I was sent for a pre employment drug test, didn't think anything about it until the Medical Review Doctor called me and told me that I was positive for Oxycotton, I told him that I have NEVER taken Oxycotton but I do take Hydrocodone, he said nope it's Oxycotton, I asked what do I do I know the test is incorrect, he advised me to send it in for a second test, which I am doing. What else can I do? My future depends on this incorrect test results!

Many drug tests are based off the color that the urine sample becomes once a reagent is added. Often times there will only be 3-5 different outcomes, such as 1. Marijuana - Red 2. Amphetamines - Green 3. Opioids - Blue/Purple. Even though hydrocodone and oxycodone/oxycontin have different opiate bases, they can be easily mistaken as one or the other.

Do you know any specifics as to what all you were tested for, and what the saturations were? A bit of insight as to what drug test was administered, and what it's results were, would be the only way to know for sure. However, I think it was just a broad opiate test, and they just assumed it was oxy.

It's in the same family of opiates. It is normally combined with another compound.

Do you have a prescription? Show them proof you have been prescribed the medication. Done.

Many drug tests are based off the color that the urine sample becomes once a reagent is added. Often times there will only be 3-5 different outcomes, such as 1. Marijuana - Red 2. Amphetamines - Green 3. Opioids - Blue/Purple. Even though hydrocodone and oxycodone/oxycontin have different opiate bases, they can be easily mistaken as one or the other.

Do you know any specifics as to what all you were tested for, and what the saturations were? A bit of insight as to what drug test was administered, and what it's results were, would be the only way to know for sure. However, I think it was just a broad opiate test, and they just assumed it was oxy.

I don't know the specifics, I just received these results yesterday so I have asked for a copy of the results and a second review. Is there another test that can be performed? The medical review officer said the only thing I can do is to send the same sample for second review and that's it! I find this hard to believe,

It's in the same family of opiates. It is normally combined with another compound.

Do you have a prescription? Show them proof you have been prescribed the medication. Done.

Yes I have a prescription and I faxed it to them and they still tell me that it is Oxycodone,

I was sent for a pre employment drug test, didn't think anything about it untill the Medical Review Doctor called me and told me that I was positive for Oxycotton, I told him that I have NEVER taken Oxycotton but I do take Hydrocodone, he said nope it's Oxycotton, I asked what do i do i know the test is incorrect, he advised me to send it in for a second test, which I am doing. What else can I do? my future depends on this incorrect test results!

Your problem is not unusual. Including an MRO that is unfamiliar with cross-reactants.

Hydrocodone albeit a semi-synthetic opioid is notorious for cross-reacting with commercial opiate panels. Most frequently this occurs when using an immunoassay (IA) test with a cutoff under under 300 ng.

In fact, a lady had this same problem and I already have the references outlined here. https://www.askmehelpdesk.com/medications/why-did-test-postive-oxycodone-when-take-hydrocodone-601856.html

Please read through that post and then get back. Once you get a copy of the test results then we can interpret them precisely.

As to the re-test, you cannot order a reliable confirmation test without first knowing the test type that was originally used. Given the circumstances it was probably an IA, in which case you would want a more precise chromatographic confirmatory follow-up.

Do not have them simply repeat the same type of test.

Dr Bill, THANK YOU for answering. I have read your posts and that has made me feel better, I am sending the money order out today for the second testing of the original urine sample, I have printed all of your references should I include them in with my money order to the lab?

Dr Bill, THANK YOU for answering. I have read your posts and that has made me feel better, I am sending the money order out today for the second testing of the original urine sample, I have printed all of your refrences should I include them in with my money order to the lab?

It is important that they understand that you have done your homework. List the information provided item by item and send it by Certified Mail, return receipt requested.

Once again, simply repeating a test (of the same type) that proved erroneous is precarious. A chromatographic test GC/MS, HPLC can easily distinguish between the two substances... they create very different metabolites. A confirmatory should have been run but obviously was not.

Repeating the IA isn't recommended. It could be, for instance, a flaw in an entire order of the panels.

You need to request a confirmation test. GC/MS, HPLC, GC/MS/MS, a test that can identify and quantify hydrocodone/oxycodone metabolites.

Likewise, It is very important that you request a certified copy of the initial test results, in writing. Do not rely upon oral representations from the lab or their MRO. Also do not fail to indicate in your request that their results were in error. All by Certified Mail.

