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Fentanyl not showing up as an opiate on PM UA?

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Posted 8/28/2012 9:19 PM (GMT 0)
So I went in for my PM appointment today, and brought up my concern with the brand of Fent patches that I use not sticking well to my skin and if there was anyway to possibly up my monthly patch count from 10 to 15 since they keep falling off early, and I also brought up my concern with not having some sort of pain med to take when needed for b/t pain. My actual doctor was out for the day (she was sick) so I saw the attending doctor on staff. He told me I had to wait a bit longer since I have only been seeing them since the beginning of July. I told them that I understood and I was willing to do whatever they deemed necessary.

However, he gave me a UA (asked for a urine sample), and I received the test results online just a few minutes ago. Apparently, I showed up negative for all drugs/alcohol, even opiates. Now I am very concerned that when I go in next month for my new script they may turn me away based on my UA results. I know they test you to see if you are taking the medication properly, and I am using the patches as best as I can, but my last one fell off yesterday and I still haven't replaced it with a new one yet so I can try to stretch out my remaining prescription to last. I told the doctor that, so he was aware of it.

Can I dispute the test when I go in next time if they give me problems? I really do not want to get turned away when I see the doctor again next month, and I am trying to establish a relationship based on trust with my new doctor. Will this negative UA go against me?
Posted 8/28/2012 9:43 PM (GMT 0)
Yikes..that is not good:( I am sorry to hear that...

Do you know if they send this out to a lab that uses gas chromatography mass spectrometry? That test is the most sophisticated and is 99.9% effective.

I would insist for another test to be done and sent to a lab that does GC/MS or a blood draw.

The way to do this is tell them you will put the patch on in front of them and then come back to do the test later that day or next morning so they can witness this.

I would also make sure if you have always had perfect urine tests, pill counts, no early refills, etc. from your previous Dr. that they have all these records..

It seems like since you told them that you hadn't worn a patch in x amount of hours....(how long had it been in total?) then they would mark this down and even if it was the GC/MS test...it makes sense to not have any medication if you hadn't had a patch on for quite awhile.

Had you called this Dr. at the beginning of the month to tell them that the patches were having trouble sticking?

The other downside is that if you didn't call them...and you seemed to be ok withdrawal wise and pain wise (no emergency need to speak with them) with not having any pain medicine in your system for a day or more....then they may think that you really don't need the medication or the strength you are on.

I am just trying to throw out some thoughts and suggestions...Hopefully you will be able to speak with the Dr..

Most of the time they will want you to try Tegaderm (spelling?) covers or other ways to keep the patch on before they up the amount they will give you. Many people have trouble with them sticking and even the manufacturer will give out things that help the patch stick better...

Sorry this happened:(
Posted 8/28/2012 11:44 PM (GMT 0)
From my understanding Fentanyl does not show up on a regular dip stick urine test. It had to be sent off for a confirmation test. My doctor doesn't send it off he just wants to make sure I am not taking anything else I am not suppose to. I don't remember or understand the reason behind it but pretty sure I am right and fentanyl does not show up on the in office dip stick desk.

I will write more later. Just got home from the eye doc andy eyes are dilated. Can't see!
Posted 8/29/2012 1:56 AM (GMT 0)
Like Iloveoliver said, if it was a dipstick test, most likely since you just took it today, fentynol would not show up, they have to use some pretty fancy and expensive tests for it, since it has no present metabolite in urine like morphine does (lol I'm really quoting wiki here) but they are most likely checking you on a routine check for other substances. Since we don't know what testing method was used, it's impossible to say for sure.

What I recommend, is to bring your used patches with you each month, with a date and time log of each patch, date and time on and off. Allow your doctor to dispose of them, and have him make a notation in your chart every time you do this, and have him keep a copy of your log, it will help with future month's supply.
Posted 8/29/2012 4:10 AM (GMT 0)
I am pretty sure it was just a standard dip stick test. As for my previous records from my last doctor, they have those and all of my previous UAs were clean and those tests were specifically for whatever med I was taking at the time, as they wanted to make sure I was taking my meds as prescribed. I am not sure if the test they gave me was for the same reason or if it was just to see if I was doing anything else. The test was negative for everything, so I am in the clear there if that is the case. I will take your advice and save what remains of my patches for the rest of this month, as I have just been folding the patches and flushing them down the toilet just like the instructions said to do if they came off.

