HELP! Growing Concern re Chronic Pain Agreement and random urine test.

[shiloh]

Some time ago, several of you answered concerns I had about the sudden request by my long-term physician (15 yrs.) whose staff presented me with a chronic pain agreement and random urine test.

Since that time, every time I go into my doctor's office, I have to fill out a form more or less describing where my pain is - same place for 15 yrs., what has my pain med. allowed me to do, physically -- what improvement have I seen????????? words to this effect. I am absolutely dumbfounded & totally confused. I'm also becoming paranoid and am beginning to feel like a criminal. Such has NEVER been the case with my doctor, or this office.

My doctor initially explained that he absolutely had no problem with me, but this has to do with the government (WA) and they can't discriminate with any patients.

Aside from my complete delusion at this time my question has to do with the stated word "numbers" when referring to the random drug urine test: In the beginning I remember my doctor telling me most pts. were in compliance, but some "numbers" weren't checking out in others. I should have asked, but I've been so overwhelmed, I'm speechless in the office. When I freeze and say 'I couldn't finish the form' my doctor doesn't indicate any concern at all, in fact doesn't even look at the forms and business is conducted as usual, however I'm feeling a level of trust changing, mostly with the staff. I hate it and it's making me crazy.

Can anyone explain to me what the meaning is (re random urine test) for phrases like 'metabolism rates for drugs in system' or 'metabolite consistent with prescribed usage' or 'metabolite of a drug' or 'how long does it take for drugs to metabolize in urine.' ... So many options because I'm SO completely confused. What is the implication of the word "metabolite."

Any clarification would be deeply appreciated. I guess the previous paragraph has to do with the word "metabolite" but I have NO idea what I'm talking about and have grabbed these phrases from different sites.

Thanks in advance, shiloh

[suse]

metabolize, etc.

Regulations, regulations, regulations. It's people who abuse drugs, and have drug-seeking behavior that screw things up for the rest of us; make us go through hoops for medication that I know I'd prefer to live without. (Sore subject! )
I may be incorrect, but I would think that if there's a higher than "normal" level of detectable drug in the urine, THAT would be a problem. From what you write whoever is ordering the drug tests probably has a pre-determined level to go by. (Does that make sense?)

Medical Dictionary
me·tab·o·lite definition
Pronunciation: /-ˌlīt/
Function: n
1 : a product of metabolism:
a : a metabolic waste usually more or less toxic to the organism producing it : EXCRETION
b : a product of one metabolic process that is essential to another such process in the same organism
c : a metabolic waste of one organism that is markedly toxic to another : ANTIBIOTIC
2 : a substance essential to the metabolism of a particular organism or to a particular metabolic process

I hope this helped some; my guess is someone else wll post info for you.

Take care,
suse s

[tic chick]

hello shiloh ,

i'm going to try and explain this the best i can and the simplest way i can.

first, all drugs are metabolized (broken down) somewhere, mostly in the liver, although every tissue in the body metabolizes drugs to some extent.

second, all drugs have a half-life. half-life is the time it takes for half the dose of the drug you have taken to break down and be excreted. for example, if you take 20 milligrams of a drug and it's half-life is 2-4 hours, then half of that 20 mgs. which is 10 mgs. of that drug will be excreted out of your body in 2-4 hours. in another 2-4 hours, half of that 10 mgs. or 5 mgs. of the drug will be excreted out of your body. in another 2-4 hours half of that 5 mgs., or 2.5 mg. will be excreted out of your body....and on and on. the longer the half-life of a drug is, the longer it stays in your body.

third, almost all drugs are excreted through the renal system, which are the kidneys and therefore they go out of your body in your urine. some drugs have a certain percentage that goes through your system unchanged, that means the original drug will be excreted in it's original form without undergoing metabolization.

a lot of drugs, especially narcotics (vicodin, codeine, etc.) break down in the body and form "active metabolites". this means that when the body metabolizes these drugs in the liver, they turn into either a stronger drug than the original drug, or they breakdown into other slightly weaker drugs that STILL have an effect on the body.

for example, the drug codeine is partially metabolized in the liver with certain enzymes to form the metabolite morphine (which is a stronger drug) and part of it is metabolized to form the metabolite norcodeine which is less powerful than morphine. so when you take codeine, you're not just getting codeine. your body is changing part of it into morphine and norcodeine and that is enhancing the pain relieving qualities of that drug by metabolizing part of it into the stronger drugs.

