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First urine test at PM

jshamussjjshamuss Posts: 4
edited 06/11/2012 - 8:55 AM in Pain Management
I had a urine test back on 7/5; evidently now in my state they randomly check patients at pain management centers. I 'failed' my test because it came back without any medication in it.

On the day of my appointment, we did a quick update; we talked about my physical therapy, my upcoming facet block, and my experience with illness recently. He then asked me about my medication (I take Lortab 7.5 twice daily). I assumed he was asking me when I needed a new prescription; instead he told me I had to do a urine test.

I told him I was currently getting over a sinus infection (a really bad one). My pain level was much higher than normal 8.5/10, it's usually 7 or 7.5. I explained that I thought I was having a reaction with the antibiotics so I hadn't taken anything recently. He asked how many days I'd been off it. I told him, "A couple of days at least, my stomach was really hurting me." He said, "Ok, it's still in your system." He told me they'd take me back to do the test and then we'd finish up.

I think we spoke for barely 2 minutes wherein I covered 3 months of my life, including illness, info about my injuries. It was shorter than a normal visit and I thought I'd see him after (I had several more questions).

Long story short, someone from their office called me a week later and told me the test showed no drugs in my system - they were now required to drop my dosage from TWO Lortabs 7.5 to ONE a day on the next prescription.

Cut it in half, in other words.

I explained to the nurse(?) on the phone about the situation. I explained that I TOLD him about my reaction. She went back and asked my PA if I'd told him about the illness,antibiotics, etc - he remembered but he said he hadn't understood how long I'd been off them. She also told me that it didnt matter he remembered because they 'can't change the chart now." She also tried to argue with me about a reaction between antibiotics and pain medication. As I wasn't about to argue with a stranger over the phone over my 4 day bout of constipation and severe stomach pain, I told her I'd make an appointment to see him.

Anyway, I see him tomorrow and hope to at least get some questions answered. I've been a patient there for 5 years, have done probably a dozen or more facet blocks, 4 RFL procedures, some epidurals, and at least a half dozen bouts of neck physical therapy in addition to 12 months of shoulder physical therapy.

I'm really worried about dealing with chronic pain with only half the medication.

Thanks to anyone who spent the time reading that, I didn't mean to ramble so long.

Any advice or insight would be very helpful.



  • First let me say welcome to spine-health. Have a look around and you will find others whom have had issues with urine test, and there is some valuable information in those threads. The problem you have run into is that your not taking it as prescribed, while I understand what you are saying, some how the doctor didn't. Without any meds in your system the time frame would have had to be different that just a day or so, as the length of time and the half shelf on the med. You can look both those up and see how long it should be in your system. The problem for you and the doctor is that many see a pm doctor saying they have pain and then sell the meds, and thus putting the doctors license at risk.

    At this time the only thing you can do is be open and honest and discuss it with the doctor. Also he/she will be able to look at the times you are getting them filled on how often and for how long at that level. Unfortunately doctors prescribing these drugs are under a microscope and so therefore so are the patients, but if your using them the way you should be, then there is no issue.

    I myself see my pm doctor once a month for med refills, upon leaving the office I make the following months appointment. In my state and the meds I use, I have to be seen every 30 days. I could and never would risk loosing my scripts for any reason. Even with the meds the pain is bad enough. When you have a issue of all of a sudden with a med, first thing you should be doing is calling your pm doctor. Further you should only be getting meds from one doctor. While I understand it was a mistake, you will have to explain it to the doctor, and see about moving forward. He/she might think if you could go without them then you only need the pill a day? Most people whom have been on the meds for long term would also go into withdrawal from not using them on schedule. Hence if he/she didn't see any of those symptoms, might be wondering how long you have not been using them. Not that i am saying you haven't but they may have perceived it that way.

    Just thought I would stop by and welcome you to spine-health. Hopefully you will get this all worked out tomorrow and have no other issues. I would be sure to be prepared to discuss this and have time frames written down logically, and hopefully they will see it was a honest mishap. good luck let us know how it works out.
  • HI,
    Welcome to spine health...you'll like it here!!
    Well by God, now I've heard everything - a urine test to see if you're taking your meds!!! I have never heard of this! I suppose in the world we live in, there is always the chance of getting scripts and selling the pills, but why would one in pain even consider this? I don't think we would... God, sorry you're having all these problems with your meds... I get all my meds through my primary dr. and have never had any problems. Can't believe what you are having to deal with...hope all works out soon, and that your meds are back on track....
    Let us know how things go...
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  • Thanks for the welcome here; I kind of just blurted out my issue without any fanfare.

