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911DOC, Board Certified Dr.
Category: Medical
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Experience:  Emergency Medicine Physician
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I was tested via urinalysis by the dr who prescribed Exalgo

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I was tested via urinalysis by the dr who prescribed Exalgo for nerve pain from a combat related blast wound.
The test said I was taking Dilaudid and an exceptionally high dose, but I have taken only Exalgo, Gabapentin, Tramadol, and Tylanol PM.
Now the dr refuses to write another scrip.
The only possible explanation that I can imagine is some glitch in the manufacturing or testing. Any thoughts?
911DOC :

Exalgo IS dilaudid

911DOC :

if you are getting this medicine through the VA it is possible that your drug test was positive for something that you are not being prescribed and that this is the reason for the doctor refusing to write the scrip.

911DOC :

I have a friend who is a VA doctor and they often get vets who use marijuana and this negates the pain contract they sign with the physician. not suggesting you use marijuana, but if you do, this might be the explanation, because one would

911DOC :


911DOC :

you to test positive for dilaudid as Exalgo IS dilaudid

911DOC :

as explained above

911DOC :

I am standing by if you have questions for me but since you are offline I will switch to the
Q and A format.

911DOC :

. If your question has been adequately answered I do so appreciate positive feedback. If you have further questions or desire clarification simply type your response in the box below and click ‘reply’ and I will be back with you as soon as I can.

Should you need my assistance in the future simply start your question with ‘for 911doc only’.

Thank you

Customer: replied 4 years ago.
That's what I thought, but they're telling me that the test can differentiate between Exalgo and Dilaudid, and they believe I am definitely abusing bare Dilaudid. This is a Private Pain Clinic, because the VA flatly refused to treat the pain with anything other than Ibuprofen, Gabapentin, Tramadol, Amatryptaline, and Lidocaine cream. Yeah, all that.
My VA provider, based in Beaumont, had grudgingly prescribed Dilaudid at the recommendation of the Houston VA Pain Clinic about two months prior, but I had run out about the time I first went to the Private clinic. Perhaps the testing lab is reading the old test through a clerical error, but I would have better hope for them than that.
So basically, I took the Exalgo the night before the urinalysis, and have had no other opiate than that since my first visit to the private clinic.
Is it possible that the Exalgo didn't release enough at first, but then in the morning did a huge dump?

Someone is not telling you the truth.

Exalgo is simply a brand name for Dilaudid aka hydromorphone. The drugs are exactly the same. Again, please see the link above.

The other thing that doesn't wash is that, if this was a urine drug screen, they do not test levels, they simply test for the presence of the drug.

I would be on the phone with them, armed with the link above, and tell them what I have told you and then demand an explanation.

If it turns out they did a more specific test that measures levels then yes, taking Exalgo the night before would cause a relatively high level if you were tested in the morning.

My bet is that they are not telling you the truth for whatever reason.

As a rule pain physicians, and regular physicians, do not like prescribing Exalgo/dilaudid long term because of it's abuse potential, it's addictive properties, and it's very high street value so someone may be spooked or under investigation by the FDA and they may be cutting back on their narcotic prescriptions. This is, at least, a likely scenario.

standing by if you have further questions


911DOC and 6 other Medical Specialists are ready to help you
Customer: replied 4 years ago.
Thanks. Frankly I knew that, but wanted authoritative confirmation.
Thank you.

you are welcome.

good luck to you and thank you for your service.

I'm prior navy but didn't have to go anywhere worse than south Texas.

If this has been helpful please consider leaving positive feedback.



Customer: replied 4 years ago.

Thanks, ***** ***** it was a Navy Corpsman who saved my life.

I was out on a joint mission with Marines.

Couldn't have for a finer crew!

Fair winds and following seas!

to you as well.