How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. Phil, MD Your Own Question
Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 55166
Experience:  Medical Doctor Trained at a Top Academic Institution
55099014
Type Your Medical Question Here...
Dr. Phil, MD is online now
A new question is answered every 9 seconds

I have a question regarding medications I have been taking

Customer Question

I have a question regarding medications I have been taking for a number of years. Some of them since 2004/2005, some since 2010, one since 2007 and one since jan 2015 and they all showed high on a toxicology report, though I didn't take them the morning the blood test was performed. Obviously they are going to build up in my system over this length of time, and they all fell within theraputic limits. My question is, that over the length of time, taking medications, I have been told, that they can start to have a lesser affect on people and my doctors have even told me that. I take my doses as I should, I might miss a dose here and there, probably miss more doses, than I should but I have no side effects from these medications, I have been on the same doses and some doctors wanted to increased them and I didn't feel the need. Is it not possible that after years of taking the same medications that the affects can actually start to not do what they are fully intended? I have even been told that I have been walking around and even driving impaired for 10 to 12 years. That is just insane to me. My doctors have also said that is crazy as if they even saw any indications of me seeming to be impaired when visiting them, and I've NEVER not passed any drug tests, that of course they would not continue to prescribe. Plus these are all monitored by the federal drug program.
JA: Is this a time sensitive issue? What type of specimen are they testing?
Customer: The medications are clonazepam 2mg 3x/day, hydrocodone 7.5/325 elixer 15ml max doses 4/day, seroquil 300mg 1x day (this is the one I miss mostly, topomax 200mg 2x/day, butalbital as needed but prescribed 30 pills per month but take 1 to 2 pills every 4 hours for migraines, but have to refill monthly, was a blood test
JA: Anything else in your medical history you think the doctor should know?
Customer: the doctors all know it. Most are prescribed by my neurologist, 1 by my psychiatrist, 1 by my pain management doctor. All have a list of all my medications. Then codeine showed up as well and it didn't show up on the first test, but showed on the second test for some reason and my pharmacist has no idea why
Submitted: 9 months ago.
Category: Medical
Expert:  Dr. Phil, MD replied 9 months ago.

Hi, this is Dr Phil, here to assist you. I am Board Certified with over 10 years of experience. I will respond with my answer shortly. Thank you.

Expert:  Dr. Phil, MD replied 9 months ago.

Do you have any other known medical problems?

Customer: replied 9 months ago.
I have orthostatic tremors which I have issues standing and need to hold to things, they go away when I walk to sit down, essential tremors which affect my voice/speech which when I get upset can cause me to stutter, repeat, have issues getting my words out, and even slur, I have panic attacks when my tremors get worse, I also have chronic back and neck pain, SI joint dysfunction, neck facet syndrome, fybromyalgia, tinnitus, bipolar, chronic dry eyes, chronic migraines which I also get botox treatments for, nystigmus, mostly when I smoke to much, I had Graves Disease and I was kept on a medication 2 years too long and developed many things that are now irreversible such as peripherial neurothogy, urinary incontinance, my essential tremors, especially in my voice became much worse, I was sent to the University of Denver and was recommended to see and ENT, have a videoscope done to see if there is a tremor in my voicebox, which is still in the works to see if I need botox injection in my voice box, my eyes became much worse, dental issues, I have been disabled since 2008 due to my tremors. I have many things wrong but my main issues are my tremors and I was mistaken for being impaired for my disability. I have been on these medications for years. They have never affected me in any way, as far as me being alert, functional, etc. They have improved my quality of life, or I wouldn't be able to function. When I get upset, my tremors become much worse, I shake more, my voice becomes much worse, especially the stuttering, repeating, and then I slur worse.
Customer: replied 9 months ago.
This is all documented in all of my medical history, all of my doctors, all of my specialists, and all have lists of my medications
Expert:  Dr. Phil, MD replied 9 months ago.

Okay thank you for this detailed history

Sorry it is taking me time to go through it

It is true that your body will build up a tolerance to these drugs over time

Is that what you were mainly wondering?

