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Pain Management? False positives

Hi everyone.. Please Help, Need advice!
I am hoping that someone on here can help me, give me some understanding about the position I am in from the news I received today in regards to my pain management program. I have been in pain management for over a year now for my herniated cervical discs. My C3-4 is slightly herniated and my C6-7 is extremely herniated. My C6-7 is so herniated that up until last month I was not even allowed to walk down the street. If I fell, got bumped had any type of accident that I could be paralyzed or worse. I have been basically afraid to live my life. I had a second MRI done and because of my lack of activity my body is starting to heal naturally on it's own and thankfully the herniation has shifted directions and is no longer on my spinal cord. It is now going towards my esophagus. I know that sounds awful still but I am just thankful that it is off my spinal cord. I was scheduled for spinal surgery for OCT 27 but because of this recent MRI I had the option to do the wait and see method. I am thinking to just wait on everything until after the holidays. Maybe my body will keep healing to the point where I would not need a plate and two screws put in my neck. Along with my herniation(s), I also have a partial tear in my L shoulder and a snapping scapula, also on the left. Right now I live my life through pain management. In which I am building a tolerance too. I take 4 10/325 percocet daily, 10mg flexirol, PRN and 100 mg Norfelx PRN and apply Lidoderm patches, 12hrs on/12hrs off. I recently switched drs because my dr moved out of state. My first appt with my new PM was last week. She did a urine of course and gave me my scripts, offered to increase me to an Oxycotin or morphine, I declinded, I do not want that stuff, I would rather just stay with my percocet. I do not want the pills to live my life, I want to live my life on the pills. I hate the fact I need these pills to get through my day. I'm sure all of you can sympathize with me. At any rate, today my urinalysis came back and there was BUP in it. The nurse was very short with me and said that at this time my dr is not going to prescribe me any more meds. I had no argument here because I had no idea what she was even talking about. I just said that I never have heard or took it before and offered to come in immediately for another test. I have nothing to hide. She said that would not be necessary and I could talk to my PM dr next moth at my appt. She will still treat me but not on Narcos. I have no idea what she even means by that.. can they do that? Just let me be in pain? No weaning so I will be sick because of physical dependence? Not even let me prove myself with a second test? I will test every day if I have to.. I was very forthcoming at my first appt. I even told them I took a valium that week, in which I was prescribed a year or so ago. So again, I have never heard of BUP, so I looked it up. BUP is short for buprenorphine, the active ingredient in Suboxone.. didn't know what that was either. I'm still so shocked and devastated. If I lose my PM how am I going to live my life? So, after doing my research, now knowing that it is an opiate blocker for people with addiction why on earth would they think I would take that? 1) I was scheduled for surgery.. block pain killers? 2) I tested positive for percocet, why would I take that at the same time?? 3) why wouldn't I have just told them I took it because i wasn't under contract with them like the Valium? I am going to call them tomorrow and hopefully I can speak with my DR and not her rude nurse. I'm not a drug addict, Has anyone else ever heard or experienced someone testing positive for BUP from taking something else? Any false positives? Is this test going to be on my permanent file for other drs to see? Such as my orthopedic, neurosurgeon? I have filed a workman's comp claim, will they be able to see this? I am so unbelievably mortified. ANY info, advice, comments, thoughts,etc.etc. would be so appreciated. Please and thank you..


  • Unfortunately, they do not have to provide you with a second test, and this late after your positive test, it wouldn't clear your name anyway.
    As for why you tested positive for bupenephrine, it has to be specifically tested for, so the likelihood of it showing up as a false positive are slim....There are butrans transdermal patches that are used in pain management and if you used those, and it was tested for, it would come up positive, as well as if you took suboxone or subutex. If you tested positive and they only contacted you today, I have to assume that the urine test was sent out for confirmatory testing, and that also showed bupe present. When confirmatory testing is done, it tests specifically for the metabolites of a drug as it is broken down in the body. The patches, as well as subutex are commonly used in pain management these days, as well as suboxone in patients with a history of misuse or addiction.
    They can still offer other methods to treat the pain, including injections, physical therapy, aqua therapy, TENS, accupuncture, swimming, yoga, and other modalities.......pain medications are not the only means to manage pain.