another example is the drug hydrocodone (vicodin). hydrocodone has a half-life of about 4-6 hours. so half of the amount you take is metabolized and out of your body in 4-6 hours and then half of that is metabolized and out of your body in another 4-6 hours. hydrocodone is metabolized in your liver and is exceted through your urine. hydrocodone, when it is metabolized in your liver with certain liver enzymes, forms a more potent drug (metabolite) called "hydromorphone" and another less potent form of hydromorphone called "norhydromorphone".

there are small groups of people that metabolize these drugs either faster or slower because that's the way their body works. also, if you have kidney problems it would take longer for the body to excrete the drug in your urine.

when your doctor takes random urine samples, he is possibly trying to see if you are taking the drug properly and metabolizing the drug properly. by asking when the last time you took the drug and then taking a urine sample, he can see the amount of the drug already excreted from your system (the half-life) and he can see the amount of drug in your body that has been metabolized by your liver into these "metabolites" or stronger drugs. if you have a pain contract, and i know just a little of how this works, your doctor has to test you to see if you are taking the prescribed amount of drug. doctors have to account for the amount of certain classes of drugs they prescribe and narcotics are a highly supervised schedule of drugs.

try not to freeze up in the office. make sure you come to the office with a list of any drugs that are prescription or over the counter that you have taken since your last visit. your doctor should be able to explain everything i have to you and probably in a better way. ask your doctor what he/she means when they say certain numbers 'don't add up".

if you are adhering to your pain contract you should be having no problems. try not to imagine what the staff is thinking, just what your doctor thinks.

i hope this helps,
jeannie

if anyone notices any mistakes i have made in my interpretations, please correct me as i have tried my best to answer the question with my knowledge of being a certified pharmacy technician. thank you.

[maryannp100]

I am pretty sure a urine test done in office with dipstick testing, can't show how much of the drugs are in your system. It would have to be sent to a lab for further testing like most docs do. And I am pretty sure the only way for a doc to know excatly how much of the drug and excatly when the drug was taken is by doing a blood test. A urine can only show so much. I could be wrong, but a urine test doesn't show every little detail other then what drugs are in your system (with in office dipstick testing).

[suse]

tic chick - GREAT answer!!!!

suse

[shiloh]

Thank You !

God Bless Each of You for responding to my post and sensing my utter confusion and concerns. My disabling injury has to do with a major surgical error (15 yrs. ago). I saw a psychiatrist (3 yrs.) who helped me deal with the shock of "Loss" which of course includes major changes to ones' life (body). I've been fortunate that I've seen physicians ever since who have treated my pain without question.

I'm also fortunate that my husband (who cannot understand my dispair) is my greatest supporter.

This recent action has almost brought me back to the original state of horror I felt in the beginning, waking from the surgery. Maybe it's related to trust. I just don't know anymore.

I need to digest all that you have written. But I needed to express my deep appreciation first. Jeannie, you especially; thank you for taking so much time to address everything that so concerns me right now, especially trust. I have to print these answers and read them again and again. I have never been the same since the surgery, but I've improved; at least until this recent action.

I was afraid I'd have no responses to this post and so I'm a little emotional after checking it today.

I used to think of myself as a Strong, intelligent person who could tackle most things. This all changed after the surgery. It seems so silly that I would be so uninformed of "metabolites", etc. But here I am. I don't know why this has set me back so profoundly.

Oh, also on this form I signed it said I would not sell my drugs, use different pharmacies, "doctor shop." It's so humiliating. I would never do any of these things. My injury is so permanent, visible. HOW can I describe improvement and all the other things stated on these forms????

Well I'm rambling, but so grateful to finally have some explanations, which I'll print. Thank you again. I take my medications as prescribed but suddenly I'm filled with doubt and confusion and humiliation. It's like one more thing added to all that changed my life forever.

Sincerely, Shiloh

[Mark N]

Shiloh, I am glad you got such good response to your post and they did a great job explaning what is happening. I would suggest that you just put down the same thing every time you fill out the form. It will do two things, one you stop thinking about what it means and second they get the info they need to satisfy the gv'ts regulation. Unfortunately I am afraid more of us are going to be facing the same thing you are right now as the gov't gets more involved with health care.

I too have noticed a big difference in my mental abilities following my surgeries. I notice it much more with my language skills and ability to explain things. I often draw blanks on words that I know but I can't pull them up for the life of me when I am writing a post. Oh what a life chronic pain brings us.

