[mshardy2u]

I recently went to my PCP for a routine check up. I see him every 3 months, I had a pain management contract with him that I complied with, my issue is that at this recent appointment I was told that he would no longer give me pain meds, because when they tested my urine the percocet wasn't showing up ! I explained to him that I was indeed taking my medicines as presribed no funny business after all I do live with a police ofiicer. I don't know why it doesn't show up in my urine,could you shed some light on that for me please. I have Harrington rods in my back that I've had since age 16,and was diagnosed after extensive testing with chronic pain,what am I suppose to do now ? Will I be able to go to another doctor to get medicine for my pain. I have been in extreme pain so bad that I dread getting out of bed,which is a must since I have a very active 6 year old.

[DrBill100]

This is a very common problem in the pain management field. The semi-synthetics such as percocet do not show up because of the sensitivity of the test or rapid metabolism. This is a well known phenomenon regularly addressed in the medical literature and journals yet most physicians don't understand the pharmacokinetics of the drugs they prescribe and remain ignorant of the drug testing procedures.

“Family medicine physicians who order urine drug testing to monitor their patients on chronic opioid therapy are not proficient in their interpretation.” (Reisfield) These findings are supported by a later survey, 2010, of physicians at a medical conference determined that 88% of doctors didn't know that they may need to order a special test to accurately screen for oxycodone. This according to information provided at 163rd Annual Meeting of the American Psychiatric Association, New Orleans, May 22-26, 2010*.

Your result may be traced to the test or to your metabolism. Either way you will have great difficulty obtaining prescription from another doctor.

Reisfield, 2007

*Primary source: American Psychiatric Association

McCarberg BH (2011) A critical assessment of opioid treatment adherence using urine drug testing in chronic pain management. Postgrad Med. 2011 Nov;123(6):124-31

Family Practice, Table 3 2010