Dr Bill, I have already requested the retest due to the fact I only had 72hours to request a second anaylisis and I felt that was the only option I had (until I found you). Can I ask the secondary lab to perform a GC/MS on the sample that is being sent to them?

Dr Bill, I have already requested the retest due to the fact I only had 72hours to request a second anaylisis and I felt that was the only option I had (until I found you). can I ask the secondary lab to perform a GC/MS on the sample that is being sent to them?

Yes. Request that the test be GC/MS or equivalent. Also, send the above information to the lab via separate letter if necessary, but make sure they receive it and sign for it.

Is this second test being performed by a different lab?

Dr Bill, yes the second test is being performed by a different lab, (but it is the original sample)

That's good. Nonetheless ask for the confirmatory.

I wonder why a different lab was chosen?

Dr Bill, I am going to mail out a request for the confirmatory first thing Monday morning to the original lab,as far as why a different lab was chosen, they told me my ONLY option was to retest the same sample at a different facility. In my opinion the facility isn't as important as the additional GC/MS testing, correct?Once again I can't thank you enough for your help.

Dr Bill, I am going to mail out a request for the confirmatory first thing Monday morning to the original lab,as far as why a different lab was chosen, they told me my ONLY option was to retest the same sample at a different facility. In my opinion the facility isn't as important as the additional GC/MS testing, correct?Once again I can't thank you enough for your help.

It is good that it is being sent to a different lab. I hope you made a note of the doctor that you spoke with (MRO). You are correct that the important component is the more specific test, not who performs it. It's also important to have a copy of the first test. They often try to ignore those requests.

Dr Bill, I just wanted to give you an update. I have mailed both labs the research papers and a letter stating my concerns, and demand that a GC/MS test be performed. I have requested from the secondary lab that I be notified as soon as the results are sent to the primary lab so that I can follow up as soon as possible. If I do not hear from them what is a fair amount of time to wait before I call the secondary lab?

The testing usually takes about 72 hours but all of the transfer to and fro are unpredictable.

I would give them two-weeks and then follow-up with a second inquiry. Keep the heat on.

Did this test involve federal employment, transportation or union membership?

I'm trying to figure why an MRO was involved.

Also, keep a record, date, time and matters discussed, of any telephone conversation involving this matter.

It would be for a large oil company but the work would be through a sub contractor. I contacted the first lab that performed the test and I was advised the primary results will be sent to the employer, so I am guessing that I will not get hired for this position since the job will be starting soon and I will not get the results back fast enough, plus the time it will take for the MRO to get this right with the hiring company. This is going to be a big financial loss for me.

The initial results should be preliminary, therefore not disclosed to anyone, except the MRO. What I am trying to figure is 1) who ordered the test 2) why an MRO is involved.

If it is a regulated test, only the final result should go to the employer. If the test is un-regulated then there are different standards.

Regulated means SAMHSA* governed. The procedure seems too irregular for that to be the case, but once again it returns to MRO involvement. Ultimately, who is responsible?

You should also make another request for the original test results. Don't let that rest.

*Substance Abuse and Mental Health Services Administration

The test was ordered for pre employment by one of the leaders in food service management and support services across the continent. I don't know if I can say the name so I am not sure how to answer that question. Why the MRO is involved I don't know either, I thought that was just standard procedure? I sent out the money order and paperwork yesterday "certified signature release" for the original test results, followed up by a phone call which they told me it would be about a week before I receive the results.

The test was ordered for pre employment by one of the leaders in food service management and support services across the continent. I don't know if I can say the name so I am not sure how to answer that question. Why the MRO is involved I don't know either, I thought that was just standard procedure? I sent out the money order and paperwork yesterday "certified signature release" for the original test results, followed up by a phone call which they told me it would be about a week before I receive the results.

It isn't necessary to name the potential employer.

In clarification, there are basically two types of workplace testing. 1) That regulated by SAMHSA and the much larger field of 2) unregulated testing.

All regulated testing, including pre-employment, has precise guidelines and practices that must be followed. Including what can be tested for and what must be done following a preliminary positive. Another of the requirements is that a third-party Medical Review Officer (MD, board certified) must review all positive tests. The MRO coordinates all of the proceedings including notification of employer. (MRO Handbook, 2010)

In unregulated testing no such requirements or guidelines are present. There is no requirement for MRO review and generally that doesn't occur. Few states have statutory requirements for testing labs or MRO participation. If not federally regulated, testing generally isn't regulated at all.

