I took a risk by being honest w/ my pain doc...

[LucidSDreamr]

Yup, 75 mg/day and I'm pretty young. It took me a few years to get him up to that much, but he's seen me go through major spinal fusion of half of my spine, physical therapy, neuropathy, many failed therapies, early onset arthritis, etc.

So, you still think save the last 7.5 mg to bring to the appointment?

Yea I would save it just to show you didn't finish the bottle yet. you'll totally have oxy in your piss taking 30 or 15 mg per day like you have been.

 

[thurston]

I pulled up my last drug screen record. It does not list kratom as a tested drug. I've had kratom before, but can't remember where I got them? Was it a smoke shop? I guess I need to make a decision quickly as I just took my second to last oxycodone...

I will definitely be looking for a different provider! Like you said, I'll only keep going to this doc until I find another. The majority of reviews for pain places around me (Phoenix, Arizona) are not good.

I said to him, "I definitely regret being honest with you." I'm usually a very strong advocate for myself, but I think I was just shocked at his reaction. As a woman, I know I have to advocate harder. It just caught me off guard, I guess... WHAT A DICK.

On mine it was listed as various mitragynine metabolites.

 

[thurston]

so its legal to grow them in he US? I am an avid artist using floral arrangements and just curious.

Not really, just overlooked.

 

[thurston]

I'm leaning towards showing up on Thursday like I don't know anything is the matter. Liiiiiiiike I didn't pick my appointment date as I would normally schedule a follow-up (every fucking month ); he was the one like, "I'm making you an appointment on Tuesday and you can be there or not blah blah blah bring your pill bottle and be ready for a urine test blah blah blah." LOL... I'm saving my last pill to take either the day before or the day of, so it will show normal levels on a drug screen.

I'm totally in on the malpractice idea. ️

Kinda sounds like he was trying to give you a heads up on the piss test so you know to cheat.

 

[chippermonk]

Kinda sounds like he was trying to give you a heads up on the piss test so you know to cheat.

It also occurs to me that, although he had a shitty attitude towards you, that maybe this is a protocol that he is required to go through with you before he can increase your dose. Hence, maybe he is trying to give you a heads up to be ready for the piss test.

 

[4DQSAR]

I think people are rather overestimating the test a pain clinic is likely to institute.

Does anyone else have an idea of JUST HOW COSTLY quantitative analysis of bodily fluids actually is?

It seems to me much more likely to be a simple urine test to see if you are positive for the medication and negative for other stuff.

I mean, if you give me a hair sample and enough money, I can tell you to within a few days every drug you have consumed for the last few months. What and how much. But it's going to be a lot of money. a LOT.

 

[516CAZ]

On mine it was listed as various mitragynine metabolites.

I don't see mitragynine metabolites on mine.

 

[516CAZ]

Kinda sounds like he was trying to give you a heads up on the piss test so you know to cheat.

I don't think this guy would do me a courtesy like that.

 

[516CAZ]

It also occurs to me that, although he had a shitty attitude towards you, that maybe this is a protocol that he is required to go through with you before he can increase your dose. Hence, maybe he is trying to give you a heads up to be ready for the piss test.

It probably is a required protocol with the company that he's with, but this fucker's behavior was totally unacceptable. And, I don't think he would do me the courtesy to give me a heads up on anything.

 

[4DQSAR]

Aren't mirtagynine drinks being sold in some US states? So for the purposes of checking a patient isn't 'abusing' drugs, how does one deal with something that you buy legally at gas stations?

I suspect the same may be true of tianeptine.

Don't overthink it all. Yes they can do such tests, but don't you guys pay for medical treatment? So I for one would query a bill where 'testing' comes in at like $1200+ a pop each month (or whatever). I mean, will private insurance places let such costs arise?

All crazy to me because in the UK we pay NI which covers benefits be it health, disability, pensions and so on. By no means perfect, but given the cost would be on the provider... I THINK such a cost would be questioned.

 

[LucidSDreamr]

I think people are rather overestimating the test a pain clinic is likely to institute.

Does anyone else have an idea of JUST HOW COSTLY quantitative analysis of bodily fluids actually is?

1000 to 3000 USD per sample insurance is getting billed for quant analysis and this was like 12 years ago. Probably more now

no they definitely do quant analysis for every sample. After doing immunassay. It’s called “confirmation.” Every sample is positive because it’s anll pain patients and rehabs so every sample must be “confirmed.” It’s a huge racket. The pain clinics themselves offer have ownership or partial stake if they are using the smaller start up clinical labs and it’s a scam. Testing 75 yr old grandma for MDEA, synthetic cannabinoids that have been out of circulation for 15 years, antipsychotics, and a bunch of completely pointless analytes that jack the cost up to bill insurance.

So many of these pain or rehab clinics open their own affiliated labs to over test and profit off this scam.

I don’t know all the business scams going on behind the scenes but I used to be involved in this field research wise and they are over testing for corruption.

