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Family Physician
Family Physician, Board Certified MRO
Category: Drug Testing
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Experience:  Medical Review Officer - Physician Trained and certified in drug test interpretation
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I had an Ameritox Drug Test today ordered by my Pain Management

Customer Question

I had an Ameritox Drug Test today ordered by my Pain Management doctor. I am in severe pain due to peripheral neuropathy and fibromyalgia, so I have to take a duragesic pain patch and Oxycodone. I'm not worried about the Pain patch, but I am worried about the results of the oxycodone 10mg in my system. My prescription says to take one 10mg oxycodone every 6hrs or as needed. Like everyone who is in REAL pain knows, somedays you have more severe pain than others, due to having to walk or other factors. I was wondering if the ameritox drug test would show that the day before the drug test, I took 1 oxycodone when I woke up, then 3 1/2-4hrs later took another one, then I waited 10-12hrs because I wasn't in pain anymore and took another one before bedtime and didn't take any throughout the night. Then I woke up and urinated once on the day of the test and took one oxycodone. I only take 2-4 oxycondone's per day and always have some left over when I see my doctor every month. I'm not an addict, but I have to get control of my pain or I will be in severe pain constantly. Can the Ameritox drug test see that I took that oxycodone early, but then waited along time to take another one? Is the ameritox test that accurate? I
Submitted: 3 years ago.
Category: Drug Testing
Expert:  Family Physician replied 3 years ago.
There really is no effective way to differentiate the timing and doses of a particular drug. While there are techiques that can theoretically detect significantly excessive dose (doses that are taken 3-4 times what might have been prescribed), there is no way to get a real dose/time from a urine drug test.
Family Physician, Board Certified MRO
Category: Drug Testing
Satisfied Customers: 12662
Experience: Medical Review Officer - Physician Trained and certified in drug test interpretation
Family Physician and other Drug Testing Specialists are ready to help you
Customer: replied 3 years ago.
Thanks for your response. Also, they found cocaine metabolites in my first drug screening test. I don't use any drugs, besides my prescription drugs. On the lab report they didn't specify anything else, like how much, etc. When they do a routine drug test (not the ameritox drug test), how would they determine the difference between actual cocaine and a medicine that metabolizes like cocaine? If they actually found cocaine, wouldn't it be documented differently on the lab report? Meaning, wouldn't they go into more detail if they actually found cocaine? Wouldn't a doctor be smart enough to know the difference between lab results that actually show cocaine in the system verses cocaine metabolites?.How would the lab results differ between the two? Meaning if they actually found cocaine in my system verses a medicine like Amoxcicillin that metabolizes the same way as cocaine? How would the difference look on the lab report?
Expert:  Family Physician replied 3 years ago.
You need to find out if the test was confirmed with GC/MS. Without GC/MS (or the similar LC/MS) confirmation, the test could be a false positive.

You may see on some sites that Amoxicillin can cause false positives for cocaine, however this has NEVER been proved in any published medical study. In fact there is a study that looked at this reported cause of false positives, and found no evidence to support this claim.
http://www.ncbi.nlm.nih.gov/pubmed/18430300

I understand your concern about why a doctor would not know the difference, however, most physicians have not had the training to fully understand drug test technology and test results. Most physicians rely on the botXXXXX XXXXXne "positive" or "negative" provided by the lab.

You need the information about the technology used (did it include GC/MS confirmation) and any additional information including levels (ng/ml) for me to give you a more complete answer.
Customer: replied 3 years ago.
Thank you. I had to call the lab and have them call my doctor and explain the cocaine metabolites and what the toxicologist meant on the report. As It turns out, per my doctors office, the person who typed my lab report made an error and is getting in trouble for it. There was no cocaine metabolites in my system at all and it was human error. Yet, I already took the ameritox test bc I'm a compliant patient. That test is going to cost me $1,100. Shouldn't my doctors office have figured that out first, before making me take this ameritox expensive test? My doctor even stated my lab report was unclear and he didn't understand it, but let's go ahead and do a $1,100 test. A patient can only be compliant so long as they can afford the extreme cost of the lab tests. Is this what every pain patient has to look forward to in the future? We're already discriminated against, why not somemore. I know my doctor would rather not prescribe pain meds and the DEA is all over them. Guess I will go to a different doctors office. What if they don't remove the false report from my file? Who can I go to if my doctor suddenly becomes non compliant
Expert:  Family Physician replied 3 years ago.
I'm glad to hear that this test was in fact nothing more than a laboratory error.

I don't have a simple answer as to why the doctor did not determine that this test was not an accurate report. It unfortunately is not a unique situation, that is an embarrassment to our profession.

I'm not sure I understand your question regarding your doctor "suddenly becomes non compliant"
Customer: replied 3 years ago.
Thanks for your last response. Meaning what if he doesn't erase the cocaine metabolites lab report from my patient file? I don't want it to be in my file at all but he was talking about just typing a note in my chart saying it was human error. If I decide I want to go to a pain management office outside of his group, they will want my records and the errored lab report might keep a new doctor from prescribing my much needed medication. All because some idiot didnt know what he was doing in the lab.
Expert:  Family Physician replied 3 years ago.
OK, that makes sense.

From a legal perspective, removing a lab report from a medical chart, even if that lab report was ultimately determine to be an error, could be considered unprofessional/unethical behavior which could subject the physician to disciplinary action. (Basically altering a medical record).

Most experts would recommend that a physician correct an error in the chart (if in writing) by drawing a line through the incorrect entry, signing and dating the correction.

Adding a note that the laboratory report (which resulted in further testing) was an error should be adequate and legally appropriate.

