Check out some similar questions!

julieanneb · Oct 7, 2011, 03:50 PM

I have multiple sclerosis.started pain managemnt(my pcp was rx my norco now go to pain management) and had urine test first visit. Went back today for my 1 month follow up and my urine from very first visit tested positive for oxycodone?? I take hydrocodone and of course it tested positive for that,but showed oxycodone! I have never taken this drug? How could this happen?

DrBill100 · Oct 7, 2011, 04:01 PM

Originally Posted by julieanneb

I have multiple sclerosis.started pain managemnt(my pcp was rx my norco now go to pain management) and had urine test first visit. Went back today for my 1 month follow up and my urine from very first visit tested positive for oxycodone?!?!?! I take hydrocodone and of course it tested positive for that,but showed oxycodone! I have never taken this drug? How could this happen?

This is a very common false positive. Hydrocodone frequently cross reacts with the opiate panel at the immunoassay (screening) level. As example see:

University of Michigan, Pathology Handbook

Drug testing laboratories are well aware of this problem. As example Redwood Toxicology (RTL) makes special note of the phenomenon in their Potential Reactants and Cross-Reactants Chart.

Hospital laboratories (as distinguished from commercial) are also aware of this cross reaction (ex. Pathology Department, Borgess Hospital, Kalamazoo, MI)

Even many OTC/home or on-site Oxycodone tests make specific note of Hydrocodone as possibly causing a “false positive” see http://www.hydrocodonedrugtest.com/ as well as http://www.drugtestingworld.com/oxyc...-oxy-p-31.html

Did you experience any adverse consequences because of this error?

julieanneb · Oct 8, 2011, 07:04 AM

I have to have a random drug test. I am talking anytime. Not just when I go in for my 1 month appt. My doc wrote me my rx,but is this going to happen again?

julieanneb · Oct 8, 2011, 07:10 AM

Dr. Bill,not good with this site. Did you get my answer?

J_9 · Oct 8, 2011, 07:14 AM

Originally Posted by julieanneb

Dr. Bill,not good with this site. Did you get my answer?

Sweetie, Dr. Bill is not online right now. Please understand that we are all volunteers here. We volunteer our time and expertise for free to help others. I promise you that he will respond as soon as he is back online.

julieanneb · Oct 8, 2011, 07:44 AM

J 9... your so kind. Thank you for your volunteer time. What I meant was,did I reply to his answer properly via computer. You have a reply to my question with my post in your reply. Ugh,am I doing it rite?

DrBill100 · Oct 8, 2011, 09:19 AM

Originally Posted by julieanneb

I have to have a random drug test. I am talking anytime. Not just when i go in for my 1 month appt. My doc wrote me my rx,but is this gonna happen again?

It could very well happen again.

Hydrocodone, requires a specific low detection level test, whereas most (standard) drugs screens use a higher setting. The problem occurs most often in the tests with a cutoff lower than 300 ng/ml. Your test (hydrocodone) necessarily uses a 100 ng/ml cutoff.

Your doctor should be aware of this foible and the testing lab certainly should. Drug testing is what they do.

Notwithstanding, you might want to printout the sheet from Redwood Toxicology (link above) provide it to your doctor and ask it be placed in your file.

julieanneb · Oct 8, 2011, 01:28 PM

Dr.Bill,I am going to print that up,and thank you. Are pain management docs not aware of this?? I mean,they specialize in pain,wouldn't they know this? I am floored. It makes me want to stop y medication. In fact,I haven't taken anything for pain today,I am trying to mind over matter the pain. I left my doc feeling so baffled and depressed. I have enough hoops 2 jumo through on a daily basis with ms, and now this? I've always hated "the system" and I feel so apart of it now. The cruel "system" of life. Wow.

DrBill100 · Oct 8, 2011, 02:04 PM

Originally Posted by julieanneb

......Are pain management docs not aware of this??? I mean,they specialize in pain,wouldn't they know this? I am floored. It makes me want to stop y medication. In fact,I haven't taken anything for pain today,I am trying to mind over matter the pain. I left my doc feeling so baffled and depressed. I have enough hoops 2 jumo thru on a daily basis with ms,,and now this? I've always hated "the system" and I feel so apart of it now. The cruel "system" of life. wow.

Should they know? Absolutely. Yet they seldom take the time. According to Journal of Opioid Management (2007) Physicians have a very poor track record in relation to understanding the drug tests they regularly order, “Family medicine physicians who order urine drug testing to monitor their patients on chronic opioid therapy are not proficient in their interpretation.”

Those findings are supported by a later, 2010, survey of physicians at a medical conference that determined 88% of doctors didn't know what type of test to order to accurately screen for oxycodone even though they regularly ordered such tests. This according to information provided at 163rd Annual Meeting of the American Psychiatric Association, New Orleans, May 22-26, 2010*.

That is why this is likely to occur again. So be prepared.

In fairness to your doctor I should note that the false positive was a laboratory error. Pain management physicians should be proficient in catching such errors but at it's base it was a test error that could have been obviated by a confirmation test. Had that been performed the false positive would never have been reported to your doctor.

*Primary source: American Psychiatric Association*
Source reference: Smith D, et al "An update on testing for drugs of abuse: Scientific background and practical clinical concerns" APA 2010;

Wondergirl · Oct 8, 2011, 02:20 PM

Originally Posted by julieanneb

J 9....your so kind. Thank you for your volunteer time. What I meant was,did I reply to his answer properly via computer. You have a reply to my question with my post in your reply. Ugh,am I doing it rite?

