Patients & Providers Tell Stories of Dreaded Urine Drug Test

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Medical providers and patients alike cringe when a urine drug test result comes back with an unanticipated result. Imagine this common scenario (or recall if you lived this) of a patient that is prescribed the following:

hydrocodone 20mg/day [classified as an opiate]
buprenorphine transdermal patch (Butrans Patch) 20mg weekly [classified as an opiate]
Alprazolam (Xanax) 0.5mg three times daily [classified as a benzodiazepine]
Venlafaxine, (Effexor) 225mg every morning [classified as an antidepressant with potential pain-relieving properties]

Results are in!

Patient is negative for opiates, presumably not taking hydrocodone or buprenorphone.
Patient is negative for benzodiazepines, presumably not taking their alprazolam.
You are positive for PCP (an illegal hallucinogen), presumably using street drugs.
You are positive for cannabinoids, presumably ingesting marijuana.

Looks pretty bad right?  How do you think the prescriber feels?  Pretty annoyed?  Potentially liable?  In the eyes of many, the patient is not taking the prescribed drug, and if that isn’t bad enough, the patient is taking illegal drugs (PCP) and smoking pot (positive cannabinoids).  OMG as they say!

Or is it not what it seems?  How do you think the honest patient feels?  Falsely accused of wrongdoing by a person they confided in to care for them – the same person with whom they shared their innermost personal thoughts and private medical problems.  Then a letter comes in the mail discharging the patient from the medical practice.  Where does the patient go?  The next person prescribing the medication will likely, and rightfully so, insist on previous medical records. Might this patient end up on the streets buying heroin or black market prescription drugs to avoid writhing in pain?  Perhaps.

What a quagmire!  And all the while everyone was truthful, at least in this case.  It was an unfortunate consequence of misunderstanding, inadequate training, stubborn cost-driven insurance carriers that refuse payment for more accurate chromatographic testing, and an unsuspecting, perhaps even bewildered patient that quite honestly is shocked beyond comprehension.

  • After experiencing the inadequacies of UDT by immunoassay, as a professional, year after year;
  • After hearing the same or similar stories over and over again;
  • After seeing honest well-meaning medical providers being spoofed by dishonest patients;
  • After learning of honest patients becoming depressed, angered and in pain;
  • And, after answering questions and trying to help people nationwide 24/7, I decided;
  • Enough is enough!

It’s about time somebody did something about it.

And so I did…

With the help of two very qualified IT colleagues, I envisioned and laid out the platform for a new, one-of-a-kind urine drug test app (UDTapp) that could help clinicians and patients.  The UDTapp was specifically developed as an informational tool to aid medical professionals and clinical/laboratory chemists.  Final analysis and recommendations should be evaluated for each individual patient and use of the information for final patient care decisions must be carefully weighed by the treating clinician and should be discussed with the patient before implementing actionable medication changes and/or requiring alternative or additional therapeutic changes or recommendations. 

The UDTapp is not intended for punitive action against any patient, but instead to educate and assist clinicians in the appropriate thought process for evaluating and interpreting urine drug screen reports, determining medication compliance, and for selecting more appropriate medications based on individual patient conditions. 

Now let’s get back to our original example.  If the UDT immunoassay screen results above are entered into the phone/PC app, below are screen shots of what you would learn by the recommendations…

UDT-1

In summary, hydrocodone is a synthetic opioid for which the dose was too low to cause a positive opiate screen by immunoassay (IA) urine testing.  The same is true for buprenorphine.  Had the “opiate” or buprenorphine screen been positive, the recommendation would have advised that the patient was probably taking a higher dose hydrocodone and buprenorphine than prescribed and/or another opiate.  Alprazolam (Xanax) goes through a unique metabolic pathway that precludes it from being picked up on a benzodiazepine screen by IA, so the expectation is a negative result.  Venlafaxine was prescribed which causes a false positive PCP screen.  The patient was taking omeprazole for their stomach which UDT-2causes a false positive cannabinoid test.  Bottom line: No foul play!

Applicability, education, and good will is also extended to the third party payers who are “frugal” about paying for definitive urine testing by chromatography which is more expensive than the commonly used in-office urine drug screens (or quick send-outs) by IA, the latter of which by comparison to chromatography are inexpensive.  How can the UDTapp help here?  It could save time for clinicians who are banging their heads against the wall trying to justify the confirmative test to insurance payers to show their patient is innocent; to deny drugs because their patient is in fact guilty of foul play; and to reduce liability.  Equally important is UDT-3that insurance payers can see a clear explanation (or at least the dilemma faced by the clinician) and why it is imperative that they pay for the test.  In the end, for those patients that are abusing the system, payment for drugs no longer prescribed because of confirmed noncompliance, substance abuse, or diversion is actually beneficial for all. And believe me, a year’s worth of diverted OxyContin and morphine costs a lot more money than a definitive test panel by chromatography – seems like a bargain really.