    As far as them being able to cut you off the norco, they absolutely do have the right to do that........they could have refused to provide you with any opiates after taking an old valium prescriptions since it is not part of your current treatment program......it doesn't matter that it was prescribed to you previously for another condition, what matters is that you self medicated with the valium.
    Yes, other doctors, including your GP, pharmacist , surgeon, or others involved in your care may also be made aware of the results of this test, as well as any new pain management doctors that you see. It will also be part of your permanent medical record.
    It is not the bupe that blocks opiates, it is the naloxone in suboxone that blocks the opiates. Buprenorphine is an opiate.
    There are many people who live with some pain every day, and manage quite well without using opiates to manage the pain, they use other modalities, and excercise, distraction and eastern methods in conjunction with other therapies to manage pain.
  • I'm so sorry. OMG! I've never heard of false positives (losts of false negatives for some reason) I don't know of anything that could give that result. Were you taking any 'natural' medications from the Internet or anything? If you're not on anything other than the prescribed meds all I can think is your test got muddled with someone else's test. As Sandi said they don't HAVE to do anything.
    I've heard of quite a few people being struck off from pain management. You haven't received a letter dismissing you. As I understand it, they're going to continue treating you, just no narcotic meds. You can talk to your doc at the next appointment (most docs won't talk to patients on the telephone) or go talk to your GP if you have a good relationship & see if they are willing to take over your care until you find a new PM who's willing to take their chances with you.
    Being this close to surgery I don't know what's for the best. Usually surgeons prescribe pain meds for a month or 2 & if you need ongoing meds you go back to pain management. Ugh! I'm sorry. It's a horrible position to be in.
    Osteoarthritis & DDD.
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  • Thanks for your response Sandi. The doctors office said that the dr would speak with me next month. I'm hoping she has some faith in me to give me another chance. I spent all of last night researching Bupe. I have never taken anything that is listed, knowingly. I do not take patches, subutex or suboxone. That is why I am completely blown away. False positives are possible from what I have researched. As far as the valium, I was not on a PM when I took it and brought in my old prescription for it. The reason I had to take it, was because I ran out of my muscle relaxers and because I do not take them often (they make me sleepy), by the time I ran out my prescription expired at the pharmacy. I'm having a very hard time wrapping my head around this. I have a TENS Unit, it helps some what, I have already went through physical therapy and I'm not allowed to do anything except walk, slowly. No injections in my neck what so ever either, been there, done that. It burns very badly.. In the past I have received lidoderm injections. But, thank you for your info. I will get to the bottom of this. I'm mostly bothered it is on my file and they will not let me test again. Typically if someone takes something once, they will keep taking it, if there is misuse. I have the right, I feel, to test again.
  • rosepitt0979rrosepitt0979 Posts: 4
    edited 10/30/2014 - 10:23 AM
    Thanks English girl.. it is awful. Yes, I take like 10 different herbs and vitamins. I see a ND every month. She just put me on Ligaplex, BPX and Thyroid Support. I wonder if there is something going on there? I am absolutely mortified, it's all I can think about. I do not want to be looked at in this light. Ugh..I thought of calling them today and getting further info but the nurse said yesterday the dr would speak with me next month.. I don't want to push it. I feel as I'm damned if I do, damned if I don't here...
  • sandisandi Posts: 6,269
    edited 10/30/2014 - 1:31 PM
    the office testing is a screening tool, simply looking for a positive/negative response. i assume that if your screen in the office tested positive, that it was sent out for gas chromotography/mass spectrometry testing. that testing is very specific for metabolites that are what remains after any medication is broken down in the body. if gc/ms testing was done, it is very specific for those metabolites and the odds of afalse positive are slim to none.....the gc/ms testing is done to test for specific levels of those metabolites.
    as far as you being entitled to a second test, that's what the gc/ms testing is done for........should there be a positive result or a negative result for a specific drug, then the urine sample is sent out for confirmatory testing. this is the gold standard when it comes to confirming or refuting a result..
    in almost all pain management contracts, it states very specificly that if a failed urine test occurs, patients will be discontinued from opiate therapy immediately...some few pm doctors may offer a taper but most don't........
    i know that you said that it was an old valium prescription but the thing is, when it comes to pain management, if you are not currently being prescribed any scheduled medication as part of your current regimine, it doesn't matter that you had it left over.......you are not allowed to use it, for any reason. if something occurs and you need more of medication, or an increase or run out, you need to call the doctors office and ask them what to do......first...
    i am including a link to the do's and don'ts of pain management and what to expect at your first visit that might help clarify the rules when it comes to being a pain management patient.
    i'm sorry that you are going through this, but hope that the links will help you better understand the rules of dealing with pain management so you don't have any further problems.