Also these labs are run by a medical doctor and technicians with zero fucking clue about mass spectrometry. Chromatograph reading is all fully automated and if the software or mass spec fucks up they will just pump out thousands of bad results and not even realize or care because it’s more about meeting the turn around deadline than doing it correctly. The amount of incompetence in these labs is staggering. Ppl get kicked out of rehab and pain clinics for these bad results all the time.

 

[516CAZ]

I think people are rather overestimating the test a pain clinic is likely to institute.

Does anyone else have an idea of JUST HOW COSTLY quantitative analysis of bodily fluids actually is?

It seems to me much more likely to be a simple urine test to see if you are positive for the medication and negative for other stuff.

I mean, if you give me a hair sample and enough money, I can tell you to within a few days every drug you have consumed for the last few months. What and how much. But it's going to be a lot of money. a LOT.

The report calls the test TOXASSURE COMP DRUG ANALYSIS,+6AM+ETG+NIC,UR.

 

[tryptakid]

It also occurs to me that, although he had a shitty attitude towards you, that maybe this is a protocol that he is required to go through with you before he can increase your dose. Hence, maybe he is trying to give you a heads up to be ready for the piss test.

I've worked with clinicians who prescribe opioids (for pain and for MAT) - @516CAZ 's provider should have been a bit more empathetic about what was being expressed as it sounds like OP has some legit pain management needs and concerns about the effectiveness of existing treatment. The provider is also under strict guidance about management of opioid prescribing by the DEA (assuming this is the US) and has strict protocols to follow about how to monitor use of opioids. The guidance that is required when misuse (taking more than one is prescribed, taking more frequently than is prescribed, taking other drugs that are not prescribed) is to require drug screening and pill counts as a first step.

While it may seem unfair, and can definitely feel patronizing, this guidance is a result of the laissez-faire prescribing that contributed in part to opioid overprescribing and the saturation of illicit markets with oxycontin and drugs like it. Prescribers have had their practices raided and license to practice suspended, some having their careers ended, and some even going to prison. I've followed a number of these cases and there have been times that providers seem to have been acting in good faith and compassionately, trying to meet the needs of their patients, and still have been punished for it.

All of that is to say - my recommendation for how to approach this for anyone on long-term pain management:

1) Talk to your prescriber BEFORE deviating from what is prescribed. If you need to take an extra dose, call the clinic and talk with a nurse. Let them know what's going on and ask for suggestions on what you can do.

2) Talk with your provider about supplementation with medications like memantine - while research is needed, there are examples of patients who have responded well to co-administration of memantine and opioids: https://www.painmedicine-casereports.com/current/pdf?article=NTMx&journal=34 - it may be worth a trial to see if it helps with pain management.

3) Narcotic agreements are common - the provider needs to know and document that you understand what's required by you to continue prescribing.

Unfortunately, this is the reality of pain management. Seeking out a different provider may help with the bedside manner, but it's unlikely to find someone who is going to be more flexible with the rules. Opioid prescribing isn't supposed to make you feel good - it's designed to manage your pain with the lowest effective dose. It sucks because it means having to reconcile with the occasional feeling of euphoria you might have and knowing that it's not something you can chase, especially not legally. Still, as someone who has chased that shit, it doesn't end well more often than not. Kratom is the only opioid I fuck with these days for a reason.

 

[tryptakid]

The report calls the test TOXASSURE COMP DRUG ANALYSIS,+6AM+ETG+NIC,UR.

So it's a comprehensive drug screen and they've added on 6-monoacetylmorphine (heroin metabolite), ETG is ethyl glucuronide which is an alcohol metabolite, and NIC, UR which is nicotine metabolite in the urine.

 

[516CAZ]

Aren't mirtagynine drinks being sold in some US states? So for the purposes of checking a patient isn't 'abusing' drugs, how does one deal with something that you buy legally at gas stations?

I suspect the same may be true of tianeptine.

Don't overthink it all. Yes they can do such tests, but don't you guys pay for medical treatment? So I for one would query a bill where 'testing' comes in at like $1200+ a pop each month (or whatever). I mean, will private insurance places let such costs arise?

All crazy to me because in the UK we pay NI which covers benefits be it health, disability, pensions and so on. By no means perfect, but given the cost would be on the provider... I THINK such a cost would be questioned.

I'm actually on Medicaid, so I don't pay anything, though with the Trump administration and Republican Congress, that will likely change... I'm in the process of appealing my Disability rejections, which will take a few years. I physically cannot work, and the hot Republican idea right now is adding a work requirement to Medicaid. That could cut off all my coverage. Maybe that will finally kill me?

I'd rather be in the UK.

 

[516CAZ]

I've worked with clinicians who prescribe opioids (for pain and for MAT) - @516CAZ 's provider should have been a bit more empathetic about what was being expressed as it sounds like OP has some legit pain management needs and concerns about the effectiveness of existing treatment. The provider is also under strict guidance about management of opioid prescribing by the DEA (assuming this is the US) and has strict protocols to follow about how to monitor use of opioids. The guidance that is required when misuse (taking more than one is prescribed, taking more frequently than is prescribed, taking other drugs that are not prescribed) is to require drug screening and pill counts as a first step.