And yes, I have already informed my doctor that I am having problems with this brand of generic patches sticking to my skin for the full 3 days. My pharmacy has ordered the first brand that I had filled back in June, as that brand was much better at sticking than the brand I have now. I told my doctor this as well, and he agreed with me that this was the right move to keep what patches I had left useful for the rest of the month. I can bring in my remaining patches to the pharmacy and they said they will take those and replace them with the other brand for me for no charge and they will continue to order that same brand each month for me as long as they can. The only thing is that if they cannot continue to carry that brand for one reason or another, I will have to go back to the brand that I am using now, so my pharmacist told me to talk to my doctor about perhaps getting 15 patches a month instead of 10, just in case they keep falling off early, so I will have enough to get me through the month.

Also, I have been trying Tegaderm and various types of medical tape to keep them on and the longest I can keep one on is 2 days or so. Its mainly because I sweat a lot and am around a lot of hot water/steam at work as well, so that doesn't help. My doctor understood and made my next appointment for the 17th of September, since my prescription should run out during that week and I will need a new one by that Friday.

If they want to roll over on me just because of the UA they gave me today, I will have them do a more sensitive test when I go back or put the patch on in front of them and return later for a test. Thanks for the help all.
Posted 8/29/2012 4:19 AM (GMT 0)
"The other downside is that if you didn't call them...and you seemed to be ok withdrawal wise and pain wise (no emergency need to speak with them) with not having any pain medicine in your system for a day or more....then they may think that you really don't need the medication or the strength you are on."

I did call them immediately earlier this month, on the 22nd, and told them I was 2 patches short for this month and that I was out. I was W/D-ing beginning on Tuesday night (the 21st), all day Wednesday (22nd), and most of the day Thursday (23rd), up to the point when I finally got my prescription that was refilled early by my doctor. I was in an immense amount of pain, and the W/Ds were terrible. The only other time I W/D that was similar to this was when I went on vacation in 2010 and had misread the refill date on my Percocet, and ended up having to wait 4 days to get my next refill because I was 200 miles away from home and couldn't get to my doctor to get my new script. Boy that really really sucked, especially since I was on vacation. It was my fault though, so I don't blame anyone but myself. I just should have made sure I had enough to last the full week that I was out of town.

Also, I could have went into the ER when I was in W/D and pain, but I honestly was afraid they would view this as a breech of contract of some sort. At this point, I just want the pain to be manageable and want to follow all of the rules relating to my PM.
Posted 8/29/2012 4:30 AM (GMT 0)
Hey, sweat and steam at work, no good for those patches I think. Try keeping them cool with a stack of cold packs. I'd get a stack of small ones and wrap them in a towel, then ace bandage them over, or above, or next to the area where you have your patch, and keep that part of your body from perspiring so much. Maybe freeze them at home, and put them in your lunch box, and change them once an hour or something. Also, if you have to wear a hard hat, keep a soaking wet bandana underneath, and that'll help you shed some heat. Wet rags around your neck help too.

I was doing miles of welding when I was on Butrans, an that patch is heat sensitive, so I bought several cold packs, anx made sure to have that barrier, plus a leather jacket, ontop of my patches, and had to do everything possible, to keep my body from sweating too much and loose the patch.
Posted 8/29/2012 5:00 AM (GMT 0)
The problem with you not having had a patch on for what appears to be at least 2 1/2 days prior to the test is that your body most probably had very little to no fentanyl left in your system. Fentanyl is transdermal, so it builds up slowly over a period of hours/days depending on your metabolism, until the steady blood plasma level is reached for the strength of the patches you are using. This could very well be why you showed up negative for fentanyl. If you had the test on the 23rd?, they could have sent it for gc/ms testing, and it can show up negative because the metabolites for the fentanyl would be below the tests threshold..and this could be a major problem, given that you have told them that the patches repeatedly aren't sticking and you are running out early. sad

Given that you sweat profusely and work around steam and high heat environments, it may be that the fentanyl patches are not the best choice in pain medication for you and it might be more reasonable to convert you to another oral pain medication in place of it.  If you aren't dismissed because of the test results, it might be a good idea to talk to your regular PM doctor about the issues with the patches and about converting you to a pill form of a different pain med.
Sandi

Posted 8/29/2012 7:15 AM (GMT 0)
If I was you I would call you PM office ASAP. and offer to drop another urine.With everything thats going on with opiate meds around the country if you don't call the office before your next appt I wouldn't be suprised if they didn't discharge you (worst case scenario) You really need to speak with someone at the office. I had a problem last month with my urine, The first in 4-1/2yr's I came back positive for dilaudid I took 24mg's once about 2 days before my appt and they found out. I was stunned that they were able to tell the difference between the different opiates...Take care Beck....
Posted 8/29/2012 2:08 PM (GMT 0)
Thanks for sharing more information....your first post didn't sound as "urgent" about the withdrawals and pain so I wasn't sure how you expressed this to the Dr. when you went to the appt.

