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Failed drug test at Pain Management D.O.

Hello there, I am looking for some advice on what options I have when I've failed my drug test with my PM D.O. I was sent by certified mail my discharge from my clinic and when I went in for my next appointment to talk to him about things he would not even talk with me even though the letter sent to me said, "The only way I can keep seeing you and giving you Rx for methadone & oxycodone is if you seek out help for your drug addiction." So I started seeing a licesened therapist with 30 years experience 10 years specialist in drug rehab like the letter said yet he would not even give me a chance to explain myself. I found out in 2011 when I started having hip pain that I had a disorder called Avascular Necrosis and in march of 2012 my left hip was 85% rotten and was replaced, at that time my right hip was 15% rotten and I was told to try to deal with the pain for as long as possible through PM and then we will replace the right hip as well. Without my pain meds I am unable to take care of my 2 small children now that I am a stay at home dad thanks to my disorder. The reason I failed the drug test was completely my fault and only a 1 time mistake. My wife and I were going through a very tough divorce and I was 32 years old living at my grandmas house unable to contact my wife or children by law and I was not dealing with this well. So I made the mistake of visiting a old friend who I knew was still using Meth and I stupidly used not knowing I would be taking a drug test days after. My wife and I are back together now and I have not had a drug problem for many many years I just made a mistake that ended up costing me a lot more than I ever knew. I know that my D.O. will put this on my permanent record and that no other PM clinic will take me because of this, but I truly need my pain meds to live my life. And the strong Rx's that I have been on for going on 2 years are gone cold turkey, no steps down, just gone. So now I get to deal with chronic pain with no meds and deal with withdraw symptoms from narcotics. Emberised by this, I don't know what route to go but I fear the worst for the future. What will my other doctors do like my phycratrist or my primary? Will they drop me as well? Is there any way I will ever be able to get my meds back? Will this failed drug test be there forever and will any/every doctor be able to see it? If anyone has any advice please respond with some good news for me. Thank you for reading.
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  • LizLiz Posts: 7,715
    edited 08/29/2013 - 7:29 AM
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  • Let me see if I can answer your questions- and if I understand your situation correctly. You are 32 years old, have AVN in both hips, have had one hip replacement and trying to hold off on a second one for as long as possible, but were seeing a pain management doctor in the meantime. You were taking methadone and oxycodone as your long acting and immediate release medications to manage the pain but during a tough period in your marriage, you and your wife separated, and then for some unknown reason, you were prohibited from contacting them or seeing them ( restraining order? ), and you met up with a friend who used, and so you used crystal meth and then wound up going to see your PM doctor, who gave you a drug test and you failed due to using crystal meth?
    You have a previous history of drug abuse, but are stating that you are clean now, other than for this one time?
    Have you had any other issues with misusing or abusing the other meds that you were on? Any at all? Taking more than prescribed, ever? Failed any other urine screen? Early refills, or multiple doctors? Running out early?
    You and worse yet, your previous history sets up all kinds of red flags, and this failure of the urine test just adds another one to the field. Especially given the drug that was found. Was the proper amount of your regular meds found in the test? The Methadone and the oxycodone? Or was there too much or too little?
    There are areas of this country where meth use is rampant, and when users can't get their D.O.C., they resort to opiates to get their high, so this test result might just make things very, very difficult for you.
    AVN is painful, I know, I have it in my wrist but there are other treatments that they can offer you , such as injections into the hip to help manage the pain in the meantime, and physical therapy.
    Your best bet is to contact an addictionologist in your area, and get an evaluation done to determine whether your use of these substances is in fact for pain or what, and see what they recommend. They may make a recommendation to put you back onto meds but with stringent controls in place, weekly or biweekly prescriptions, urine tests at every visit and surprise ones in between, pill counts both scheduled and not, and a new contract, spelling out the ramifications of not sticking to your contract.
    No PM doctor, nor any doctor needs to give a patient a tapering schedule or a month of meds once they discharge you. The reality is is that YOU broke the contract, therefore he owes you nothing in continuing your care or tapering you off the meds. And yes, he can contact, your other doctors to let them know that he dismissed, you and why. Those urine results are a part of your permanent record, and depending on if he sends copies to your other doctors or not, they can also become part of your records there as well.
    I am not sure how much methadone and oxycodone we are talking about here, but if you have any of them left, it would be wise to split them and taper yourself as much as you can.
  • dilaurodilauro ConnecticutPosts: 9,587
    Once that mistake was made that cause the test failure, it iis with you and can hang over your shoulder all the time. In today's medical environment, health insurance, DEA, etc. everyone is a bit timid regarding Narcotics.