 

Who wins?  Everybody. UDT-3

The insurance company saves money because they shouldn’t have to pay for drugs that are being abused or diverted. 

The addicted patient should be referred to a substance abuse program for help. 

The person diverting should be reported to appropriate legal authorities.

The prescribing clinician should feel more confident about making fair decisions regarding therapy.

The honest patient is more likely to be treated fairly and with respect, and definitive testing will only be ordered when indicated. 

UDT-5

UDTapp by REMITGATE, LLC, will be available April 4, 2015. click HERE.

PATIENTS  & PROVIDERS:
Please comment or tell about your UDT disaster here in anticipation of launch day! I want to be certain that patients and providers are aware of the availability and applicability of this important tool.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24 thoughts on “Patients & Providers Tell Stories of Dreaded Urine Drug Test

  1. I am a,45yr old woman who had a bad accident in 2004. I was in the hospital for 3yrs and given 3 80mgs oxycontins. After m’y hospital cc stay, I found it hard to find doctors who prescribe it. I had just returned to Edmonton, Alberta after living in Ontario for several years. My last doctor helped me but o,Ly gave me 2 40mgs of oxyneo for a few yrs. Never upping my dosage! Then on March 30, 2019 he requested a urine test. Then I was called back in too see him April 10, 2019. He told me that my urine test came out with the use of morphine! What?? Never touched it. I called my pharmacy as well as the urine sample people. They both told me that morphine is in oxyneo’s and that my doctor should’ve known better! I’m disgusted with his performance, now I may never be prescribed the medicine I need for my pains. I don’t even think he’s ever reviewed the injuries I sustained from accident! I need help!

  2. I am afraid every time I have to take a urine drug test. I’m not sure if I took a norco 10-325 on a Sunday night and one the next morning along with MS Contin 15mg. What will my drug test show for pain management. Does anyone know?

  3. I am upset went for a urine screen I am prescribed 5
    325 hydrocodone when the urine test came back my doctor told me the oxycodone was present in my urine I have never taken an oxycodone and I am upset because she is accusing me of doing so

    1. You always make them send it to the lab. So many medication can cause false positives it’s crazy. There’s many many lists of known medication that can cause a false positive.

  4. What if U are alcohol dependant for over 20 years and U want to stop but when try to stop hve massive panic attacks that sent me to ER where they dne several EKGs and swore I was hven a heart attack 3 days in a row but when I go to drs and honest with them that I get DTs and shakes and siezures and stuff if I go without and they refuse to medically treat me cause they say they think I will drink with medication.
    So I believe that them drug testing is a violation of the Bill Of Rights and takes away the freedom of choice that Violates the US Constitution….
    What happened to the land of the free…..
    Pathetic Im an American born citizen who is watching all our freedoms being taken away…..
    Its not the police U need to watch its Ur health care provider……. Who else can get ur DNA or prescribe U sumthn that changes or manipulates Ur mind or body to be under there controls as set by government.

  5. Blown up in Iraq June 2004. Suffered an incomplete spinal cord injury Equida eqina, right leg below the knee amputation and a limb salvage on the left, nerve damage and weakness of the left leg making the amputation my strong leg.
    Over the years I’ve fought to not rely on meds but come to the point 13 year later I needed more help. Started taking Methadone up to 5 mg a day but mostly 2.5 every night to help sleep through the night and 10mg hydrocodone. Each of these meds are a simple 30 pills a month that last 2 plus moths. Well at my VA I just found out that I’ve failed 3 false positive test and have been cut off completely. I don’t share my meds, I take more when issues are more persistent and less when things are calm. I’ve gone cold turkey off both and now move like a slug.
    After doing some research I’ve found that their are a lot of us who metabolize way different and even more so when it’s a low dose and being active. My doc gave me info for a pain Cline that is 3 hours away. I refused, this is my local VA’s job to take care of me. So I will be meeting with my director and the news paper soon and blow this up.

