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drug testing at pain managment clinic

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Posted 8/28/2009 8:22 PM (GMT 0)
HI, i'm kinda new to the whole pain management clinic scenario. I am being seen for severe endometriosis and abdominal scarring/adhesions. I was diagnosed 9 years ago, and had a complete hysterectomy about 5 years ago, unfortunatly all my symptoms returned and it turns out i develeloped severe scarring afterwards, that gives a lot of the pain and symptoms as the endo did. Things seemed under control until about 2 years ago, i needed more and more vicadin to control the pain. I finally got in to see a pain interventionalist about a year ago, and set up my trial for scs. it worked really well and in march i got my stimulator implanted in march. I'm doing a ton better, and got set up with a real pain management clinic in may. I had some trouble a month after my implant from the swelling and have had to reprogram my machine several times for muscle cramps. as the swelling has gone down, my area of sensation has changed some and caused muscle spasms. I've had to take muscle relaxants and mobic off and on the last few months as it has eased up.

my first visit they did a urine drug test (i'm assuming to make sure i am taking only what i said i'm taking)

I also found out i was a canditate to try trigger point infections, and for the last three months that is what i've done---- I'm down to 20 darvacet a month (from 60-90) before the scs was implanted.

I'm going in to see my dr on thursday 3rd of september. My problem/concern is this---- I was traveling and 3 weeks ago was driving and started hurting. I didn't think about it, i just grabbed my prior recieved prescription for the non-narcotic pain killer tramodol (ultram) which doesn't work nearly as welll as darvecet. but doesn't make me drowsy and is safe for me to drive with. I realized afterwards that i broke the dr's rules. this is an old prescription and i didn't have permission to take it. It was just that one time about two weeks ago. I am now worried about what this  means for the rules. I feel so stupid for taking it---but it is what i'd been doing when i needed to drive for the last 9 years--- I didn't think about it until that night.

will this show up in the drug test? I am thinking i need to just go in and be upfront and tell them what happened--- but paert of me hopes it was long enough ago that it wont' show up, or that they are testing for narcotics etc... and that it wont' even be an issue. I'm an extremely honest person, and feel so stupid and so forth for not thinking it through.  Does anybody know what they are testing for, or how long it takes for this to get out of my urine?

Regaurdless i really think i need to be upfront and honest and hope that they will be ok with it. If they drop me as a patient i'm screwed though. It took forever to find a clinic that would see me, and there arent' a lot of choices in the area, as it is i'm traveling an hour and a half to get to austin texas to these drs.

Hoping for advice and insight.

I'm hoping and praying they won't even test me this time, but even still it is just in my nature to admit the whole thing and hope they will forgive me this time if i turn in the old prescription.....

afraid i screwed up big time!! ~~~Emily

Posted 8/28/2009 8:33 PM (GMT 0)
Hello, Of course you should be upfront with your doctor. I would think the more honest you are with them, the more they will trust you, plus maybe if it helps you I wouldn't see why htey couldn't prescribe it for you so you'll feel batter tkaingi t knowing it's prescribed by them. Also Ultram doesnt come up on a normal drug screen, I think that has to be tested diffrently, atleast I thought so, I could be very wrong. I know most common drug tests test for benzodiazipines, barbituates, meth, cocaine, methaodne, opioids, and few others, I cant remember right now, I have my drug screening papers and it's listed on there. Plus also ultram shouldn't still be in your system after 2 weeks, espcially if you only took it that once. But you should still let your doctor know about that breakthrough pain and not wanting to be drowsy. Plus Ultram always use to knock me out, it is a sedating drug, so your doctor may find it hard to beleive you took it so you could drive, but that's up to them. Good luck.

Remember to be honest, as a good relationship cant be built on secrets.

-carmen
Posted 8/28/2009 8:50 PM (GMT 0)
Emily

I think carmen gave you the very best advice! Honesty is the best bet!  If nothing else print out your post and give it to them  heck an ours too if needed or mine. If you explain it to them the way you have to us, there should be no problem, Heck I can feel and see your concern and  anxiety just in your post! You will feel better about it and I bet your Doctor will too, because he will know how much you care and how honest you are! If your Pain Doctor is a Good one that will mean allot to him to have a patient so honest!

Good Luck to You

White Beard

Posted 8/28/2009 10:08 PM (GMT 0)
Emily,
I have to agree with White Beard and Kitty. It's not only about what shows up in the drug test; it's the truthworthy behavior you display, and hopefully the doctor will not hold that against you.

Although ultram isn't an opiod, it is a controlled substance, just at a different level. It may also show up on repoting systems via pharmacies and your insurance company, so if you're seen as being dishonest down the line, that will definitely get you dismissed as a patient.

Like Kitty, though, I'm surprised you can drive with the ultram, but that's between you and your doctor. Everyone is different. People are amazed I can drive with the percocet, but if I take a muscle relaxant, forget it!

Good luck! Let us know how it works out.

