because their level may fall below the threshold, but drugs are indeed in their system, yet the test says otherwise.

With all this being said, it's CRITICAL that you know EXACTLY when you took your last dose. When you get tested, they will ask you this question. So, if it's been a while since you last dosed, it gets taken into consideration. It's possible you could fall below the threshold, and they think you're diverting meds.

If you take your meds as prescribed, you won't have any problems. SWIM loads up right before each appt to make 100% sure there aren't any issues.

Finally, if you ever get caught in a situation where you took something (like a spouses valium or whatever) that you shouldn't have and you're getting tested, it's imperataive that you fess up ahead of time. I heard through a PA that my PM Doc will give patients one pass if they are in this situation.....Assuming they go to addiction counseling and the reports come back as good. Also, I guess it goes without saying that those patients are then watched very carefully. Conversely, if you don't fess up and get caught, it's OVER. So, you have to decide at that time if you want to gamble or not.

Docs drug test to keep in good graces with the DEA....Which is good....They want to show that they are doing everything they can to be prudent and help control the spread of illegal drugs. The more PM Docs test, the less hassle from the DEA. The DEA knows which Docs have good, sound mgt practices and which ones don't. Diversion AND drug seekers are their main target(s). If you get meds from a GP, then chances are they won't test or that the DEA cares because the amount of total narcotic scrips are so low. Think about it....The DEA watches those offices who pass out the most narcotics. Docs are also kinda paranoid, so they put a system in place to CYA.

Most PM clinics randomly test and it's about once per year (per patient). However, every clinic is different. The test is billed to your insurance. Some patients report that they've never been tested. I think it also goes without saying that the higher the level of drugs you're on and the higher the qtys, the more likely you'll get tested (for the obvious reasons). If you are selected and can't pee, they will send you for a blood test. At my PM clinic, all first appointment folks get tested, which makes sense...They want to know right off the bat where these people stand.

I can't stress enough that if you are a legitimate PM patient and take your med as directed, you have NOTHING to worry about. The testing system is set up to catch cheats, who eventually slip up. Most people who fail tests are not diverters, but rather people taking other shit...Pot, meth, coke, or someone elses meds.

Hope this helps and isn't too much info.

YP

[Woody Bear]

I thought it would be interesting to list the tests they billed for on the last urine test. I'll list the items right off the invoice:
Creatinine
PH
Specific Gravity
Fentanyl
Alcohol
Soma
Buprenorphine
Meperidine
Amphetamines
Barbituate
Benzodiazepene
Cocaine
Methadone
Opiates
Oxycodone
Phencyclidine(PCP)
Propoxyphene
Methadone Metabolite
GC/MS
I assume that they searched for each drug (the first three and last items are tests or measurements) because each line had a dollar amount associated - and it totaled over $1,000. Yes, you read that correctly - over one thousand dollars.

There's the cheaper quick dip test, where they just test for a couple substances, if these test positive, then they send it off for a full work-up. The full work up is the GC/MS which stands for Gas Chromatography-Mass Spectrometry. This test will find everything, there's no way to cheat this test, and just because something like hydrocodone, isn't listed as something they test for, it doesn't mean that it won't show up on the test.

The way the GC/MS test works, is they vaporise a bit of your pee, pass it through a long capillary tube which acts kind of like a porous filter, as it lets certain substances through quicker then others. It then shines light on the gas, and measure it's angle of deflection as the individual components come through.

The pH test was done with a pH meter, and the specific gravity was done with it's own thing. But I do think the doctor's billing was a bit excessive and deceptive, as if they did individual dip tests and GC/MS, that makes the dips test unnecessary. The way it's billed it makes it look like 20 tests were done for specific substances, but that's not the way GC/MS works.

For the GC/MS test, they may have separated the urine into a few fractions, such as basic soluble materials, acidic soluble materials. But they don't divide it up into 20 fractions and say, well this is one is testing for methadone, this one is testing for cocaine. As the test is done, each fraction comes out, and the computer spits out a read out with a series of peaks. The computer also has a record of what peaks correspond to what substances. So you'd get one print out which has peaks for methadone, cocaine, and hydrocodone, then they'd know you'd taken those substances. By analysing how high the peaks were, they'd know how much of the substance you'd taken.

Where it gets tricky is when you take a substance like codeine, which gets changes into morphine, which gets changed into hydromorphone. But by analysing the peaks, they'd see that the hydromorphone level was 1/100 of the morphine level, so they'd know that you just didn't bang a load of dilaudid and morphine and say that you took some codeine.

Anyways, GC/MS is the most sophisticated analysis technique, it's a nice bit of kit, but you can't try to cheat the system if they're using it. But it's so expensive to pay for a GC/MS analysis, that they usually do the cheaper quick dip tests which are easily fooled.

[Woody Bear]

For example, it's been speculated that poppies on bread may show up as very small levels of pot. So, they set the threshold much higher so there isn't any way possible for someone to eat poppies and test + for pot.
Actually it's hemp seeds that give false postives for pot, because of the trace amount of THC that gets stuck on the seeds during processing.

Poppy seeds show up as a false positive for morphine. This is due to the trace amount of poppy sap on them, which contains morphine.

And Vicks Inhaler shows up as a false positive for methamphetamine, because it contains L-methamphetamine. It seems bizarre to me over in England to think of that the USA sell would sell a product like that. But I remember hearing about some sportsman who failed a piss test, but it was a false positive from use of an OTC Vicks Inhaler.

[strikks]

at my old pm doc only had to worry about the special test that shows oc and meth hydrocodone and ms will show up as opiates(morphine type) then oc will show as oxycodone and opiates and so on i would not worry about NOT having any in your system cuz you could say the norcos have not been working and you ran out early hence to why you are switching docs the maybe he will switch you or increase you to a better dose/med:D