  6. I am prescribed 50mg vyvanse and 2 1.4zubsolv per day. I do not take anything else illicit or not prescribed. At my sub dr I’m drug tested regularly my last test was + fetanyl heroine and cocaine. I’ve never done fetanyl or heroine on my life and haven’t done cocaine in atleast 10yrs and Im a total homebody no way this was put in a drink or something crazy. A few years ago I had cocaine show up too and same meds but not taking anything else, how can this be? No one believes me but I seriously have not done any drugs and feel like I could be totally screwed ever time I take a urine test bc I can’t explain these + results but know that I haven’t used anything. My daughter could b taken away and I’m not lying I’m so sad. It’s been over 30 days since the test so I can’t do anything ab it and my sub dr discharged me and recommended inpatient. This isn’t right I’m so sad and don’t even know who to band at I kno he has to go by the tests but I kno I didnt do any of those drugs.! This sucks.

  7. I’m gonna share a quick story on how an innocent patient can be screwed over involving a UA and the misleading information you will find online and poison control center. This is my story, from my first day I told them with only 3 a day I take my first one at around 5-5am then go back to sleep. Therefore I run 2 days short every month. The 3rd month I went in they told me they can’t write me 30mg morphine IR anymore because my drug test are coming back clean. I argued that I have to take them. So I went online to see how long it will stay in your system, it states on 10+ sites 3-4 days. So I went to ask a pharmacist, he said if you’re active it can be out in 8hrs but metabolites will be in there longer. I had him print that out. I had my family doctor help with my pain medicine for 3 months while I tried to get into a new doctor. It was then I interpreted that my report must say that I’m a risk and possibly selling my pain medicine because no new doctor would take me. I got back with same doctor after bringing in old pay and saying u really think I gave this up to sell my needed pain medicine. It was at this time treated once again. Lots of misinformation out there even among the trained “professionals “ I also see clinical trials as a joke in this field. You really think you can take either ones with minimal opioid experience, or those that need it and get a real answer in its effects, when they are already stigmatized and in fear of losing it(not UA related). Most people have no idea on how to convey their pain, our average person can’t even give you a well thought out description of their person. Yet they are determining scientific studies based on their responses. They need to hand pick for clinical trials, using those with a better IQ level and opioid users. With an average IQ rate from 80-100, randomly selected people just aren’t gonna get us toa great understanding of the medication effect. I know I covered two subjects I. This, but once I get going on this I can’t stop because it effects my life so much

  8. Finally some pain relief….for 1 whole month! I was prescribed butrans patch with hydrocodene along with a muscle relaxer and anti-inflammatory, and I’d never felt better. Then, I failed my very first drug screen! My Dr said I tested negative for my prescribed meds but positive for oxycontin, valium and fentinyl and dismissed me from the practice. I have not used ANYTHING I wasn’t prescribed and I’m totally confused. Either my pee was switched with someone else’s or something was wrong with the test showing false results. They just dismissed me for my “poor choices and unethical behavior”. I requested they do a blood test or hair follicle but they told me I am not welcome there and to not call again.

    1. I/we totally understand ur misfortune. My wife has had chronic pain most of her adult life. She was prescribed Nucynta 100mg. tabs 6times daily. She’s taken them faithfully for almost 10 yrs. Never taking more, or less than directed. This stuff ready did work well, as she was able to function as a human being. Suddenly, amidst the”Opioid Crisis”, we’re being told that the meds are Not showing up in her urine test. This cannot be possible.wtf? Now, wrongfully accused of Not taking her meds! Accordingly, they’re also saying that if she’s not taking the meds, she shouldn’t have withdrawal.OMG! HELP. What can be done? This treatment (?), is totally f-d up! Major withdrawal, & pain. Basically being” Black Listed” what do we do now? If you have Any suggestions, I/we are more than willing to listen! Please help if you can. Thank you.

      1. my husband is going through it right now im pist he has a broken back and a broken neck and told him his tests coming back negative he now has to go for an eval so we can try and get his meds back he is a diabetic and drinks lots and lots of fluids cause he is allways thirsty sugar never under 300 even with insulin

  9. Too late! I’ve lost four doctors in four years due to false positives and false negatives and am now on less than 25% of a therapeutic dose. After each dismissal I did research (that doctor should have done) on my drug/drug interactions. Upon finding the expected results, when I would call my Pain Doctor they each informed me, ” yeah it’s just easier to dismiss you since we can’t be sure that WHY those results came up” I hope this tool helps patients but in Nashville/Hendersonville I doubt any oain doctors really give a damn enough to use it.

      1. my doctor ordered 2 tests a drug of abuse screen using automated analyzer cpt and a opioid screen pain management urine automated analyzer with eia? what are these?