PaLady
Posted 8/28/2009 10:42 PM (GMT 0)
Really? I take Methadone and Oxycodone and have never had trouble driving... maybe because I'm so used to it. And of course I only drive about a mile at a time because everything I need is so close to where I live... I do agree about just coming right out, as soon as you get into the room, and tell the nurse about taking the Ultram..that way they see that you are an honest patient and believe me...that will go a long way if you ever need them. So, good luck..'

Me.
Posted 8/29/2009 12:07 AM (GMT 0)
thanks so much for all your responses. I will definalty tell them up front what happened and that i wasn't thinking about it when i took it, i'll also bring my bottle so they can take it away if they want it. As for the drowsyness, becuase it was my first line of defense for so many years i got to the point that it didn't make me drowsy or high, in the begining it did---although not as loopy as when i had to take something stronger. becuase i used it so many years i just stopped getting drowsy from it. for those who have never taken it before absolutlly be careful about not assuming you'll be fine after you take it. Unfortantly not only does it not make me as drowsy anymore, it doesn't work as well as it did years ago either--- which is really too bad becuase honestly it made me feel safer to take something non-narcotic long term than opiods.

Oh well, at least now the scs and the trigger points seem to have cut the use of the opiods by a LOT---- I was always worried that if i used that many at 30 years old, how would i handle 50 more years without running out of drugs i hadn't grown tolerant too. now i feel a lot more secure in the belief that i won't end up addicted to my meds.... Thanks for the advice--- the way you looked at it is the way i feel most comfortable. I hate being dishonest, and really hope that if i tell them this they wont' refuse to see me anymore..... but if they do, then i'll deal with that as it comes.... thanks again----here's hoping they laugh it off and recognize i wasn't trying to do anything wrong.
Posted 8/29/2009 1:05 AM (GMT 0)
Emily,
I agree with the others about being honest. Ultram actually is a narcotic pain med. It is a mild narcotic & is not scheduled, but it still can show up on UA tests. It is not often abused, so they might not test for it, but I know my PM's office just has a routine test that they order for all their patients. It includes all the narcotic meds they prescribe (including Ultram) and certain habituating meds like anti-anxiety pills (like Valium) and such. Best thing you can do is explain what happened, turn in your old meds -- best to just remove the temptation altogether -- and let him know that it was a one-time mistake. I do think you should discuss with him that the pain is not being managed well enough at this point & that you would like his input on what to do when the pain gets horrible.

He might recommend more meds, or might suggest something else (massage, PT, bracing/wraps, etc.), but in any case even though it's up to him, I imagine he will want to try to help you. I have an SCS that I've had for 3 years. It took me a good 11 months to get the programming just right. They would reprogram it, then it would better, then worse for a while, then they would reprogram it, etc. The one med that I found that helped the most is Voltaren gel. It is an NSAID topical gel. I put it over the area where my battery pack is located, where the scars are & as needed in other areas. I don't know whether or not it would work for you, but I know other SCS users have benefited from it as well.

feel better,
France
Posted 8/29/2009 7:21 AM (GMT 0)
Emily, my PMS had a policy that every patient did a UA every time they came in. I am not sure about yours. I agree with being honest. It would look rather suspicious if there was a hit on your UA panel and then you tried to explain it. Being up front is always the best policy in these cases. Funny things can and have happened on UA tests. I hope that your dr understands and that you can possibly change meds around that will help you more.  
Posted 8/29/2009 2:01 PM (GMT 0)
I take the Ryzolt 300 mg ER (Ultram - Tramadol) and love the stuff. Its my main pain med with percocet for break through pain which I take about 120 of them a month.

Regarding testing my office is random. In 8 months I have only had one test. It does not test for Ultram. My office brags this med up it is a non narcotic. Its the first type of codiene that is classified non narcotic.

As everyone has said be up front and honest. Ultram is a mild pain killer and with the script in your name plus being such a mild one they will approve of your honesty. Its not like you were seeking out a hardcore big dog pain med.

I also get very loopy on my pain medication. I have to plan out taking my meds so I can drive to work and then drive home. Any other driving its my husband or my daughter who got her drivers license about 4 months ago. Wouldn't it be great to be 16 again..lol

Honesty is your best friend
Laurie
Posted 8/29/2009 6:07 PM (GMT 0)
I'm a bit confused about all these doctors who say that Ultram (generic=tramadol) is not a narcotic pain reliever. The manufacturer says it is; the FDA says that it is. It is a mild narcotic & it is much less likely that a person will become addicted to it than with other pain meds (though I have met a couple of people who developed an addiction to it).

Here is what the manufacturer, Ortho-McNeil-Janssen Pharmaceuticals says:
"ULTRAM® is a centrally acting synthetic opioid analgesic."

Here is the link to that statement:
http://www.ortho-mcneil.com/ortho-mcneil/shared/pi/ultram.pdf#zoom=100

I think the vast majority of doctors are like Laurie's and don't even test for the drug, but if your luck runs like mine, you will end up with one of the very few PM's who like my PM test for all the drugs they prescribe. I think it's super-expensive to run those kinds of tests so that is probably why most docs don't do it. Mine does not test every session, just at random times or whenever he is suspicious of something.

