I have been going to panin clinic for about 10 months. I was prescribed long acting medication. Well about three months ago they started prescribing 2 hydro a day for break through. It is so few a month that I don't always take them and save them for times when I am in severe pain. Anyway when they test me will I get in trouble if I do not have any of the hydro in my system? I always take my long acting medication exactly as prescribed but not the hydro. Just started worrying that they would notice it wasn't in my system when they tested me and I might get into trouble.

Two a day is just not enough on days where I'm really hurting. For awhile after I receive my shot my pain isn't as bad. The shots only last about 3 or 4 weeks though so I save the break through medication for the days the shot isn't working.

Thanks.

Hissy, your best bet is to take the hydro for 2-3 days before each appointment. Then if they spring a urine test on you it'll be in there. A girl was thrown out of a clinic close to me because she didn't take her percocet that day (she had an early morning appointment and wasn't in much pain, but had taken one the night before). It didn't show up and she was shown the door.

So just make sure some is in your system when you go in for your visits.

So it went way out of her system that quick? Wow. I really would like to know what meds stay in your system and for how long and vise versa.

Back to topic. Your are right. I would most definitely take it before going in and make sure it is a couple hours before at least. If it is too much for you, take half early and the other half before you go. I've never had this happen to me, they have never tested me yet, but the papers I signed, they call call me in any time for a pill count and urine test to make sure I'm taking my meds.
I know that there are plenty of people on this site that can help you that has had the experience.

Good Luck.

Taz

Thank you. I hate this testing and pill counting. It makes me feel like a little kid and I'm 56. I could see doing it if someone messed up or was running out and calling for more but if a patient isn't doing anything wrong why treat them this way. Oh well I had a test Thursday and I know there was no hydro in my system. Just my morphine.
thanks everyone.

If you take morphine, and that is your main med that should be OK. 2 hydro's a day is not much. They probably don't expect you to take them all the time since you have morphine. JMO

That is what I was hoping. However, she did tell me yesterday I could increase the hydro to 3 if needed just to call and let them know I'm doing that so they do assume I'm taking the two a day. I'm not going to increase it this month. I'll wait and see what they say on my next apt. I'm hoping they just let it slide. After all I'm taking morphine just as prescribed. I'd think that would be the main concern but they are so picky now days.
I appreciate the advice and info.
thanks.

hissy also just a thought but if you have a signed contract, i would not increase to three without them putting it down as okay in writing. i know sounding anal lol but these doctors are really doing it to patients so i would ask about it, but just my opinion. i take no word of anyone anymore these days lol but just me

I know what you mean. My first apt. after being prescribed the hydro I didn't bring it for count just the morphine. The lady said oh that's ok we mainly want your morphine. Well the next time I came the doctor said where's your hydro. I told him what the lady said and he said well that's not true. You need to bring it too which I did on Thurs. Then they didn't even ask for it but I gave it to them. I will be sure it is written down before I do that. I'm going to wait awhile before going up to three anyway.
Good advice and it is all appreciated. I'll let you know if I get into trouble. I don't have another apt. till Nov. though. Will they contact me about the hydro? Who knows about these guys.

Since I have never been to a PM doc, I don't understand all the in's and out's of being a patient at one but I am curious about something.

If the doc RX's an IR medication for breakthrough pain, wouldn't that mean that it is something one only needs to take if the pain comes back before they are supposed to take the next dose of long-acting medication? So, in effect, there might be days when none of the IR med is needed? If so, why would the PM doc be upset if there wasn't any of the IR med in a patient's system?

That is because they want to make sure that it is in your system and not selling it. That is what they told me. I had to sign a long list of do's and don'ts. If the prescribed meds are not, then you are out without question. Hope this helps.

I can understand their concern, but that means that patients end up taking extra medication when they don't need or want to. Seems like it might be better to just have the patient keep a log of when they take the breakthrough med and then bring that and the med to their appt so the doc can reconcile the two.

That does make a lot of sense. I really think that it is in your system longer than a day anyways. But yeah, if you don't need them at certain times, I would definitely log it. Show them everything.

Pain management,rx'd long acting med covering you 24/7. Should be in your system within a therapuetic window for your dose.
PRN med for breakthrough....If you test neg but don't refill everymonth you are fine. You may even have left overs to show.
If you get #60 2 per day prn and refill everymonth... this would indicate non- compliance as you must be taking 2 every day to need a refill, if you then tested negative...
ouch.
A doc might increase your dose and drop the prn part, give you a break and increase your dose prn thinking you aren't acheiving pain relief...
Or he can fire you.
They take narcs seriously...DEA.....test results, licenses, livelyhood.