The elements you have described led me to believe that this procedure was unregulated with the exception of MRO involvement. It just strikes me as unusual. It's an additional expense that most private sector employers aren't willing to pay for pre-employment testing.

A general requirement for an MRO is that they cannot be an employee of the entity ordering the test or the laboratory performing the test. An MRO must be an independent physician. Of course, if unregulated, the restrictions and qualifications would not necessarily apply.

Just trying to get a better feel for what we're dealing with. As soon as you get the initial test results let me know.

ADDED: The most unusual element is that a certified MRO wouldn't have immediately made the connection between Oxy and Hydrocodone. That information is widely known and extensively published in the toxicology literature.

Dr Bill, just an update, well really there is no update. I faxed paperwork on 11-4-11 and have not received any news, just got off the phone with the second lab and they advised me that they just received my sample on 11-21-11. I still have not received my first results,I am going to call them right now.

Dr Bill, just an update, well really there is no update. I faxed paperwork on 11-4-11 and have not received any news, just got off the phone with the second lab and they advised me that they just received my sample on 11-21-11. I still have not received my first results,I am going to call them right now.

When you have a chance please advise what state you reside in. I'll look up some possible resources to cut through these stalling techniques. There is no reasonable basis for this type of delay in re-testing...

Also, per previous advice, keep a record of each of these contacts.

I reside in California. I have been dealing with the post office they seem to have lost my certified signature package to ASAP drug solutions, which was for my first test results, on the other hand National Toxicology did receive my package for the secondary test. I called National toxicology and was advised that they just received my urine sample on 11-21-11 and I requested the retest from ASAP on 11-4-11 and I find it quite odd that I requested this retest on 11-4-11 and they just received my urine sample on 11-21-11, is this a normal time frame? Since this was for employment, I am losing thousands of dollars from loss of work. Dr Bill this has been such a bad experience but it would have been a whole lot worse if I didn't have your advise, THANK YOU..

OK I just received the initial results, it just says positive for Opiates screening cutoff 300 ng/ml, can you put this in layman's terms for me?

First of all it says nothing about Oxycontin. Hydrocodone, as noted previously, is well known to cross-react with Opiate panels (immunoassay).

Please clarify: Is there any identification of the test used? Any headings? Lab identification, date, time, numbers, someone should have certified the results.

Does it use the term screening?

300 is a standard cutoff so that is not unusual.

Verified Drug Results: Positive Panel: 9421048
Collection site: Date collected: 10/24/2011
Specimen ID: Date Lab reported: 10/26/2011
Accession No:G7478419 MRO verified: 11/03/2011
Laboratory: MRO:...

DRUG TEST POSITIVE FOR:
Screening Cutoff GC/MS Confirmation Cutoff Drug 300 ng/ml ng/ml
Opiates

OK well that didn't show up on the screen like I typed it but hopefuly you can get what you need off that information

If a GC/MS confirmation was performed this report should show a quantitative result: Ex: "507 ng/mg" (or something above 300)

The use of the term Positive Panel applies to initial screening.

There is no MRO name?


This response came from ASAP Drug Solutions?

ASAP has a website which indicates you can obtain results on line. Why don't you try that and see if it contains anymore info.

The bottom should read. Drug:Opiates. Screening cutoff:300ng/ml. GC/MS Confirmation Cutoff ng/ml

Yes it came from ASAP drug solutions, the Dr's name is Dr Tang. There are no numbers for the GC/MS so I am assuming the GC/MS was not performed. I sent the PDF in my previous reply hope you can open it

The bottom should read. Drug:Opiates. Screening cutoff:300ng/ml. GC/MS Confirmation Cutoff ng/ml

Now we're getting somewhere. There was no confirmation performed. This "positive" was the result of an immunoassay, denoted "Panel", that is prone to false positive opiate readings in the presence of Hydrocodone. Furthermore, in all probability the "package insert" required by the FDA (Title 21, I, Part 809 et seq (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?FR=809.3)) contains advice of this cross reaction.

When you explained to the MRO that you were prescribed Hydrocodone he should have immediately called the testing laboratory and asked them to provide the cross-reactivities from that sheet. MROs receive frequent updates on all issues involving test interpretation (see advisory on this issue AAMRO (http://www.aamro.com/docs/news/18.pdf)). There is really no excuse for this, even though I still don't see why an MRO was involved in an IA review.