[houghchrst]

Welcome Shiloh, I am sorry you have to be here but very happy you found us. I am so glad you got such great answers, helped me too, Jeannie's a whiz. My local clinic, well it is a satellite of three connected throughout the city, that I have been going to for years has became a state run managed care clinic and they have become so much stricter, constant paperwork and now I have to be there every three months whether or not my conditions change. Every time I go I have to go over my med and information form and they frown on any pain meds stronger than Tramadol which is ridiculous unless you have never taken any thing stronger than aspirin. In a pinch my doc will write an ER scrip for my usual pain med from my pain management doctor, who is awesome. My regular doc is very nice and does what he can for me and no he doesn't read that stuff that I fill out when I get there but the nurse who brings me back does and makes notes about questions.

The staff there is the absolute worst and their rules and regulations have gotten even tighter. Every specialist office that I go to is familiar with just how awful they are but I like my doc so I stay. So you are not alone and maybe ask some questions about policy changes and any other concerns. They work for you and you deserve answers.

I hope you don't mind if I hijack for a second but I have a question for Jeannie

Jeannie I am wondering if someone with renal issues could metabolize their meds to where they could be overdosed if they were say on a regular strong dose of morphine or desyrel?

Mark I am with ya. My mental faculties are kaput and it seems to decline even though I try my hardest to keep my brain active. I am spending even more time hitting the backspace key than anything else and sometimes the loss of a simple word drives to frustrated tears. Cup, book, car. Very frustrating.

I really wish that all doctors would become members of message boards such as this because I think they would learn a lot more than school teaching.

[alex44]

Shiloh - Welcome to the board. Not much I can add except i understand about government clinics - I went from a great campus the VA Medical Center in Florida (Bay Pines) to a little sattalite clinic Here in Arizona. I will only pray that our Men and Women get better pain Management then I did, talk about jumping thru hoops, this place took the cake. I wound up on SSI and Medicaid (Arizonas Version) - the quality of care is much better. Maybe you could find a differant Doc, being fearful of staff is no good. If you can, you have the right, get copies of your medical records -you might be surprized. Hope this fins you feeling better.
Blessing
Love and light
Alex44

[shiloh]

Hello dear people.

This was the one site that really increased my panic ... I thought I could copy more, but this was all it would allow me to do ... I live in WA state, btw. I hope many of you will review this site ...

Only registered and activated users can see links., Click Here To Register...


Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain:
An educational aid to improve care and safety with opioid therapy
2010 Update

Somewhere within I found a statement to the effect that "improvement" needs to be established in opioid therapy ... and this is an additional reason I freeze (with "little orphan annie eyes") when filling out those forms at my docs. I'm not going to improve. I'm permanently disabled and this will never change, nor will the CP & other related issues. If I don't improve are they going to recommend stopping treatment and let me die?

Alex, thank you for posting to me. This has happened at my personal physician's office of 15 yrs. I have complete trust in him. Again, the staff is creeping me out. They've always treated me with dignity - and then this, several mos. ago. If this is a WA state gov. enforcement, I have no where to go where I would not be subject to the same policies. (And from the above site, it seems this is exactly the format that my doc's office has adopted.)

Mark, good suggestion. I agree, but then there's the statement about "improvement" at the WA gov. site, above.

I hope a few CP readers will check out the site. Pretty scary to me, discussing exactly what's happening to me right now! And I do think this Guideline? is going to be adopted by many more states in the end. I heard one of the clerks in the office tell another pt. "this is State law" when pt. questioned new forms, etc.

Thanks again to ALL. Love, Shiloh

[Jo6]

Shiloh, welcome to BrainTalk. I think I can understand to a certain extent what is making you so bothered. I have found in most of the many Drs. I have seen over the past 12 + yrs are real big on handing you a stack of papers to read and sign, but very slow to answer any question you may have.

It took me awhile before I finally figured out what was going on. When my family Dr. sent me to my first Neuro Dr. He asked if they had me on any narcotic's. I said yes and he simply said that he would take care of the other problems I was having and leave the pain Meds. up to my Neuro Dr.

OK, the beginning of years and frustration. Every Dr. had their papers to read and sign. I will have to say straight off, I have never been without meds. that I needed. If they ceased to be helpful I told the Dr. He tried several precedures which helped temporary, but the pain always came back with a vengence.

Neuro did more precedures, same deal. He increased my pain meds. Then refered me to a Pain Management Specialist. thats when things got interesting. I, like you were very confused about all the papers and forms I had to fill out every month when I came back.

