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?

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 (http://www.pathology.med.umich.edu/Handbook/details.php?testID=4798&PHPSESSID=9e8fef675e034a7d67b87c5917e6c6c0)

Drug testing laboratories are well aware of this problem. As example Redwood Toxicology (RTL) (http://www.redwoodtoxicology.com/documents/products/cross_reactions.pdf) 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 (http://www.ncsconline.org/wc/publications/res_judedu_substanceabusematerial19pub.pdf))

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/oxycodone-iscreen-drug-test-kit-urine-oxy-p-31.html

Did you experience any adverse consequences because of this error?

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?

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

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.

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?

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.

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.

......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.” (http://www.ncbi.nlm.nih.gov/pubmed/18290585)

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* (http://www.medpagetoday.com/MeetingCoverage/APA/20253)
Source reference: Smith D, et al "An update on testing for drugs of abuse: Scientific background and practical clinical concerns" APA 2010;

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.

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.

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

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

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 (http://www.med.umich.edu/1info/FHP/practiceguides/pain/drugtesting.pdf)

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.

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.

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.

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.

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.

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 (http://www.drugs.com/) and
RxList (http://www.rxlist.com/script/main/hp.asp)

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.

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!

Yes I agree with research research research. The more you are informed of your disease, treatments and your medications, the better off you'll be. I even research doctors on line before I go so I know the good and sometimes the bad about them and can make my own decision on whether I want to make an appointment with them or not (just remember that not everyone is always happy. With pain management you will find the drug seekers give bad reveiws. You can usually tell the bad eggs in the bunch). And yes like you I was very lucky to stumble onto this website and found Dr Bill. He helped me a lot,and I'm grateful for him as well. He has great information and is more then willing to go out of his way to help. Do what he says about putting that in you chart. If you need to write a letter do so before you go to the doctors so it'll be ready to have it placed in your chart. Last thing you need is for the situation to be stated one sided on YOUR chart. Good luck to you. Let us know how it turns out.

yes i agree with research research research. the more you are informed of your disease, treatments and your medications, the better off you'll be. i even research doctors on line before i go so i know the good and sometimes the bad about them and can make my own decision on whether or not i want to make an appointment with them or not (just remember that not everyone is always happy. with pain management you will find the drug seekers give bad reveiws. you can usually tell the bad eggs in the bunch).... if you need to write a letter do so before you go to the doctors so it'll be ready to have it placed in your chart. last thing you need is for the situation to be stated one sided on YOUR chart. ....

There is the wisdom of practical experience... ccmom56 has just emphasized the real significance of written communication that I failed to emphasize. The chart maintained by your doctor is about you. Should you change doctors in the future that is the record the new doctor will review. Comments you may make to your current doctor will not be included. Written communication must be included. Make certain that you are included in your record.

Thank you ccmom56. Thank you for coming back and lending support.

Dr.Bill,what king of written communication? Do you mean write a letter in addition to the links you provided me with? What do I say?

Julie,

Did you receive a copy of the test results? I'm looking for the name of the lab that performed the test if you know it.

I will put together a list of the items to include in a letter to your doctor to which you can attach and reference the printouts. It's brief. Just want to look at my files.

Also please let me know which items you intend to print so I can provide the full citation (rather than rely on internet reference).

I printed out th redwood tox report,the oredering and interpreting urine drug tests,and,the pathology handbook review of oxycodone in urine.

No,I did not receive a copy of lab that performed test. Shall I stop in and ask for it?

No,I did not receive a copy of lab that performed test. Shall I stop in and ask for it?

Don't need it now. You should get a copy for your records when you're there next time.

Okay. So,should I just bring the papers I printed out when they call me in? Or should I stop by and ask the front desk girls 2 just put them in my file? Also,you mentioned I should write a letter for my chart?

Julie,

Following are the elements for a letter, modify for your own use.

Date
Address to doctor (and medical group if applicable)

On or about (insert date) I was advised by your office that a urine drug test had found oxycodone in my urine. As you are aware I am not prescribed oxydcodone. Be advised that I do not now, nor have I ever, taken oxycodone.

The urine drug test performed and relied upon by your office was in error or misinterpreted.

Since receiving advice of these errant findings, it has been brought to my attention that this error is not uncommon. That there are many studies and advisories warning of drug test cross-reaction between hydrocodone, my medication, and oxycodone. I am attaching three (3) such documents from 1) a nationally recognized drug testing laboratory, 2) a university hospital laboratory, and 3) Practice Guidelines (U of Mich). [These are by example only. Every major drug testing laboratory reviewed makes note of this cross reaction]

PLEASE MAINTAIN THIS CORRESPONDENCE IN MY PERMANENT MEDICAL FILE.

[Your signature]
[Your name printed]

Your awesome Dr. Bill. Should I swing by and drop all my print outs and letter off,or wait until they call for a random? I am guessing just drop in and ask if they could please place in my chart? Correct? I have soooooooooo many other questions,not pertaining to this but the cocktail of meds I am on and what its doing to me. I hate taking medications.B4 the ms dx,I was a long distance runner,surfed quite often,etc... Now,not sure if it's the MS or the medications. The docs all tell me,oh,it's the disease process,but I do not believe that. I take 4 different meds,alllllllllllllllllllllllllllll sx management. One thing at a time. When I get your answer on my newest question about dropping my "stuff" off,I am going to run some things by you. If you have time. 1 thing,does mild thistle really help with liver function?

I would drop it off. Demonstrates concern and immediacy. Also ask for a copy of the test.

Please be careful in this process. The doctor seems to be cooperating to this point and it isn't beneficial to get them too riled up unnecessarily.

While I am thinking of it, do you have to pay for the tests?. and the random tests, that was a result of the errant test?

Please remember the limitations I cited above. I am a PhD, not an MD. Among other things that means I can't write prescriptions, I never learned to play golf, and I work on Wednesdays.

Always happy to help with anything I can but, for instance, I have no idea if milk thistle promotes liver function.

Dr. Bill,I saw pain management today,letter and literature in hand. The first doc that came in was a resident,what a joke,than my regular doc came in,I gave her my handouts and they were so busy,she wrote rx,put said info in chart and out the door I went. Thank you so much for your time. I have something to discuss with you that I have been researching. Low Dose Naltraxone. It makes so much sense to me that people with autoimmune disease have low endorphins. I recall a time when I exercised 4 hours a day. Well,when I was dx in 2009 with MS,I was still a runner,but I had a good balance... I was not fanatical about it. I started norco about 6 months after DX and feel my MS has progressed. My question is,does Norco suck your endorphins dry? I am constantly trying to figure out how I went from being DX and feeling good to where I am now. After much research,I am starting to think it may be all the symptom management meds. The docs all say It's the disease progression and I have always felt in my gut that was BS! Your thoughts please? And again thank you for your help!

julieanneb and Dr Bill thank you guys for posting. This is a battle I have just begun but reading your story has given me hope, I am sure this report is probably going to get to the employer before I can get it straightened out, which means I won't get the job due to this incorrect report.