    I wish I had any more advise other than what Sandi told you....

    I've known people who failed their urine test almost 10 years before all the DEA crackdown, and still to this day it almost impossible for them to find a doctor who will prescribe another narcotic.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • which doctor would not let you explain yourself? The PM clinic doctor or the addiction doctor you were referred to? The good news is that you were not dismissed right off the bat. In most situations, you would have been. The fact that the letter did not outright dismiss you, means that he is still willing to treat you but that you must also prove that you are being treated for the substance abuse issue.
    I suspect he was angry at the substance that turned up in the test, as well as what he felt was betrayal on the part of your relationship with him and you.
    But I would make a point to offer him an explanation and believe me, he will know if you are being honest with him . So don't lie in any way shape or form when you do sit down with him.
    I would tell him just as you did here, what went on , and why you did what you did, and that you are seeing dr xxxx for that issue, and want to prove to him that it was a one time slip that you won't be repeating and discuss what you plan to do to prevent it
  • shintysshinty Posts: 26
    edited 08/30/2013 - 2:55 PM
    My only advice is to show this post to prospective doctors, as it explains your story so eloquently. It is going to be hard to find another doctor to treat you with narcotics unfortunately. You did do this to yourself, and now your paying the price. A lot of non violent people are in prison for simply using drugs, so your problem is mild compared to some. You still can get treatment for any withdrawal symptoms you may be experiencing though. Suboxone helps withdrawals, and some pain doctors even use it to treat chronic pain, so it's worth looking into. good luck.
    shinty
  • Implementing such draconian measures without bothering to specify a clear path to redemption is not only an oversight, but inhumane. No one that is willing to seek help should be sentenced to a life of pain. Wouldn't implementing an immediate policy of weekly prescriptions, pill counts, drug screens and counseling achieve a better result?
  • that is all and well but what if a person is lying about his pain? back pain the the most common complaint for disability and as everyone knows, there are all sorts of people that make up their pain and complaints to get pain meds. this is why disability spies on people, taking pictures and movies. it is easy to go in and say i hurt my back and the pain is unbearable. i need to get on disability. lying about ones pain and taking meds that go against ones contract should in my opinion let the pain dr off the hook. he does not have to do anything. if you cheat, you are out and if you have to go through withdrawl then so be it. i see it so often on this site that the drs don't believe me after they have had numerous cat scans and mris that show nothing. with all of the stuff drs have to go through, i don't blame them if they dismiss someone outright. they don't owe anyone anything especially if they don't follow the contract. it is the patients fault and he must bear the responsibilities.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • jmhar68jjmhar68 Posts: 60
    edited 09/02/2013 - 6:02 AM
    All I am saying is there should be a defined process in place that gives the honest person a chance.
  • sandisandi Posts: 6,556
    edited 09/02/2013 - 12:45 PM
    to a known addict, that is in large part why they must dismiss a patient when there is a problem with the urine screens.
    Yes, in some cases, I do think that there ought to be options available for redemption, and that is why I suggested a consult with an addictionologist, and if the addictionologist doesn't feel that relapse or abuse of the meds is a concern, they can make a referral to a pain management doctor for the patient. Some are also doctors, and will prescribe meds within some guidelines to ensure compliance.
    A part of the problem is the continued , ongoing misuse of medications by patients, some of it is a lack of clear communication between the patient and the doctors regarding proper use of and compliance with the use of pain medications, and part of it is addicts who are using prescription drugs. That is why compliance with our contracts is such a huge deal, and if you already have a history of previous abuse doctors are less willing to take on a patient with a history.
  • terror8396tterror8396 Posts: 1,838
    edited 09/02/2013 - 1:44 PM
    i have had incidents where i lost my meds. i keep them in a small container and a couple of times when i went to get my keys, apparently they fell out and i did not know until i went to get my meds. i only keep 4-5 pills in the container and take it to work and have when i take them. i have never gone to the pain dr and said i lost my meds because i don't want a blot on my record and an excuse to get on my case. i just buck it up and take a few less a day. i have talked to the office about what they do if people say they lost their pills and they said the dr will give them the benefit of the doubt if there is no history of it, but for me why take the chance? as a result i am a lot more careful about my meds. when i go to work, i put them in my backpack as soon as i leave the door.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • I do not understand why you keep supporting ambiguity. I assume it is because you have a negative opinion of meth-amphetamines. Well, so do I. But I am willing to give someone a chance, maybe even two or three. if there is a law that prohibits a doctor from prescribing controlled substances to addicts, then there should also be a law that defines the legal process that doctor then implements to treat the addiction and pain simultaneously. The answer should not be different behind every door.
  • jmhar68jjmhar68 Posts: 60
    edited 09/02/2013 - 2:42 PM
    terror8396 said:
    i have had incidents where i lost my meds. i keep them in a small container and a couple of times when i went to get my keys, apparently they fell out and i did not know until i went to get my meds. i only keep 4-5 pills in the container and take it to work and have when i take them. i have never gone to the pain dr and said i lost my meds because i don't want a blot on my record and an excuse to get on my case. i just buck it up and take a few less a day. i have talked to the office about what they do if people say they lost their pills and they said the dr will give them the benefit of the doubt if there is no history of it, but for me why take the chance? as a result i am a lot more careful about my meds. when i go to work, i put them in my backpack as soon as i leave the door.
    jon
    Yes, we have to play the game. It has forced me to find alternative methods of relief like acupuncture, hot showers and sometimes just lying down for an hour or two. The original poster needs to figure out what is truly important to them and stick to it.
  • there is a law. it is the contract that a patient signs when starting pain management treatment and it is very specific. it also stipulates that if you break the contract the doctor can drop you. i believe in my contract, it says can drop you so i believe there are circumstances that the doctor can weigh in if he wants to drop you. but i think that when one signs a contract, you say you understand the rules and if you break them, then one should be dropped. it is up to the doctor. i think most will give a warning if there have been no other issues. but some will drop a patient with no warnings. one should be very clear about the contract. if you break it knowingly then you should be dropped without warnings.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • HuggyHHuggy Posts: 321
    edited 09/03/2013 - 4:22 AM
    I realise that PM docs often 'fire' their patients for using other opioids or (illegal) drugs, but in other cases the situation seems somewhat murky. A widely used pain management text that I looked to for answers stated:

    'Opioids, if they are appropriate, should not be withheld from patients with pain who also have addictive disease.'

    It also states, as a guideline to medical staff:

    'Remind staff that (a) prescription of opioids to a known addict for the management of pain IS NOT ILLEGAL... ' (Caps mine, for emphasis)

    Source: Pain Assessment and Pharmacologic Management (2011), Pasero & McCaffery

    I was surprised, as I'd assumed that prescribing to people in pain who are also addicts would be discouraged, if not against the law. I would think it is frowned on by many doctors, regardless.

    Edit: Just to say that, I guess the main difference here is the use of opioids in the treatment of those with acute pain versus chronic pain.


  • It is illegal to prescribe opiates to maintain addiction- which is what doctors are refusing to do, since many addicts when not able to get their D.O.C. , will substitute with any available opiates.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853184/
  • sandisandi Posts: 6,556
    edited 09/03/2013 - 5:52 AM
    Your excerpts are correct, when it comes to treating chronic pain in patients with addiction histories. In this particular situation he used recently, went to his appointment, was tested and failed.......thus his doctor refused to continue to treatment.
    I was not very clear when I posted earlier, I should have clarified that it is illegal for doctors to provide opiates to maintain an addiction- in other words, if a doctor knows that a patient is addicted to percocet, they by law can not continue to prescribe to said patient.....
  • Thanks for clarifying, Sandi.
  • is a cunning disease. I am an addict who has been clean 10+ years and yet I have suffered with chronic and sometimes acute pain. I have had to use narcotics after several major surgeries, clean. I have also had to use narcotics recently as a result of continued chronic acute pain after failed surgery. The important thing is, my PM Doc KNOWS everything about me. I ahve been honest and not tried to hide my past or repeat it. Motives matter. It kills me to no end knowing that I have to take that which will kill me just to be able to survive. It is like telling an alcoholic to drink only one or two drinks a day.
    That IS alcohol abuse in their eyes! :(

    I have always been an open book to my PM and he has tested me regularly. I have no objection and have asked him to keep me accountable, much more so than his usual patients. I do NOT want to go back to the nightmare that was my life before and I pray that the SCS turns my life around shortly.