As others have mentioned...since it was about 2 and 1/2 days being without a patch on...then yes, even the GC/MS test would probably not show any Fentanyl...

**I know someone else asked...but did you bring in all the patches so you could show them? This at least would prove to them that you didn't sell them and they can see how they have been slightly used (the ones that fell off) and that you have them all. Make sure you keep every single one this time.

And when I asked about calling them...it was more about the first time a patch fell off and you couldn't use it to let them know...I'm not sure if calling them once you had completely run out will do the trick...

But all you can do now is go forward from here. As Msrm mentioned, if they don't dismiss you...it would be best to speak with the Dr. to change to something else if you can't get the overalys to work for the patch. I'm assuming that you have gotten those now and trying to use them?

Good luck...keep us posted..
Posted 8/29/2012 10:46 PM (GMT 0)
I just read your other post on page 2 about the issues with your previous PM and getting dismissed from their practice as you were in the hospital and accepted pain meds from their Dr. to take home with you (the patches) but didn't notify your PM..

So I didn't realize that you have had problems with them falling off and running out early as you state in that post that this Dr. told you that she would not refill your medications early again and that you needed to make the 10 patches last.

With that information...this may make this situation you are in now even worse as they have already warned you that you need to find a way to make them stick using Tegaderm or other means as you've been on them since this past June. And added on to being dismissed from your previous PM...they are watching everything you do very closely unfortunately.

I still don't know if you ended up bringing in all the patches in to show them this time around when you did the UA?

I really do hope it works out for you and you can convince them to put you on something different than the patch....
Posted 8/29/2012 11:32 PM (GMT 0)
Have you tried other locations for the patch? I have found that on my midback area I have no trouble at all with them staying on with a tegaderm.

Its the nature of using these types of meds, my dr will not replace early. I was told to either find a way to make it work or I would need to try something else. If you can get them to do it by actually bringing in the patches that fell off to show you have utilized everything that is great, but then wont you have the issue of insurance filling a script early? They will pay for a different dose, but not the same thing early.

As for the UA, I have never had a "random screen" or even a scheduled UA. So I dont know what comes up and what doesnt. But from what I have been told by the dr is that the fentanyl is active in your system for over 18 hours after a patch is removed. He said it also takes about 12 hours to show up in your system when it is applied.

I hope you can find a way to make the meds work!
Posted 8/30/2012 6:23 PM (GMT 0)
"I just read your other post on page 2 about the issues with your previous PM and getting dismissed from their practice as you were in the hospital and accepted pain meds from their Dr. to take home with you (the patches) but didn't notify your PM.."

See, here lies the problem. The doctors at the hospital told me that they would contact my PM and let them know what they were doing with me while I was there. They also told me they had set up a follow up appt with my PM doctor for when I was released from the hospital. However, when I went in for my appt, they told me they never heard from the hospital and they didn't have an appt scheduled for me at that time and day. I told the doctors there exactly what I was taking for the pain and gave them all of the info they needed regarding my PM doctor.

Also, I called my doctor yesterday about the test and they told me the doctor said that since I hadn't had the patch on for a couple of days that there was a very high chance that the Fentanyl was not in my system or not enough to show up on the test. They made a note of the fact that I hadn't worn the patch for 2 days before my appt and I told the doctor this before I even knew I was going to be tested. I was waiting to put a new one on just in case they wanted to switch me to something different. After my appt, I put a new patch on when I got home. I don't think the test will cause me any problems, and if they bring it up, I plan on having my patches on a regular basis until my next appt if I can keep them on.

I will try the icing method, thanks. I honestly never thought about that. I will also try to put it on a different area and have already ordered some covers from the manufacturer.
Posted 8/31/2012 5:23 PM (GMT 0)
Have you tried TegaDerm to put over your patch? These can be bought at a hospital supply store or your pharmacy can order them for you. When I used the patches this was the only way I could keep them on. TegaDerm looks just like the clear tape they put over an IV and it really sticks well.

If you are working where its hot and you are sweating let the dr know so he can change you to something else or this will be nothing but an ongoing problem.

I have not read all of the posts here so this may have been already recommended to you. Good luck..Susie
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