Customer: replied 9 months ago.
they arrested me for a dui/duid that morning when i was just sitting in my car texting and because i have handicapped plates and they assumed i was taking meds. I didn't have my keys in the ignition, car wasn't running, and they got me all upset and i hadn't taken my meds that morning as I had taken them late, around 2am and it was about 10am and it was bout time to take them so my tremors were starting to get worse, and of course I was getting upset, and the more I get upset, the worse my tremors are, especially my speech, so they assumed I was impaired. I had 2 letter in my glovebox from my neurologists explaining my tremors and they refused to get them out. They wanted me to perform roadside tests and I explained that due to my disability, orthostatic tremors, I had to hang on and that was on the letter and they still wouldn't get it, and plus my speech was getting worse, the stuttering, and repeating, and then even got to slurring, but again all documenting in my records. When I couldn't do the heal to toe manuever, due to my orthostatic tremors, as that is balance related they arrested me. They took my blood and of course my meds showed up and the toxicologists is stating that mixture of meds would make me severely impaired. I have never been told not to drive, my botttles don't say that, pharmacist never stated that, but of course am smart enough to know that. anyway, the toxicologists insists that the mixture of those meds would absolutely cause me to be severely impaired but my meds say don't operate heavy machinery until you know who this medication affects you. Obviously after 10 to 12 years, I know how it affects me. Plus, like I said, my doctors all looked at the report and say it's all fine but the toxologist is insistent that I am extremely impaired. And if I say I've been taking for that long, well, I've been driving, etc. for that many years extremely impaired, or impaired. I know they mistook my disability for being impaired. A stutter or speech issue is not an impairment, nor is a balance issue. I have been taking the same doses for years. If they are in my system, they are going to build up and stay there and not going to go away since I take daily. And they work less and less the number of years I take them. I have a court case coming up and am not sure how I can go about this as obviously they are there but dunno how to get a hold of anoter toxicologist with the information I'm asking of another doctor. Many of my doctors have changed, some moved to other states who started me on the medications to begind with.
Expert:  Dr. Phil, MD replied 9 months ago.

I'm so sorry this happened

This just shows that people aren't willing to think outside of the box.

You will need to find a good internist locally to support you

I can probably help you find one

what is your zip?

Customer: replied 9 months ago.
what is an internist?? My zipcode is 80538
Expert:  Dr. Phil, MD replied 9 months ago.

A doctor that is good at seeing the overall picture

see this doctor

https://www.healthgrades.com/physician/dr-peter-smith-y83q2

Customer: replied 9 months ago.
my public defender won't even look into trying to find a different toxicologist which doesn't make sense to me and just keeps referring to the toxicologist report. Even though I have provided him all of this same information
Customer: replied 9 months ago.
I have medicare and blue cross/blue shields
Expert:  Dr. Phil, MD replied 9 months ago.

See that internist

that is your best bet

you need a doctor on your side

Customer: replied 9 months ago.
I do have one doctor on my side but says he can't do anything about it because he is not a toxicologist and didn't prescribe all of the medications
Expert:  Dr. Phil, MD replied 9 months ago.

That doesn't matter. They should be able to back you

Customer: replied 9 months ago.
i actually had 2 but the other has moved on to another position an cannot reach him any longer.....
Expert:  Dr. Phil, MD replied 9 months ago.

that is terrible

I'm so sorry this happened to you. :(

Customer: replied 9 months ago.
I'm still not sure what an internist is and if they didn't prescribe any of the medications how they can help?
Expert:  Dr. Phil, MD replied 9 months ago.

they do prescribe the medications

I am an internist and I prescribe all of them

Customer: replied 9 months ago.
i mean they didn't prescribe all of the medications I am on. They didn't prescribe them originally. that is the issue I'm running into. As the one doctor I have is very helpful and states that the toxicologist is so wrong and I've been on them so long and he only prescribed one of the meds and can only speak about that one. He can't speak about the others.
Expert:  Dr. Phil, MD replied 9 months ago.

that doctor can testify if your lawyer asks him to

Customer: replied 9 months ago.
He won't though because he says he is just a doctor and says only a toxicologist can talk about how it affects it in your blood so it doesn't make sense because to me, it should be the other way around. The doctors are the ones who see me all the time, and have for years on end. The toxicologist doesn't know me at all. All medications affect people different ways and I've been taking them for years so they obviously built up, that doesn't mean I'm walking around impaired all the time.
Customer: replied 9 months ago.
If I don't feel right, I don't drive. If I have a horrible migraine, I don't drive. They can't say I've been driving impaired for 10 to 12 years. that is just crazy, just because I take my medications.
Expert:  Dr. Phil, MD replied 9 months ago.