Yes, J_9 is one cool woman! Yes, you replied just fine. The "problem" is that you are on one "skin" and we are on another. On our "skin," we can quote, but you can't. We hope that feature gets added to the skin that you are on.

ccmom56 · Oct 8, 2011, 02:33 PM

I also had a false positive of oxycodone while taking hydrocodone. I know exactly how you feel. I also went through a lot and waited a long time to even get to see a pain management doctor. I was not given any pain meds while I waited for my urine screen to be sent out for further testing. And although my doctor treated me with dignity, the staff did not. It took a month to get everything straightened out as I had to wait to see the doctor again before they would discuss my results with me. Of course as I knew, my results were negative for oxycodone. I like you am also surprised this clinic was not even familiar with the false positive of these (and other) medications. The only thing I could come up with is that I live in a very small coastal town. I did exactly what you did and copied everything I could on the subject just in case. Worries me that they would/will make the patient suffer for this, but they do. Hopefully when the doctor gets to know you better this will not be a problem as they will have developed trust with you. Have faith, as you are not alone.

julieanneb · Oct 8, 2011, 02:51 PM

D.r.Bill,my M.D. did not refer to it as a "false positive" She wrote my response in my chart,advised me of random drug testing,and wrote my rx. I really like this doc,she seems more down to earth,smart and dedicated to pain management. However,I can tell you,I do not feel she believed me. Your thought's? Btw,I am so grateful for your expertise

julieanneb · Oct 8, 2011, 02:55 PM

Ccmom,I also live in a coastal town. Jacksonville beach Florida

DrBill100 · Oct 8, 2011, 03:00 PM

To your doctor it was not a false positive. They send the sample to a lab and expect to get accurate results in return. However, with an error that is so prevalent in pain management practice, she should be particularly vigilant and at least have spoken with the lab.

So my advice is to point out to her that this seems to be a rather common problem and that you would appreciate her placing the information in your file so the error is not repeated in the future.

An additional resource for print is:

Ordering and Interpreting Urine Drug Tests

Hopefully everything will work out. Many doctors simply stop prescribing so, at least, your doctor seems somewhat understanding. With the documentation provided she should pay attention and perhaps it may save other patients future problems.

Your experience is repeated thousands of times each day in the US. Semi-synthetic analgesics (hydrocodone is one) are amongst the most widely prescribed in the world. By providing that info to your doctor just maybe she will contact the lab for clarification and indirectly you will influence the outcome of thousands of tests.

Please check back and let us know how things turned out. You may also want to check back occasionally and offer support for others going through this experience. I have the technical background but a word of support from those similarly situated is invaluable. As I recall that is how ccmom56 originally came here.

julieanneb · Oct 8, 2011, 03:36 PM

Dr, Bill,one more question... I told her I was going to research,online,this topic,and her response was... "You will just drive yourself nuts" Your thoughts,and wow,Thank you Thank you so much. You have made my mind quiet.

DrBill100 · Oct 8, 2011, 03:58 PM

Originally Posted by julieanneb

Dr, Bill,one more question.......I told her I was going to research,online,this topic,and her response was..."You will just drive yourself nuts" Your thoughts,and wow,Thank you Thank you so much. You have made my mind quiet.

There are thousands of self reports on line in relation to the cross-reaction, false positive for oxycodone. Interesting and reinforcing but easily discredited as anonymous claims.

I have provided you with information from Redwood (RTL) above, which is one of the largest drug testing labs in the nation. The other info is from University of Michigan, Practice Guidelines. Both will be recognized by any doctor and not easily ignored. The problem you have experienced is well known and documented by reliable scientific sources. That should be sufficient to get her attention.

julieanneb · Oct 8, 2011, 04:11 PM

Dr.Bill,thank you. Until this site,I loathed technology and the computer. My fiancé bought me this computer awhile ago and I have just recently starting using it. Dr.Bill,do you know anything about the disease modifying drugs used to "treat" ms? I am starting to think they are garbage and they lead to more sx management drugs. Again,I am profoundly grateful for your knowledge and help.My dmd I am taking is Copaxone. Whenever you have a chance,I would like to hear your take on these meds if you know anything about them. I feel like I should pay you for your help? How is this possible to get this info for free? Wow.

Wondergirl · Oct 8, 2011, 05:02 PM

Originally Posted by julieanneb

Dr.Bill,thank you...I am profoundly grateful for your knowledge and help.

DrBill is a treasure, isn't he! I grabbed onto him as soon as I noticed how knowledgeable he is.

DrBill100 · Oct 8, 2011, 05:08 PM

My field is physiological psychology, sub-specialty in addiction. I am experienced and knowledgeable in drugs of abuse and psychotherapeutic agents. Beyond those parameters I can't be of much help.

I am not qualified to speak on the therapeutic efficacy of drugs in relation to a specific condition. That is left to the MDs.

Since you are attuned to the computer now you have access to a wealth of information on any and all drugs. I do recommend every patient thoroughly research any pharmaceutical prescribed.

Most of the drug websites have not only the FDA required information but also user reports. Very valuable info.

Two such sites are:

Drugs.com and
RxList

Just enter the name of the drug in question and you will get pages of information.

I do understand the mechanism of drugs (so far as known) so if you encounter terms that need clarification you can always return and ask.

Wish I could be of more direct assistance, and thank you for your kind words.

Wondergirl · Oct 8, 2011, 05:11 PM

Originally Posted by julieanneb

Dr, Bill,one more question.......I told her I was going to research,online,this topic,and her response was..."You will just drive yourself nuts" Your thoughts,and wow,Thank you Thank you so much. You have made my mind quiet.

My oncologist said the same thing to me two years ago, not to waste my time searching for information online. I mentioned to her I'm a librarian and know how to search. She snorted in derision. I didn't have DrBill back then, but I lucked onto several people who knew their medical stuff and helped me a great deal. ***ADDED*** And drug user reports were invaluable!