  10. I just started a treatment program. Have always been on addralle and suboxone. I just called my insurance and was told I failed for PCP!! I don’t even know what this is! I was never told by any doctor I failed for PCP where is my health insurance getting this info from?
    Soooo annoyed atm!

  11. I’ve never failed a drug test. I failed badly for a pill count test in february. So that means my oxycodone 5 prescription is automatically stopped.

  12. Here is another negative Kaiser pain patient experience, from Oregon, posted on “Pissed Consumer” (review #6189320) 1 day ago, by sadmadglad. I don’t know who this is, but I believe them. To find it, just type ‘kaiser” in the search box at Pissed Consumer, or at ConsumerAffairs.com, another place patients go to complain. Probably works for Blue Cross, et al, as well.
    I hope this is OK to post here. It is in public domain now.

    ” I Went online to look up reports just like this because I just got completely screwed by dr at kaiser and she did it in a sneaky way.I’m a pain patient &have pretty bad a.d.d (very foggy Brain).well, I am to take a urine test every so often and have for 5years here.It’s their safety precaution.well I had never had issues with a test coming up bad until last year.BUT, Heres the thing, I never took anything that they say I have in my test.

    I go to get my meds few weeks ago and told dr has suspended my meds! Ive been on a long acting for 8years and an a.d.d med For 14 years off and on.I did a urine test last month and it came back with consistant with what my meds are ,but I notice it also says confirmatory for amphetamine and codeine.which I thought” ok strange “but my dr must know its a mistake and thats why she said my test was good.A week later she tells me I’ve had 2another tests come back with amphetimine prior and she didn’t realize it wasnt consistant with what I take because she thought thats what methylphenidate broke down into. said she didnt know how to read the test correctly etc.Im bawling now telling her theres NOoo way it can show up with what it said I had taken.Then she goes on to say another test in last year showed up for hydromophone.I flipped because I didnt know what that even was.but yet that test also came back normal according to her. So those tests were marked bad, and I was led to believe they were all good then later am told it wasnt and so I wasnt given a chance to go back and test again to proove they’re dealing with bogus tests.Something is up!!.so her first reaction is she’s taking me off all controlled meds.The a.d.d med that keeps my brain functioning and pain med that somewhat allows me to function and get up out of bed.She has me tapering now and i’m so sick.

    This dr has made little comments for years about taking me off my meds .Theres no way I can drive without having my a.d.d meds because of my distractibility.

    And the thought of going back to being in pain has me anxious and freaking out. And now no one can prescribe for me because they think im taking something due to the tests.The week before my urine test the only thing I took was allergy meds,sudafed, and my vitamins, diet pills.I mean ***, I dont drink ever, I’ve never smoked pot ,done drugs but now thats what kaiser thinks and I’m so humiliated To even go in again with this fake stuff on my record.Ive no recourse im sure.even though ive read all over the net that these tests can be messed up because of human error etc.im at a loss on what to do.Ill never Be able to lead a normal life again all because of a witch hunt to get pain patients off their meds at any cost apparently.My 74 year old mom even got drastic cut back on her meds. I mean come on!!! Im so ticked off!!”

    1. I realize this was a year ago, I’m going thru a similar nightmare, only I never gave a urine sample of any kind and I was treated terrible in the ER and completely profiled, and then had bogus results put into my file.
      I am astounded, and mortified.
      Anyone else have this happens? What’s my best course of action?

  13. I am so excited for this to get off the ground! It has been a long time coming, and is desperately needed; both for doctors and patients. The number one complaint I hear from patients is that their doctors think they are just drug seeking. No, they are seeking relief from debilitating symptoms and a disease that doesn’t care what you have going on in life, it’s going to hit you with everything its got. MSK doesn’t take a second off, ever.

    Luckily, the times that I have been in pain management, my doctors have been sympathetic. While they had never heard of my disease, they were willing to listen and try to help. I do know others – many others, that haven’t been that lucky. There have been many conversations in my support group that have centered around patients being told by medical professionals, both ER doctors and their own personal doctors, that they aren’t going to be prescribed pain medications because they’re addictive and there is no need. I have been told that myself on several occasions over the years. They are told that they are just drug seeking. They are bounced around from doctor to doctor because no one is willing to prescribe pain medications. These patients are seeking HELP. There is a tremendous difference. It isn’t our fault that the only thing that helps is medication. If we could choose any other way, believe me, we would. We hate taking pills all the time.

    I have never had an issue with a urine drug screen that I am aware of. If there was an issue, my doctors never mentioned it. I am fully aware that I am in the minority on that. I have always had a fear that something would come back as a false positive, not because I wasn’t taking meds correctly, but just because I’ve heard it can happen for all sorts of crazy reasons. I have also heard horror stories from patients on that subject.