    I totally agree with your points. Not taking the pills for a few days was not a decision I took lightly, by any means. It was an AWFUL weekend. Sickness, fever, stomach/intestinal problems, combined with withdrawal symptoms, just terrible. However, at the time, it seemed like the right thing to do. I was really worried about not having gone to the bathroom for days (sorry for the graphic description here).

    I was further worried that the pain medication would mask the pain related to the constipation and I'd do real harm to myself by not going to the bathroom for days on end. Combine that with a holiday weekend and my choices were

    A. go to the emergency room
    B. try not taking my meds (which have caused me to be constipated in the past
    C. keep taking my meds and hope it goes away

    Incidentally, my stomach did start to feel better, but I had just an awful weekend. Obviously, I should have made myself clear to him, but I was still feeling wretched when I saw him, sweating, fever, pale as a ghost.

    I hope to clear this up with him tomorrow and clear up a lot of my confusion regarding treatment and what is expected of me.

    I've gone on and off about 6 different muscle relaxers, a sleep aid (which turned out to be an anti-depressant - this was a huge ordeal too). I at least want to clear things up with him, if only because there needs to be trust between doctor and patient.

    Thanks again for the sympathy and advice.
  • A lot of Drs (& nurses) see a pt. with no medication in their system, complaints of a cold ( in your case "I told him I was currently getting over a sinus infection (a really bad one)") and think the pt. is in withdrawal. Most patients will take a pill rather than suffer the pains of WD, so your Dr. may have thought that you had simply run out of medication. I'm only speculating and have no idea what your Dr was thinking. I failed a UA myself once and I am a compliant patient..I won't let that happen again.

    Be very open and honest with your Dr., because that way everything will work out ;))
  • Just got back from the appointment; it went really well I think. I explained exactly what happened and why; he was very understanding. He said that he knew me and we had a relationship going back five, six years. He said we will continue to move forward with treatment, and also they would eventually readjust my medication dosage back to what it was.

    I was very happy to clear the air and got to ask a lot of questions (spent about 10 minutes talking).

    Oddly enough, in passing he mentioned that they were not really concerned if there was even marijuana in tests like this. They were more worried about harder drugs. He also mentioned that if someone looked at my history, they'd have to be able to justify the medication. My test made it look like I wasn't taking my treatment seriously (even if there were extenuating circumstance). He knew I was a good patient and serious about taking care of myself and my condition.

    In the future, if anything like this arises, I will call them ahead of time, we agreed. Obviously, this might have all been averted if I'd done that in the first place.
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  • I even brought the antibiotic bottle and went over the timeline as accurately as I could remember. I also went into greater detail as to the physical problems I had.

    Anyway, I feel a lot better now. I am worried about dealing with my pain in a couple of weeks with a lower prescription, but there's not a lot I can do about that. I'll just try to take it easier and curb my activities.
  • Just want to say...

    Happy that it went well:) You must be SO incredibly relieved. But, definitely stick to your prescription to a T, even though it may be very difficult because of the decreased dose. Still stick to it, because you will probably get another test next time.

    Also, take your pain pill about 8 or so hours before your appt., so it will show in your next urine exam. I think that you will be tested at the next visit, and since you're on a small dose, it will be easy for them not to show.

  • jlrfryejjlrfrye ohioPosts: 1,111
    Under my pain contract if there are no meds in your system they assume you either ran out by taking too much or are selling them. Immediate termination from the practice. Ohio is getting so strict on the pain clinics the doctors do not allow any deviation from the contract. The urine test that I have to take can tell the doc if I am taking too much, too less and not exactly as prescribed. The test cost my insurance 1800.00. If I deviate from my contract at all I place a call to the nurse and ask for permission to deviate from the contract. I am allowed 2 opana and 2 oxys for breakthrough pain. On really bad days i need 3 breakthrough pain pills. I have discovered that if I call they always allow me to do this but my chart is noted and my butt is covered.
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