You are absolutely right

I totally agree with you

Customer: replied 9 months ago.
but i don't know what i'm supposed to do. if I go to trial and he is dead set on just this toxicologist and not even talking to my doctors, and I know I did nothing wrong. I can't help I have a speech issue or that I have a balance issue. If I have this on my record, then anytime I might get pullled over, they will see I have it on my record and I'll automatically be charged again for as long as it shows on my record and I didn't do anything wrong. anyone who takes anything can be considered impaired, aspirin regimin, wearing glasses, multiviatimins, it all affects people different. I just happen to have multiple for for 10 to 12 years!!!
Customer: replied 9 months ago.
just a question, but if you were a my doctor and you had seen this report and you had all of this information, is this something you would agree with and testify in court that I would not be impaired after taking for so long, of course you would have to see my medical records so assuming you had and could verify all of the infomration I have provided is true and in my records and prescribed from the University of Denver at the Movement Disorder clinic, doctors from the Mayo clinic and carried through to local neurologists, 12 of them over all of these years, would you consider your patient to be impaired, having also provided them drug tests over all these years as well and them never not passing one of them?
Customer: replied 9 months ago.
also if I provided you the levels of the tox screen results would that be helpful?
I haven't had any luck with talking to anyone regarding them. this is the first time I've paid for help to ask questions, otherwise I keep getting ignored and my court date is sept 28th.
Expert:  Dr. Phil, MD replied 9 months ago.

There is very little I can do online other than provide advice to you

But your story seems legitimate to me

And I think you are an honest person

Customer: replied 9 months ago.
oh, I know that. I just was wondering since you said to go see an internist, like yourself, if he/she had all of the same information, would you consider your patient to be impaired if you've prescribed them medication, same dose over a period of 10/12 years. you say the local dr. would look at the overall picture, such as yourself, would they look at the same way? Someone certainly cannot think they would be impaired for length of time, if taking their medication as prescribed and passing all drug tests, and using one pharmacy, being on medicare, you can't refill early, go to multiple doctors, no changes in doses etc.
Expert:  Dr. Phil, MD replied 9 months ago.

No they would not be impaired

their body is adapated to the drug

Customer: replied 9 months ago.
can i send you the information from the tox report?
Expert:  Dr. Phil, MD replied 9 months ago.

sure :)

Customer: replied 9 months ago.
my computer keep freezing but i'm going to upload the file
Customer: replied 9 months ago.
codeine shows up for an unknown reason. talked to my pharmacist and all my doctors and none of my meds contain it. it didn't show up on the original test but just on the second test for some reason.
Expert:  Dr. Phil, MD replied 9 months ago.

maybe it is a metabolite?

Customer: replied 9 months ago.
i am not sure....i think that it's a part of a medication
i tried to google it......so a break down of a med
Customer: replied 9 months ago.
oh, sorry, i though you were asking.....we thought maybe that, i'm guessing you are talking about the codeine, but no, none of my meds contain it
Expert:  Dr. Phil, MD replied 9 months ago.

okay. I see. yes, thank you

Customer: replied 9 months ago.
we thought at first maybe butalbital because there is a form that contains that, but not the type i take....it's in the capsules, i dont take the capsules and its not in the hydrocodone either...that was the other one we thought. the pharmacist and i went through all of them and codeine is not in any of them
Expert:  Dr. Phil, MD replied 9 months ago.

I see.

That is certainly interesting.

I don't know how to explain that

Customer: replied 9 months ago.
conversions to ng/mg
butalbital is .3025 ng/mg
clonazepam is .00239 mg/mg
7-aminoclonazepam .00554 ng/mg
topirimate .9750 mg/mg and there is not theraputic set level as of yet but it's still well under what the supposed set level is
codeine .00091ng/mg
hydrocodone ,00197ng/mg
quetiapine .00984 ng/mg
Expert:  Dr. Phil, MD replied 9 months ago.

Yes, I think you were not impaired

I stand by that

Customer: replied 9 months ago.
can you come to loveland??? :o)
Expert:  Dr. Phil, MD replied 9 months ago.

HAHA

Colorado seems beautiful.

never been there

Customer: replied 9 months ago.
All of the doctors I had look at it all agree as well but they have all moved on and cannot locate any except the one who won't do anything because he didn't prescribe any of the medications but he is totally on my side looking at exactly what you are and says only a toxicologist can make that call.. which doesn't make sense because he is not a doctor and only just looks at blood and doesn't know the patient or my background and has no idea how long I've been taking the medications
Customer: replied 9 months ago.
do you know any doctors here that you can consult with? it's so late now and I've been trying but i run into the same issue, they didn't prescribe it, they don't know me, even though I have every single medical record and i don't know that to do
Customer: replied 9 months ago.
in your opinion, how does a doctor stand up to a toxicologist as far as experti witnesses? Or how do they fair, vs, vs, I should ask?
Expert:  Dr. Phil, MD replied 9 months ago.