    It is my sincere hope that doctors across the country will get on board with this new tool. I find it extremely sad that it’s come to this point, that an app or website is needed in order to validate trust between doctor and patient. I do understand that not everyone is honest and unfortunately, some have ruined it for all. I pray that doctors are willing to set ego and prejudice aside and take full advantage of this great new website. Thank you, Dr. Fudin and colleagues, for taking the time to create this site and for providing the science to not only help doctors, but patients as well. I wish you much success and look forward to future updates.

    Mary Maston
    MSK Advocate

  14. I have been a Kaiser member for 30 years. Over that time, I have received many opioid RX, for chronic pain related to multiple spine fusion surgeries after being hit by a car as a pedestrian. I have never abused or diverted meds, nor given anyone any reason to believe that I had; this is well-documented in my Kaiser charts. But since the opioid witch-hunt received new impetus upon the up-scheduling of hydrocodone combination products, this is the new Kaiser:

    At the same Oakland Medical Center where I have received care since 1985, ​​I make an appointment​ with a new Family Med PCP​. I pay $25. I show up ten minutes early and I am put in a room. 40-50 minutes later, the doctor comes in for 5-10 minutes, Takes no history, relies entirely on a chart. Doesn’t perform a pain assessment, doesn’t ask me about current meds, fails to update even the non-controlled Rx she’s refilling. When I finally suggest she refill what has worked in the past (hydrocodone/APAP 5/325),​ she leaves the room for 15 min, ​returns and hands me a 4-page single-spaced pain management agreement with my name printed on it, and tells me I have to sign it without going over it or signing it herself. Doesn’t give me a urine specimen cup either. ​Then she walks out of the room. I figure she will return after she has given me enough time to read the Med Agreement. But she doesn’t. ​Since she never returned. I had to ask staff for the urine sample cup. I don’t think they knew what it was for, because they elaborated on the protocol for a “clean catch” specimen, as if it was a urinalysis for infection. When I asked her staff to call her back in the room to provide Informed Consent for the PMA, she calls Security to escort me out of the entire building. I did not leave the PMA unilaterally signed by only myself. But I did leave the urine​​. And a month later, I received an invoice, since Kaiser forgot to request a co-payment for the urine test at point of service.
    ​The visit was coded as Level 4, billed at $331, which doesn’t match the published Kaiser Perm Northern Cal 2014 Fee Schedule value of $220. [plus my acuity should have been coded much lower than level 4]. The “Lab: Blood Screen” [even though it was urine] was listed 3 times = $760 + $92 + $92 = $944! plus a Creatinine = $36 [which I had just had done <2 months ago, so was unnecessary this visit] = $980 Lab Total. Add Co-pay = $35. Grand total, one new visit + urine screen = $1346!!

    That visit was June 13, 2014, and I have never received a prescription for the 30 tabs of Norco I expected. In fact, I have yet to receive any pain management treatment plan at all. I filed Member Grievances, which led to recommendations that I be prescribed Capsaicin (?? I don't have diabetic nerve pain) and Nortriptyline (which I have a documented reaction of acute blindness to). This led to more grievances needing to be filed, since there is obviously something wrong in my chart, or nobody is reading it! I am almost age 60, have been a Kaiser member since 1985 and I have no major medical problems, just spine surgery after a car accident. This is the first time I've ever been asked for a urine screen and for a Rx I've received previously without incident several times over the last decade. I was planning on dropping this insurance, since my premium is so high, but this single visit cost MORE than my monthly premium of $1276! Something is seriously wrong here! No wonder people buy drugs on the street-it's cheaper. Since street drug dealers don't bill for useless labs, this kind of billing only encourages drug diversion. Has Kaiser even thought about this? [Invoice for services available on request]

  15. In theory this sounds good, in reality will physician take the time, and will patients understand the complexity of urine drug screens? Patients tell me they feel like a criminal when all they need is pain relief. The physician should also be in tune with behaviors that suggest abuse or misuse.

  16. This looks promising and I hope doctors use it. I have a understanding with my Pain Specialist and I simply tell him the truth. I see no point in being dishonest , after all its my life full of chronic pain I’m dealing with , I have nothing to hide.

    Every single time I’m asked to give a urine sample a switch turns off and no matter how hard I try I cant deliver . The restrooms are right there next to the front desk and all this sound outside the door is a no go for me. But I must deliver so I go down one floor and use the restroom where there is no noise.

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