There is a formal process to request a correction to your medical records as provided by the HIPAA Privacy Regulations. If your provider is not willing to follow those provisions, you can file a complaint with the Office of Civil Rights at the Department of Health and Human Services.
Customer: replied 3 years ago.
That makes sense. Thanks! I'm sure he will take care of it the correct and legal way which is fine with me so long as it doesn't affect me in the future. Thanks again for your time!
Expert:  Family Physician replied 3 years ago.
You're welcome. I hope you understand that most physicians are trying to do the right thing.

As a physician, it is difficult to differentiate between the "real" patients in pain who are compliant and using their meds appropriately, the patients who are in pain but who are abusing their drugs, and the patients who are using the physician as a legal "dealer". The use of drug tests is advised by most professional organizations to help with this difficult process. The interpretation of drug test is not as easy as many people imagine, and the well intentioned physicians sometimes get caught in the middle between patients who claim to not be using drug and the laboratory test which gives a different answer. How does the physician KNOW that you aren't just a good liar.

Work with your doctor, who appears to be at least trying to do the right thing.
Customer: replied 3 years ago.
Ok thanks! You're right and I completely agree. I want to prove to my doctor that I take my meds accordingly. I also dont want him to lose his license to practice so I'm not too upset bc I had to pay for a $1,100 drug test so long as i dont have to do it every month. If i could afford it, I would though. Even though like yesterday, I had an emergency come up and I had to run to the ER to pick my daughter up bc my mother-in-law who watches my daughter during the day, had to call 911 due to chest pains. So I had to take a pain pill a little early bc my body started getting in severe pain due to all the walking, etc that seems to make my pain worse for some reason. Therefore, I have to take an oxycodone 2hrs early, but then waited along time before I had to take another one bc I was able to get my pain under control. I used to always judge anyone who took narcotics for pain and I will admit that I discriminated against people on Social Security because I thought they were living off the government. I never knew how sick someone could get and how much pain the body could be in without having cancer or some well known disease. Now, after suddenly becoming sick so fast, I understand. Everything used to be so black and white to me and I was so closed minded as most of the people in this world are. My friends that I rarely get to see anymore, but still text message back and forth ask me why I don't just take Tylenol. It's offensive, but I know they don't understand. Maybe someday, I will find a doctor that can find out what Disease I truly have and cure me so I won't have to take my narcotic pain meds anymore. I've been diagnosed with a lot of diseases; severe narcolepsy (I go into REM sleep during the day within 1-7min per my sleep study which was an overnight sleep study with an MSLT), peripheral neuropathy, fibromyalgia, proteinuria, raynauds disease, polymyalgia, just to name a few. I know the diagnosis isn't supposed to be important but the treatment is. I'm only 31yo and I can't give up trying to find out what's wrong with me. Especially if it's somehow hereditary and my daughter could get it. Anyways, you seem open minded and intelligent. Thanks for all your help. Good luck and I hope you never get a disease. They are a million times worse than a healthy person could ever imagine. I almost died bc I couldn't move for a few days (well I could move my torso and barely raise my head bc I was so weak, but I couldn't move my arms or legs..I could barely move my finger with a lot of concentration and effort) and every time I got out of bed before that which wasn't often bc I slept for days in a row without waking up, I would start to passout bc I couldn't get enough oxygen and everything would go black when I exhaled and then when I inhaled I was able to see again. My severe pain started at my feet and slowly ascended upwards and when it got to my waist, it was only in my hands. The higher my pain ascended up my body the stiffer my muscles became. It reached my neck and then it went up to the top of my head and I was completely consumed with severe pain and weakness. I had episodes where I would twitch so badly that my arms were flailing all over the place while I was standing up trying to feed my daughter and I got ketchup all over my walls and ceiling and all over my daughter. My arms and legs would flail all over the place while I laid in bed and it became very annoying. I even pulled a shoulder muscle bc I tried holding my arms down under my head and when my arms went flailing, I thought it was going to rip my ear off. If you know of any disease that causes this but shows normal labs, CBC, please let me know. My doctors can't seem to put it all together. My ANA is high sometimes and sometimes not, my RNA antibodies are high and I have protein in my urine. I'm not on my deathbed now, but still feel horrible constantly. If you have any ideas about what Could be wrong with me, I'm welcome to hearing them. MRI's of brain are all normal. CT of cranial nerves normal. C-reactive protein is high. My pain is burning, aching, sometimes throbbing pain. It feels like I was buried in the snow for hours and then came inside and set in front of the fireplace. My extremities don't change color, but my pain gets extremely worse when I'm even slightly cold. I sleep with a heated blanket, and a small heater next to my bed. I can't remember what it feels like to be healthy bc it's been 3yrs. I'm willing to travel far for a good doctor that is willing to take me seriously and not just want to prescribe meds.
Expert:  Family Physician replied 3 years ago.
Unfortunately, without your complete medical history, a physical examination and test results it would be impossible to make a diagnosis over the internet.

If you have not already been evaluated by a rheumatologist (arthritis specialist), that would be the logical place to start.
Customer: replied 3 years ago.
I have and my rheumatologist told me I would probably never find out what's wrong with me and to just let him treat the symptoms. I'm so sick, there has to be something somewhere in my blood or fluids. How can I get a doctor to do a lumbar puncture? I know the risks and I'm even willing to sign a waiver. My infectious disease doctor mentioned Guillian Barrè syndrome and I think he's right, but he says the antibodies couldn't be detected now bc there's probably none left. I looked it up online (a reliable online website) and it fits me to a T. Isn't there a chronic kind and an acute kind of Guillian Barrè syndrome? What kind of doctor dx Guillian Barrè syndrome?
Expert:  Family Physician replied 3 years ago.
You would really need to see a neurologist if you were looking into that type of problem or looking for someone to perform a lumbar puncture.

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