The re-test should clear this up definitely so long as they perform the test you requested.

It's puzzling that the initial test lab waited for 3 weeks to forward the sample. That should have been done within 24 hours.

Dr Bill, THANK YOU! I contacted ASAP today and they called me back with the MRO and they advised me that my results from the secondary lab came back negative. I find it kind of sad that the MRO tried to tell me that this is a rare occurrence. I requested a copy of the results for my file, once I receive a copy of the results I am going to discuss this with the MRO and explain my research and how this has cost me several thousand dollars all because of their inaccurate findings, any advise?

Dr Bill, THANK YOU!! I contacted ASAP today and they called me back with the MRO and they advised me that my results from the secondary lab came back negative. I find it kind of sad that the MRO tried to tell me that this is a rare occurance. I requested a copy of the results for my file, once I receive a copy of the results I am going to discuss this with the MRO and explain my research and how this has cost me several thousand dollars all because of their inaccurate findings, any advise?

I'm so pleased that you prevailed. You must feel relieved. Does that mean that you get the job?

However, take no action until you have the new results in hand.

Then, send the MRO a certified letter advising him that you are willing to discuss the matter with him prior to taking further action and setting a deadline for him to call you. It is not advisable to call him. You are in charge now.

I have the MROs office address, medical license #, and Certifying Agency should you need it.

Don't forget the laboratory. They are the primary offender, made the initial error and they selected the MRO.

I would appreciate it if you would post the new results (like the other) when you get them. Those are very helpful in showing future victims how the two tests differ by report format. As before remove your personal identification first.

Once again I'm very happy for you.

Dr Bill, I have not forgot to post the secondary findings, I just have not received them from ASAP. I called them again! And requested the results again! Which they advised me they have aleady sent the results but they will copy them and resend them to me. I didn't get the job but hopefuly I will get in on the final part of the contract. You mentioned for me to send a letter and have the MRO contact me, what advise can you give me as far as what I can say to the MRO? Nothing I can say to him is going to get me back my loss of wages.I am relieved but at the same time It worries me that they can just say sorry and that is the end of it, when this has created such a hardship for me. I can't think of how many people may have lost a job or not got a job because of false positive results, I feel I need to somehow let people know, or report ASAP to the Better Business Bureau.

Dr Bill, I have not forgot to post the secondary findings, I just have not received them from ASAP. I called them again! and requested the results again! which they advised me they have aleady sent the results but they will copy them and resend them to me. I didn't get the job but hopefuly I will get in on the final part of the contract. You mentioned for me to send a letter and have the MRO contact me, what advise can you give me as far as what I can say to the MRO? Nothing I can say to him is going to get me back my loss of wages.I am relieved but at the same time It worries me that they can just say sorry and that is the end of it, when this has created such a hardship for me. I can't think of how many people may have lost a job or not got a job becouse of false positive results, I feel I need to somehow let people know, or report ASAP to the Better Buisness Bureau.

A complaint to the BBB will get no results. Sometime back I posted a list of the various agencies that have responsibility for drug testing, labs and MROs. That is available here:

https://www.askmehelpdesk.com/medical-science/oxycodone-false-negative-urine-test-393019.html

In addition, the MRO is a licensed physician. You can file a complaint with the medical licensing board for your state. He must also be a member of a MRO certifying group, AAMRO (http://www.aamro.com/), or Medical Review Officer Certification Council (MROCC) (http://www.mrocc.org/). You can check membership on-line and then file a complaint with the proper agency.

It is exceedingly important that an MRO is knowledgeable and attentive. They are the last line of defense in preventing these types of procedural errors.

By complaining to the appropriate agencies you will get action and the MRO will be called to account for his actions.

Of course it is also important to address the labs role in this matter.

By the way, the MROCC provided a monograph series on this subject for it's members. See Series (http://www.mrocc.org/monograph_prescription.htm). A little additional ammunition for you.

Did they say oxycontin or oxycodone? Oxycodone is Percocet and will often throw the same positive that hydrocodone (Vicodin) will. Hydrocodone and oxycodone are both opiate based partial synthetics and fall in the same class as codiene, heroine, morphine, etc. Oxycontin (often pronounced like oxycotton) is purely a synthetic opioid-like substance and produces different metabolytes and requires a different test. Hopefully this helps and you are just throwing an overall opiate positive, which is covered by your hydrocodone prescription. Good luck!