I don't know anyone specific. I'm sorry

All I know is that I am a doctor that lives far away and I agree with what you are saying

I wish there was more I could do

I would say a toxicologist is a good scientist. not an expert because they don't know the patient

Customer: replied 9 months ago.
based on that information, would consider your patient to even be slightly impaired of years of that same medication? Even slightly??? That is also a big question.
Expert:  Dr. Phil, MD replied 9 months ago.

Not in my opinion no. Taking these meds after years allows one to feel normal. Not impaired

Customer: replied 9 months ago.
In your opinion an internist if the type of doctor I would want to try to see???
Customer: replied 9 months ago.
how do they differ from like my pcp or my neurologists or other doctors? I'm not sure what an internist is?
Expert:  Dr. Phil, MD replied 9 months ago.

Yes, that is my opinion

internists are trained to deal with complex problems mainly

Customer: replied 9 months ago.
i probably can't get into one in time before my court date then. especially one that takes medicare. are you sure you can't come to colorado??? I get to have one expert witness. What would it cost?
Customer: replied 9 months ago.
you could have a nice vacation and see the mountains while it's not too hot and help out a desperate mother of 2....who may lose her house and her children
Expert:  Dr. Phil, MD replied 9 months ago.

I'm sorry but I have a full time practice here, 2 kids and I do this on the side.

I really can't.

I really emphathize with you and feel bad for your situation for what that is worth. You have a doctor here who believes you and wishes the best for you

Customer: replied 9 months ago.
try the doctor you linked above and otherwise look for an Internist. that is the title of the doctor I'm looking for?? Are there any other links you can send besides just the one? The other zipcode is 80526 if that helps.
Expert:  Dr. Phil, MD replied 9 months ago.

I would just google search internists in your area.

I picked that one because of the impeccable reviews

Customer: replied 9 months ago.
but that is definitely the type of doctor I am looking for?
Expert:  Dr. Phil, MD replied 9 months ago.

yes, in my opinion.

Customer: replied 9 months ago.
any other type by chance?? my time is running short is why I ask
Expert:  Dr. Phil, MD replied 9 months ago.

No I don't think so

Customer: replied 9 months ago.
well i see my pcp tomorrow morning and she has a social worker there who is pretty good about getting me kinda of emergency referrals so keep your fingers crossed they can find me one i can get into. i'm also having serious issues with fibromyalgia and the last few rheumatologist they have sent me to have been forgive me, idiots, one tried to tell me the serious hardness in my muscles around my neck, was my clavicle!! then i said my clavicle is here, and pointed to it, and i've very thin and it clearly sticks out and he then said, oh, ya, it must be your scapula then. I then had to point to that! He should NOT be practicing medicine. I had to walk out. Since I have so many medical issues, would an internist be a good doctor to see due to me having so many medical issues, vs seeing so many different specialists and also for fibromyalgia? As I keep having to get trigger points, been getting for about 4 years, every 2 months, sometimes up to 35 to 40 at a time. I also, don't want to keep getting meds, like I take baclofen, I tried lyrica, I can't even name them all but I'm starting to be allergic to so many and having serious edema issues and I am tired of band aids. There is something wrong and no one is taking the time to find out. I know I have been checked for lupus, tumors, ms, cancer, etc. and all negative, thank goodness, but they are missing something and doing all those trigger points, plus PT constantly, is just not helping. They talked about stem cell therapy but I can't afford that and it's not covered by insurance. my endocrinologist almost made me have my thyroid removed just because she kept me on my medication 2 years too long and I developed all of those issues I told you about that now are irreversible. I want to get better and NOT with meds. But somethings I can't function without meds, like my tremors and migraines and the constant muscle spasms. Maybe an Internist is the type of doctor who can get to the bottom of of lot of these things??
Customer: replied 9 months ago.
I just have toooo many doctors and it's getting tiring. Name a specialist, besides an Internist, and I have it.
Expert:  Dr. Phil, MD replied 9 months ago.

Thanks for this reply

yes, I treat a lot of fibromyalgia

A good internist can do that and can also get to the bottom of this as you suggest

complex patients almost always require an internist

I have to sign off for the night. Eastern time zone

Im happy to answer you in the morning

please don't forget that positive rating when we are done. Thanks

good night

Customer: replied 9 months ago.
OK. thank you so much for your time and suggestions and mentioning an Internist. I had not heard of one before. Maybe that will be the best besides the 17 doctors I see now. Have a great night and I thank you for your service very much.
Expert:  Dr. Phil, MD replied 9 months ago.

You're welcome :)

glad to help