    The spot you find yourself in is a tough one but learning from it is crucial. Poor decisions can cost us a lot in the end.
  • when a person is trying to scam the government with a fake condition, they basically want money out of the system. why is there a problem with filming people? they do this to catch fakers who are bilking the system out of millions of dollars to get money and also to get out of working. a guy i work with has a workman's comp against the district for neck issues and his lawyer said work comp was filming him lifting heavy wood and moving it around. this is for a person who is supposed to have neck issues. so basically taking money for false pretenses is basically robbing the system out of money. not only are they cheating the gov't out of money they cry out about how much pain they are in and insist on pain meds. this stuff goes on all of the time and that is why workman comp films people whom they suspect are faking it. remember this money that these people want is coming from our pocket books. i still don't understand what the oath that drs take has to do with taking people off meds when they break a contract. a doctor has the obligation to continue to give meds to an addict because the oath says they are to treat people? a contract one signs says the dr has the right not to treat us if we cheat to get more meds.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • the patient is given plenty of forewarning, in what will happen in certain circumstances. The patient violated the contract, not the doctor . So there is no patient abandonment, to my knowledge.
    You are right in saying that some doctors don't necessarily live up to the Hippocratic Oath, at least from what we read here in these forums, but we are only getting one side of the story, and sadly, there are times when all of the rest of the information that we don't have could change the entire picture once it was known.
  • jmhar68jjmhar68 Posts: 60
    edited 09/03/2013 - 5:02 PM
    You all sound like nice people and I can appreciate your opinions. I just think the answer should be the same behind every door. The lack of legal framework invites abuse and leaves honest people no recourse.
  • shintysshinty Posts: 26
    edited 09/04/2013 - 6:46 AM
    ------------"All I am saying is there should be a defined process in place that gives the honest person a chance."-------------

    There is a "defined process", it's called a narcotics agreement, or contract. It defines everything that's going to happen if the rules aren't followed. It's simple really. The problem is when the reason for discharge is a false negative urine test result, which could mean a defective test. Then an "innocent" patient could be discharged. My pain management doctor won't dismiss you outright for a negative urine specimen, but will put you on probation. They understand that it does happen once in a while. I'm sure there are other examples of honest patients getting "caught up" in the stricter guidelines that need to be followed nowadays.
  • over time, i have noticed one fact from the posters on this board, they tend to support the patient's point of view and not the doctor's or workman comp. workman comp tends to be the evil entity here. i believe they along with doctors have a hard job to do. they have to ferret out the dishonest people from the honest ones. who really has a back injury and who does not. they will send people to doctors to get mri's but when it becomes negative then it is workman comp or the doctor that is the bad one. workman comp does not take one set of movies, they take a bunch over time to catch the ones whom they feel are being dishonest and i have no problem with this. there is a bunch of abuse and it cost us a lot of money. people here tend to support the people who post without the benefit of getting another side of a story. doctors can't post here so we only get one side. why people support the patient without reservation is beyond me. people post to get sympathy or also to vent that their doctor is unfair or workman comp is bad by not giving me benefits. i have no problem with either workman comp or pain doctors. their job is hard enough dealing with people who want narcotics or don't want work. so please spare me the insults by thinking i am calling everyone who tries to get workman comp as lair and don't read into my post something that is not there which happens a lot also. we need to be more subjective with some of the posts and look it from both sides, the patient and workman comp and pain doctors not just one side. It is not too good to make a judgement when one reads only one side of an issue. we need to look at all sides of the issue and then make up our minds
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • sandisandi Posts: 6,556
    edited 09/04/2013 - 1:53 PM
    I'm truly sorry for what has been happening in your mom's life with her doctors, and that poor innocent baby......there are no words for that......I do disagree with the idea that all therapy should stop when it comes to a negative test. My opinion and it's only my opinion, is that in the event of a negative test result- that same sample should immediately be sent out for confirmatory testing. Until the results come back , the patient should be offered medications to ease withdrawal symptoms, with a follow up scheduled for the following week once the results are back. The other option would be to have an immediate blood draw to confirm the results of the failed test. That way, one way or another, the patient has some form of redemption - if they are taking their meds as prescribed, then the confirmatory test will show that, and if there is some problem, the results of the confirmatory test show that as well. Either way, the patient is not left to get through withdrawal on their own......
    As far as the other therapies go, my PM won't discontinue other modalities, but he will in fact, cut off meds until he gets the confirmation test results..
    I don't believe that injections, physical therapy, rfa's or whatever other options are given during a patients treatment should be yanked as well. I think that is counter productive, for both the doctor and the patient.
    If the test comes back illegal substances, then that is a different story.........the abuse factor of illegal drugs makes it a bit of a different situation. In that event I would want ongoing measures put in place, very frequent testing, random pill counts, family member in charge of the meds, with the understanding that a second dirty urine would automatically result in dismissal, no questions asked, but if the patient is willing to seek treatment that can be confirmed, and the addictionologist is reasonably sure that relapse is not an imminent danger, then I don't think that automatic dismissal is always the right decision.
  • Was in bad pain an daughter left Xanax for me cause I did not want go ER. During the nite I took those instead of the fomotodine. Next day I could not beloved I did it cause I know I get tested.

    So I had to fess up at next app. Told them what I had done. I got chewed out about it. 2/3 phone calls about it but was ok in the end.