    this link might help you with what other options you have for further pain management as well...
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  • If they find a drug in urine then is usually but I have heard some meds cause false positive. My next question is when you got the urine cup was your name already on it? Or did you hand it to the nurse and she put it on? Normally when drug testing you are the one who puts the label on the cup of if there a label the cup you check it then put the sample in the bag. However I went to my last PM and they had new staff member who put labels on the cups then handed them to a patients. The problem was she gave the cups to another person then what the name was on the label.. Thank God someone notice. Since they could not be sure if the names matched with the urine they dumped it all. Now the office has you check the label and you sign your name after you check if your name is the cup and you put in a bag. I have also seen urine sitting on tables bathrooms ect with no labels on them. I not saying they made a mistake but we are all human and we all make mistakes - even nurses. This could become a new topic.
  • Even though this is for a pain management drug test there are very specific chain of custody in force. The nurse gives you cup, you pee in cup, you bring the cup to the nurse, she checks temp to make sure it's fresh, you sign the form certifying that it's your urine in the cup. Once this happens you are 100% saying yes this number matches my urine. That number is how the lab identifies everything. Once this gets to the lab your urine is tested under a basic test for individual general metabolites of different substances as a lot of substances test positive for the same metabolites i.e. Oxycodone processes in the body as oxymorphone, hydrocodone processes as hydromorphone, herion processes as morphine etc.... This means multiple substances can show up in a test as the same general metabolite. Once the general metabolite shows up general then it gets retested using gas spectrum testing that can show exactly what was the original substance used to show positive. My wife use to work in a lab that tested for substances. The odds of an actual "False Positive" are like 1-1.5 million tests yes that 1,500,000 to 1 very very rare. All substances tested for have cutoffs that allow up to a certain amounts that can be in a persons system to avoid the "I touched some my friends drugs then licked my finger", "I took herbal things that show up as other things etc"....Bup Is especially rare to show up as a (False Positive) due to the fact there are only a few drugs in the world that show up as BUP. My wife was one of the people as part of her job that called to interview the people that tested positive to see if there is a legit reason why the test came positive. I.e. Pre-employment screen person is actually prescribed Percocet and takes it legally. She said the excuses she heard from people were insane a couple include. "My friend accidentally dropped some herion into my coffee I pulled it out but drank the coffee not thinking" , "the pharmacy or drug company must have made a mistake giving me the wrong pills", "I haven't taken that in over a year don't know what happened"

    Bottom of the line is drug testing is a great thing in pain management to make sure your actually taking what's prescribed and not selling them, make sure your not over taking or taking substances your not suppose to. These tests now required make it much easier for the people that are ACTUALLY IN DAILY PAIN AND NEED THEM!!! It's a joke to go to pain management clinics and see who goes in and out of these. I can't tell you how many times I've seen people walking in the clinic limping, holding their back, crouching in excruciating pain etc. then as soon as they walk out the clinic door magically stand strait up and run to the car. It is unreal. Pain management has become trendy in the last bunch of years many doctors I see on a regular basis tell me that only about 20% of people in a extended pain management actually need to be there. They also told me when the DEA started requiring drug tests for PM that a lot of people were discharged for one of the reasons listed above. So many people that don't really need extended PM are the ones that make it harder for us that truly live in pain 24/7 and need a pain management program to live day to day. When I first started seeing PM 15 years ago I had to drive 45 miles to go to a specialty PM clinic now they are like walgreens on every street corner.

    You don't need to agree with my post but I can assure you most people that don't agree with my stance on this are people that truly do not need a PM program in their life to live day to day. Just my two cents!!!
    L5-S1 anterior/posterior 360 fusion Aug 2013
    Grade 2 spondy, Severe DDD L5-S1
    L4 Facet arthritis
  • horselady21hhorselady21 Posts: 191
    edited 12/30/2014 - 1:13 AM
    Well, since you were tested positive for it, why not talk to your Dr. about actually getting it prescribed for you? Most Dr.'s LOVE when you ask to be taken off a Schedule II drug in favor of a Schedule III. I did it, my Dr. was thrilled that I asked and I was on the Butrans patch for 8 months. I don't know why you would test positive, but I would think it was better than being on Bup and testing positive for something stronger.

    Also, Percocet is stronger than morphine. Morphine never had any effect on my pain at all.

    Wish you the best.
  • show up that you are not prescribed currently is a bad thing.........no matter what it is.
    Percocet isn't stronger than morphine. Morphine is the gold standard when it comes to opiates, and every comparison done regarding pain relieving properties is based on morphine's effectiveness versus another medication.
    Some of us find that one medication works better than another, for me, morphine makes me insanely itchy and get hives, nausea, etc........vicoden makes my stomach burn for hours......far too much tylenol or something and doesn't do a thing for pain for me.

  • Drugs below the "morphine 10 mg" are stronger, drugs above are weaker.

    Just fyi

    Opioid Conversion Table

    Opioid Strength (Codeine) Equivalent Dose (30 mg codeine) Strength (Morphine) Equivalent Dose (10 mg morphine mg)
    Aspirin 1/36 1080 mg 1/360 3600 mg
    Difusinal 1/16 480 mg 1/160 1600 mg
    Dextropropoxyphene 1/4 120 mg 1/40 400 mg
    Codeine 1 30 mg 1/10 100 mg
    Tramadol 1 30 mg 1/10 100 mg
    Anileridine 2.5 12 mg 1/4 40 mg
    Demerol 3.6 8.3 mg .36 27.8 mg
    Hydrocodone 6 5 mg .6 16.67 mg
    Morphine 10 3 mg 1 10 mg
    Oxycodone 15-20 1.5-2 mg 1.5-2 4.5-6 mg
    Morphine IV/IM 40 .75 mg 4 2.5 mg
    Hydromorphone 50 .6 mg 5 2 mg
    Oxymorphone 70 0.4 mg 7 1.4 mg
    Levorphanol 80 0.26 mg 8 .8 mg
    Buprenorphine 400 0.075 mg 40 .25 mg
    Fentanyl 500-1000 0.03-0.06 mg 50-100 0.1-0.2 mg
    Carfentanyl*** 1,000,000 30 pcg 100,000 100 pcg
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