While it may seem unfair, and can definitely feel patronizing, this guidance is a result of the laissez-faire prescribing that contributed in part to opioid overprescribing and the saturation of illicit markets with oxycontin and drugs like it. Prescribers have had their practices raided and license to practice suspended, some having their careers ended, and some even going to prison. I've followed a number of these cases and there have been times that providers seem to have been acting in good faith and compassionately, trying to meet the needs of their patients, and still have been punished for it.

All of that is to say - my recommendation for how to approach this for anyone on long-term pain management:

1) Talk to your prescriber BEFORE deviating from what is prescribed. If you need to take an extra dose, call the clinic and talk with a nurse. Let them know what's going on and ask for suggestions on what you can do.

2) Talk with your provider about supplementation with medications like memantine - while research is needed, there are examples of patients who have responded well to co-administration of memantine and opioids: https://www.painmedicine-casereports.com/current/pdf?article=NTMx&journal=34 - it may be worth a trial to see if it helps with pain management.

3) Narcotic agreements are common - the provider needs to know and document that you understand what's required by you to continue prescribing.

Unfortunately, this is the reality of pain management. Seeking out a different provider may help with the bedside manner, but it's unlikely to find someone who is going to be more flexible with the rules. Opioid prescribing isn't supposed to make you feel good - it's designed to manage your pain with the lowest effective dose. It sucks because it means having to reconcile with the occasional feeling of euphoria you might have and knowing that it's not something you can chase, especially not legally. Still, as someone who has chased that shit, it doesn't end well more often than not. Kratom is the only opioid I fuck with these days for a reason.

I wish that didn't happen to good doctors.

I actually didn't realize I could call the pain clinic outside of business hours until that day. I really don't want more than what I'm already Rx'd, I just couldn't take the extra pain I was in at the time.

I'll check out that case study. Thanks for the link!

 

[516CAZ]

So it's a comprehensive drug screen and they've added on 6-monoacetylmorphine (heroin metabolite), ETG is ethyl glucuronide which is an alcohol metabolite, and NIC, UR which is nicotine metabolite in the urine.

Thanks for the interpretation!

 

[LucidSDreamr]

I just couldn't take the extra pain I was in at the time.

you have to absolutely verify they don’t test for it…and also it’s an OTC cough medicine so people take it just for colds (but that wouldn’t necessarily mean they wouldn’t cut you off for testing positive for it). But DXM is a fantastic drug to increase the potency and analgesia of opioids. Take 100 mg one hour before your opioid dose and the opioid dose will feel like you took 25 mg instead of 15 mg.

You won’t waste pills going over your allotted dose then.

It’s not something u want to do daily just during those worst times. It’s easy to want to do it every dose to get the most out of your meds but DXM will be hard on your organs with daily use.

Also be warned DXM can have a”dirty” feel to it but as soon as the opioid dose kicks in and combined with it you’ll feel too damn good to notice the DXM feeling.

This can help conserve dosage.


Lastly, during good lain days it’s always best to conserve. Take less and always try to build a back up supply for the expected pharmacy fuckery and for days where you need more than your dose.

When I was on methadone I would some days take 4 pills and on good days only take 1 and it would balance out and I never came up short.. and if I ever do come up short I’ve got an emergency supply of Suboxone.

Cheat drugs tests if needed, dose when and how you need. These rules are not designed for how chronic pain manifests itself. There are flares and good days. There used to be a practice called “breakthrough meds” where you would get a handful of something really powerful like some opana to supplement an oxy script on the worst days…but the DEA put an end to that. Havnt heard of breakthrough meds in a decade being scripted.

 

[4DQSAR]

Wow - I stand corrected.

It just seems such an immense waste of effort and money to me.

I guess if you make something for-profit and legislate such wasteful tests, you have a system designed to steal from sick people.

Which sounds like an awful idea to me.

 

[DeathIndustrial88]

The amount of incompetence in these labs is staggering. Ppl get kicked out of rehab and pain clinics for these bad results all the time.

Abso-fucking-lutely.


I've been on klonopin for years & years & for whatever reason, it barely EVER shows up on my piss tests. Whether it's a simple panel test or if it's the one where they send it into the lab & can see everything. I would literally take my klonopin the night before & before I went into my appt & it still won't show up. Complete fucking mystery & it pisses me off because I know I'm taking it. Made my doctors suspicious for awhile until they realized that a lot of people at their clinic who they had on klonopin, weren't showing positive for it.

So thankfully they just quit worrying about it & still prescribe me it. But it made me wonder how many people get fucked over because these tests claim they aren't taking their meds or whatever. If my doctors had been assholes they would've taken it away from me for pissing negative for it so many times. And it makes zero sense to me how I can take it the night before & before I go into my appt, yet some how it doesn't show up. That tells me there is something wrong with these stupid tests, whether it's the stupid 10-15 panel ones or the lab ones.