Had similar happen to friend on PRN breakthrough... person was fired.

I say save a small stash to cover your arse for a pill count, for really bad pain days, just plan ahead and do not get in the game of catch up with meds.

Pain docs are hard find, trust is established over many visits... Even if you still hurt follow directions and talk to doc ... be patient.

perocet the night before....could take days to show up and the amt might be subtherapeutic, if she only had that one perc....

Hard to see getting fired for forgetting one dose.

You could take 2 pain pills with water on test day and test clean. Doc would know you had abstained long enough for drug, drug metabolite and drug 1/2 life to have come and gone.

Dr must conclude non-compliance or diversion.

All the narcs have updated drug info emphasizing abuse, addiction, diversion, and commom drug seeking behaviors.
Took me by surprise at rx-list.com

Well I didn't have any hydro in my system as I hadn't taken it in a week or more and they did test me. When I went back for my follow up they didn't say anything. I was sweating it. Thanks for everyone who gave me advice.
hissy

I was under the impression they do a 10 panel test. But from what everyone is saying, the implication is that these PM docs are doing drug specific tests, and I imagine those are expensive. Are they not just doing dipstick tests for opiates specifically and the other illegal drugs. Ie a 6 panel test: amphetamine, thc, cocaine, opiates, benzodiazepines, barbituates.

Some do a 5 panel, some a 10, some more, just depends on the clinic.

I have a friend that goes to a clinic and the test they do give the levels, she has blood drawn, they mean business at that clinic. There are actual PM docs that refer patients to this group.

They do some heavy duty prescribing for some of the most stubborn pain conditions.

Lumbar, I honestly don't even know if the girl was telling the truth. I only know what she told me. She said she told one the night before but not that morning, that they did the dip stick test and it didn't show her medicine so they didn't prescribe anymore to her.

And it depends on the type of medicine you take at some clinics as to whether they do a dipstick or blood test. I was on Opana and it doesn't show up o a dispstick test so my tests were always blood and urine tests at Labcorp. Many of the other people at the clinic were on oxycodone or hydrocodone and they could dipstick test them right there and know if it was in their system.

Perhaps that girl wasn't taking enough daily to have a theraputic level? I don't know. Maybe she was selling her medicine and only kept a couple to take right before she went to the clinic and it wasn't enough to show up properly.

But I think everyone who got kicked out was blessed in a way. That clinic wanted to do procedures constantly; epidurals, MRIs, EMG's, radial frequency nerve ablation, etc. How many years can you have those done over and over before they do more harm than good? (not the MRI, but I guess if you had enough of them you might get too much radiation; I don't know).

I guess what was funny is that a guy I was talking to that day admitted smoking marijuana with some friends a few days earlier and he passed his test. I busted my butt to stay in their guidelines, didn't party, I don't drink, I explained every symptom I had every month, I have never even seen most street drugs except on tv and they kicked me to the curb without a chance to even retest to see if it was wrong (because Labcorp has now been wrong 4 times with me; one time I was giving blood at work and they said I had hepatitis B! My family doctor rushed me off for another test and I came back negative. I have no trust in any of those facilities unless they start training people for longer periods of time)

I think the problem w/this approach, is one can not save the extra breakthroughs for a rainy day (i.e., super painful). And of course, this rainy day may not be w/in the 30days of the script.

Also docs don't get it that we don't always trust them not to just cut us off or to support us in a temporary need for more meds.

Although, I do trust my doc. However, she could get hit by a bus. I mean, who knows?

Does anyone know if any UDT measures quantity of drug present, or are they all positive/negative results above or below a certain threshhold? I have never had a blood test but would imagine that drug levels would be more easily measured from blood rather than urine tests.

I have also been reading that most pain meds are only present on a UDT for 3 - 5 days. I am having second thoughts about an IOP purchase and am concerned what might show up if I am randomly tested. It has been 14+ days since ingestion.

Thanks for any feedback. Have a pain-tolerant day!

I am not sure what kind of test they performed on me but I suspect they are mainly testing for drugs that they are not prescribing for me. Right before I did the test the lady said you are only taking morphine and hydro right? The test is very expensive and my insurance does not cover it. Something like $1,200. They eat the cost.

The reason I think this is when I went back the last time I did not have any of the hydro left since I had used more than prescribed on a few days. I should have had some left but didn't. I explained to the doctor I had been having more pain and I used more on a few occasions. He did not seem concerned even though the month before my test had probably shown no medication in my system. He did increase the hydro by one pill a day. So I suspect they are testing me for medication they are not prescribing. Not sure though.

Hissy