I have been in pain management for over 5 years. I am prescribed to take Percocet 10/325 mg 5x/day, MS Contin 30mg 3x/day, Xanax .5 3x/day, Lexapro 20mg 1xdly and Ambien for sleep. A while back (couple of years) he switched me to Lortab 10 due to cost, but switched me right back to Percocet the next month. If I do not take 5 a day, I will put them away in another bottle in the event I need them later. I had about 6 Lortabs in that bottle. Due to having some extra pain lately, I took these 6 Lortabs about 48 hours before my 12 panel urine test and never gave it a second thought. But on that same day I saw him he told me that my last test showed that I had Ativan in my system and this is not possible. I have had 3 reconstructions on my right shoulder with a hamstring transplant and I take my pain management very seriously. Now I am concerned that I will be in trouble if this next test shows Hydrocodone along with Oxycodone. Is this going to happen. Remember, I only took 6 10mg Lortab approximately 48 hours before my test. I am 5'2" tall and weigh about 150 lbs. not overly active, and drink only a moderate amount of water. Also, why would Ativan show in my urine when I did not take that!

You mention urine test and 12 panel... leads me to assume this was a point of collection test (POC) viewed at office?. not followed by a confirmatory test?

In that you take drugs of a similar class (benzodiazepine) I am surprised that a POC could distinguish between drugs within that class (ie Ambien/Xanax/Ativan)

My first guess would be test error in relation to immunoassays (ave around 15%) but I remain puzzled about the specificity in identification of Ativan.

If not mistaken they do a POC as well as send for confirmatory to RAND. I take pain management seriously and do not take anything not prescribed to me... I am confused.

Add me to the list of confused. You should discuss this with the physician (who probably can't explain it either). Generally, the confirmatory tests are accurate at identification by GC/MS (or similar). However, multiple medications, particularly those within a similar class can interact in ways that are not fully understood. I'm sure the physician is aware of this frailty.

As to your question about hydrocodone and oxycodone the answer is greatly complicated, once again, by multi-drugs and the type of test used. The respective half-lives for each are no longer applicable due to competition with other drugs for metabolic enzymes.

Neither substance is usually detected in standard drug panels and multi-panel would have to be looking for the specific drug.

Once again, instruments equivalent to GC/MS can test for either but must be specifically looking for the spectrum. Usually, confirmatory testing does not occur unless there is a positive at POC, which adds to the confusion in relation to Ativan as being in similar class shouldn't have raised concern.

Wish I could be of more assistance in re to pain meds but I find it impossible to analyze elimination (even in broad terms) when multiple and similar compounds are involved.