    But I doubt they let me get by with it again. But I have no history of abuse. Doc even offered me few extra pills cause I'm taking the minimum. I was very lucky.
  • jmhar68jjmhar68 Posts: 60
    edited 09/04/2013 - 3:56 PM
    sandi said:
    I'm truly sorry for what has been happening in your mom's life with her doctors, and that poor innocent baby......there are no words for that......I do disagree with the idea that all therapy should stop when it comes to a negative test. My opinion and it's only my opinion, is that in the event of a negative test result- that same sample should immediately be sent out for confirmatory testing. Until the results come back , the patient should be offered medications to ease withdrawal symptoms, with a follow up scheduled for the following week once the results are back. The other option would be to have an immediate blood draw to confirm the results of the failed test. That way, one way or another, the patient has some form of redemption - if they are taking their meds as prescribed, then the confirmatory test will show that, and if there is some problem, the results of the confirmatory test show that as well. Either way, the patient is not left to get through withdrawal on their own......
    As far as the other therapies go, my PM won't discontinue other modalities, but he will in fact, cut off meds until he gets the confirmation test results..
    I don't believe that injections, physical therapy, rfa's or whatever other options are given during a patients treatment should be yanked as well. I think that is counter productive, for both the doctor and the patient.
    If the test comes back illegal substances, then that is a different story.........the abuse factor of illegal drugs makes it a bit of a different situation. In that event I would want ongoing measures put in place, very frequent testing, random pill counts, family member in charge of the meds, with the understanding that a second dirty urine would automatically result in dismissal, no questions asked, but if the patient is willing to seek treatment that can be confirmed, and the addictionologist is reasonably sure that relapse is not an imminent danger, then I don't think that automatic dismissal is always the right decision.
    That sounds like a reasonable contractual obligation so long as it is universally implemented and enforced. Submitting to procedures once reserved for convicted criminals should at least buy us a little uniformity. ;)
  • Methamphatine is probably the most dangerous drug that you can take. I have been told it is eight times more addictive than heroin and could be responsible for you current condition. Years ago I attended an autopsy where someone had been taking methamphatine and his brain was so fried it fell through the doctor's fingers like mush. It is so dangerous to your body and mind. It has the opposite effect of opiods, speeds you up instead of having a calming effect, so taking it for pain seems counterproductive. It fries your brain. Once you have seen an autopsy of someone on speed you would never contemplate using it. They give Ritalin to ADHD kids and that seems to have the opposite effect - it slows them down - but have you seen the guy who invented this condition admit he made it up on his deathbed. I did a whole Uni semester on labels they give children that carry through to their adult life. Guess being an ex addict carries it's own label and judgements.

    However I do believe there should be protocols in place. Sorry I did not mean to have a go at you. There must be a lot of recovering drug addicts who are treated unfairly due to their past. I really don't think it should matter, if you have recovered you are a strong person anyway. We do not have contracts in Australia. The Dr believes you or not and I have had the same GP for 15 years and he is at my local shopping centre so everyone has kinda seen me before and after the accident so I am lucky to have a supportive GP and pharmacist who have seen me in all kinds of states so know I am not faking.

    I just hate methamphatine with a passion. Can you get your addiction specialist to write to your PM specialist and ask him for another try. I think there should be protocols in place as well and your past should have no bearing on your present situation. Or if it has bearing on the situation it should make it better for you - you have been honest and you have been strong enough to kick a drug habit. That's not easy.

    I don't want to turn into a bitter, angry person but think I was having a rough day . Like most people I am human and have flaws. I wish there was a simple answer. I wish this forum didn't have to exist, that spine injuries were simple and could be fixed easily for everyone.

  • regarding dismissals, both because of abuse of meds and illegal substances, and wrong dismissals because of a screening test not detecting meds........in the screening tests, there are threshold set by the manufacturer, and if there is not enough of the metabolities to meet the threshold, you can get a false negative, and also a false positive for say a cough syrup of a certain manufacturer.....so of course, I spent some time thinking about what might be a better option for both the doctors and the patients at the same time and that was what I came up with.
    Now , if we could only convince the doctors, the DEA, and the testing facilities that it was a viable plan we'd be good.
  • terror8396tterror8396 Posts: 1,838
    edited 09/05/2013 - 8:04 AM
    this is why i have never or will never apply for workman's comp. i have never gotten to the point of being injured on the job to get it and i doubt if i would apply for it. we have something called catastrophic leave where we donate one sick day to a bank and if we need extensive time off, surgery etc, we draw off of it. we still get paid but we have to reapply every 30 days and have to have the union vote on it and get a dr note. i have only used it for 2 back surgeries and try to det it at the end of the year so i won't have to miss a lot of school.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
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