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    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #1

    Nov 4, 2011, 07:34 PM
    Why did I test positive for OxyContin when I am taking Hydrocodone?
    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!
    sarsface's Avatar
    sarsface Posts: 3, Reputation: 2
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    #2

    Nov 4, 2011, 08:18 PM
    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.
    CliffARobinson's Avatar
    CliffARobinson Posts: 1,416, Reputation: 101
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    #3

    Nov 4, 2011, 08:18 PM
    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.
    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #4

    Nov 4, 2011, 08:57 PM
    Quote Originally Posted by sarsface View Post
    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,
    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #5

    Nov 4, 2011, 09:02 PM
    Quote Originally Posted by CliffARobinson View Post
    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,
    DrBill100's Avatar
    DrBill100 Posts: 3,241, Reputation: 502
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    #6

    Nov 4, 2011, 09:25 PM
    Quote Originally Posted by SMB71 View Post
    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/medica...ne-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.
    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #7

    Nov 5, 2011, 09:43 AM
    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?
    DrBill100's Avatar
    DrBill100 Posts: 3,241, Reputation: 502
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    #8

    Nov 5, 2011, 10:30 AM
    Quote Originally Posted by SMB71 View Post
    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.
    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #9

    Nov 5, 2011, 11:18 AM
    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?
    DrBill100's Avatar
    DrBill100 Posts: 3,241, Reputation: 502
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    #10

    Nov 5, 2011, 11:22 AM
    Quote Originally Posted by SMB71 View Post
    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?
    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #11

    Nov 5, 2011, 11:36 AM
    Dr Bill, yes the second test is being performed by a different lab, (but it is the original sample)
    DrBill100's Avatar
    DrBill100 Posts: 3,241, Reputation: 502
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    #12

    Nov 5, 2011, 12:27 PM
    That's good. Nonetheless ask for the confirmatory.

    I wonder why a different lab was chosen?
    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #13

    Nov 5, 2011, 01:32 PM
    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.
    DrBill100's Avatar
    DrBill100 Posts: 3,241, Reputation: 502
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    #14

    Nov 5, 2011, 02:21 PM
    Quote Originally Posted by SMB71 View Post
    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.
    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #15

    Nov 7, 2011, 04:56 PM
    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?
    DrBill100's Avatar
    DrBill100 Posts: 3,241, Reputation: 502
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    #16

    Nov 7, 2011, 05:35 PM
    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.
    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #17

    Nov 7, 2011, 05:51 PM
    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.
    DrBill100's Avatar
    DrBill100 Posts: 3,241, Reputation: 502
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    #18

    Nov 7, 2011, 06:11 PM
    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
    SMB71's Avatar
    SMB71 Posts: 20, Reputation: 1
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    #19

    Nov 8, 2011, 03:25 PM
    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.
    DrBill100's Avatar
    DrBill100 Posts: 3,241, Reputation: 502
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    #20

    Nov 8, 2011, 04:45 PM
    Quote Originally Posted by SMB71 View Post
    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.

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