I will say that I made a similar (some might say "worse") mistake one time. I was just in miserable pain & couldn't get a hold of my doctor's office. I had some leftover Kadian that I took. I had it from before & was allergic so I stopped taking it. I took it 2 days & eventually came to my senses and felt really guilty about that. I felt sneaky, though that wasn't my intention at the time. So I brought in the remainder of the bottle to my next visit with my PM & told them what I had done. They didn't run a UA or anything, just took the pills, counted them, marked that I had returned them in my chart & then destroyed them. The nurse told me that she was really impressed that I had returned them. She said almost no one does that voluntarily & that it showed that I was not trying to be sneaky or deceptive. Everything worked out fine & my PM continued treating me. He gave me a stronger topical medication for a time (I could still have it, but it's not covered by insurance & I can't afford it) & scheduled me for more frequent visits for a while to bring the pain under control.

I think you probably just need his help to get your pain better managed during those special occasions where you are more active for a while. I'll be keeping my fingers crossed that everything goes very smoothly during your next visit & that you get all the help you need. :)

Let us know how things go.

hugs,
Frances
Posted 8/30/2009 1:37 AM (GMT 0)
Frances,
Thanks for the clarification. I knew it was a controlled substance (I think C5, but I'm not exactly sure) but didn't realize it was an opiod. Either way, it's still addictive as you said, just not as high a potential as some other stronger meds.

PaLady
Posted 8/30/2009 3:41 PM (GMT 0)
PA,
Actually, surprisingly, it is not controlled at all. Makes no sense to me, but its not. It's "sister drug", Nucynta (which we all know I recently found I hate) is a C2. Apparently part of the reason is that they found that some people still found ways to abuse Ultram & ended up in respiratory arrest. Leave it to the addicts to find another way to make things harder on the rest of us. :(
I think maybe the fact that it is not controlled is why some people think it isn't narcotic. But all they have to do is read the label. Maybe part of my frustration was with my own PM (soon to be former PM) who couldn't be bothered to read the label on the Nucynta & just relied on the rep to educate him about the product. I guess we all just need to look out for ourselves & others since it seems sometimes that is the only way to get accurate information. Such a sad statement, but I've found it's true far too often. Oh well.

take care,
Frances
Posted 8/30/2009 7:44 PM (GMT 0)
Frances,
It doesn't make sense that it's a narcotic and not controlled at all. Sometimes they're not labeled as such in ways we would think of, because the control on C5's is pretty minimal - I mean you don't go through the problems with refills and such. So I was pretty sure it was controlled but it's kind of an esoteric debate as it may not effect the consumer that much. But either way people shouldn't take these medicaitons lightly.

I'll have to read up on nucynta, as I can't take tramadol because of it's effect on seizure threshold. I'll have to see if nucynta has the same properties. Actually, anything with a sodium molecule in it affects me; I can take generica ibuprofen, but not naproxen or alleve. So I always check the molecular structure usually listed on the pharmaceutical's website.

It seems like nucynta is really being pushed by the drug reps. But like anything it will work for some people, and not others. Glad you got off of it!

PaLady
Posted 8/30/2009 9:24 PM (GMT 0)
Ultram is on the FDA watch list, but for some odd reason they do get away with it not being a scheaduled drug, eventhough I absoutly think it should be. I know lots of people do drug seek for it, and I even hear the withdrawals is worse then other pain meds cause Ultram has an anti-depressant properties in it. But I'm gona tell a story about being honest with doctors about taking other meds and how the outcome is better then if I was to not tell him.

When I first got on Suboxone, which is a scheaduled narcotic, my doctor drug tests me quite often, but not all the time as he trusts me, or so he says. Well I had a migraine one day, about a month after starting the Suboxone, and I took Fioricet, which has a barbituate in it, cause I had not had a chance to see my neurologist yet and tell her I wasnt suppose to be mixing barbituates with the Suboxone (it takes forever to get in with my neuro doctor). Well I called my doctor that prescribes the Suboxone and told them to ask the doctor if it was okay for me to take the fioricet. Well they didnt call me back til the next day, which by then I took the fioricet cause I couldnt take the migriane anymore. Well I saw him a few days later for my scheaduled appointment. I told him right away what happened and was freaking out that he may boot me out the door. Well he told me it was okay and not to worry, and he was happy that I was honest. He then gave me Cymbalta to try to see if it would help with migrianes, and it does. I havent had to take the fiorcet again, and because I told him right away, he trusts me a whole lot.

So being honest is a wonderful thing, cause I knew he was gonna drug test me for that drug, and he was well aware before the results came back so I had nothing to worry about. Also your doctor will be aware that you may need something for pain that doesnt make you sleepy so you can drive.

A few years ago I was forced to redo my drivers test cause my doctor at the time had to tell the driver license place that I was taking narcotics for pain, so I had to show them that I was capable of driving while taking pain meds, and I passed it. So the state of Washington License Deparatment is well aware that I drive while taking narcotics. And usually I am able to drive okay, but of course I know when I shouldnt be driving as sometimes my meds do make me sleepy, But we should always use common sense.

-carmen
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