I mean, how do YOU rate your pain today compared to the first time here on a scale of 1 to 10. That was just one of the many questions asked, everytime I went to the office. My pain issues have gone thru many changes. I learned quickly that the Dr. can taketh away as quick as he can giveth. Nothing he did seemed to make any sense to me. He also had many precedures and PT's he wanted to try.

I have always taken my meds as prescribed, took as little as possible, but that changed also. Gradually I found myself in a world of hurt, but had to jump thru hoops to get dr. to even LOOK at what was happening. Well, it's been a very long struggle to get where I am now.

Over the yrs. I stopped filling in all the blanks. then the urine testing. I had no problem with that except I had to go to hospital and walk a mile to get these done. Just random, never everytime.

The Drs.office moved so they do their testing at the office. Almost 500 $$ a pop.

Dang, I love this auto restore. I lost half my post and I have no idea how long I was off line!!

((((((Shiloh)))))) I wish you much luck and hope you are getting the meds. you need without any extra hassle. Lord only knows we would not be in the Drs. office if we had a choice.

Take care, Jo

[alex44]

Shiloh - I am on Medicaid, i see a LNP (Licensed Nurse Practioner) and get tested every visit except where tthey are backed up, our doc trusts us, she is just covering her - backside. weather or not this is a state requirement, i do not know, and the thought of someone dictating how much pain medicine, read RELIEF, is horrible but could happen - may already in WA. State. Good luck, Don,t worry about urine test, pretty much standard procedure now, Hope you are doing better and as out of pain as possible.
happy holidays
Blessings
Alex44

[shiloh]

Just leaving a brief msg. in appreciation !

Dear friends,

Jo, Alex thank you. Also Christina. I've been here several times to re-read your replies and input. Christina and Others, I can so relate to the way that pain and related issues has affected my mental faculties over time. Also my confidence in myself.

I've decided thus far to follow suggestions from Mark and Jo about the forms. I'm going to do it the same every time I go in. That will make things less Kinetic(?) in my brain each time. Thank you.


Again, I'm so appreciative of ALL the input from each of you. Kindness & compassion. And also knowledge. I've needed your support and you've all given so freely. Thank you from the bottom of my heart. Jeannie, I keep your post nearby and review it frequently.

Bless each of you and I'll be back (I'll have to see the doctor next week) or maybe the next. Some time before Christmas. This time though, I will feel the support of all of you.

Love shiloh

[Gary]

I usually post on the multiple Sclerosis board but I do lurk around here. I have a great doc that treats my chronic pain as best as is possible my pain meds do go up and down depending on how I feel. I am glad that I have a Dr. that listens. I am truly sorry that a few people that abuse the system make it nearly impossible for people that really have pain. I cant say that I blame them (the Drs) I have one kid that is a critical care nurse and one that is in med school. All the money that is tied up in their education can be destroyed by 1 person abusing their pain meds. As my son says "dad you would be shocked at the number of people come into my er with a hang nail and only a large dose of Vicodin will help them."

I hate to think that the whole country will be requiring everyone to jump through the hoops to treat chronic pain patients.

[Pharmacist.steve]

Here is the low down on why the feds/states don't want to help stop diversion.
Watch this video Only registered and activated users can see links., Click Here To Register...

There exist a driver's license database and Federal SSN database... the only problem.. the states will not grant permission for healthcare professionals to have access to the former and the latter is only for an employer to determine if they are hiring an illegal alien.

All healthcare professionals have to accept the ID given WITHOUT QUESTION.. and report it to the state Prescription Monitoring Program (PMP).
If healthcare professionals had access to and were mandated to validate a NEW PATIENT'S patient's ID before prescribing or dispensing a controlled substance to a person... and if the ID's don't match up with the databases... they get the ID's confiscated and not treated by the practice... how many fewer bottles of legal drugs would make it to the street ?

If a new patient comes into a practice and mis-represents (lies) about who they are.. why would anyone in their right mind give them controlled substances. Likewise, if a abuser or diverter is caught and it is determined that the healthcare professional didn't check the databases.. the healthcare professionals would have some explaining to do.. to the DEA...

Right now, the state could have the computer compare the ID reported to the PMP against their driver's license database or the SSN database and invalid patients could be reported back to the health care professional...

of course, the first process would prevent some drugs from reaching the streets and the second would be more of the same "fill & chase" that the war on drugs has always been.

How less paranoid would prescribers be... if they eliminated bogus patients from their practice even getting in the door.

The down size, all those DEA agents would have to focus on those importing illegal drugs and selling them on the street.