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

[chippermonk]

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.

Maybe he was tops in his class when he took "Being a Dickhead 101" in med school

 

[chippermonk]

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.

Well all I can say I is, thank God that they are testing for Demon Nicotine! The ultimate gateway drug.

 

[LucidSDreamr]

Well all I can say I is, thank God that they are testing for Demon Nicotine! The ultimate gateway drug.

The most shocking test of all that every single lab that sends it for LCMS testing does is MDEA. A drug with no known record of existence for the past 40 years.

What’s even dumber is that it metabolizes into MDA and they test for MDA anyways.

 

[kris66]

It's true you get false positives all the time too. I had to sign a pain contract with my Dr when I was on hydrocodone for migraines and he told me I had to have a drug test. It came back positive for meth!! I've never even seen meth!!

Luckily the Dr believed me, but what about the patients who have a false positive and their doctors don't believe them?

 

[516CAZ]

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.

They do test for dextromethorphan. Boooo... I've used it for withdrawals before & it did help. I've never considered it as a potentiator. I can handle dirty. Uggghhhhh. That sounds so great. If I only take it occasionally, do you think I could I get away with saying it was for a cough?

It's always been so hard for me to conserve my pain meds. Unfortunately, I've been in constant pain for the past 5 years, so my body has always been like, "WE FUCKING NEED THOSE!"

How long ago do you think breakthrough meds stopped happening? I've heard of it while lurking on chronic pain forums, but they all seem to be older patients. Maybe we're too young?

 

[516CAZ]

It's true you get false positives all the time too. I had to sign a pain contract with my Dr when I was on hydrocodone for migraines and he told me I had to have a drug test. It came back positive for meth!! I've never even seen meth!!

Luckily the Dr believed me, but what about the patients who have a false positive and their doctors don't believe them?

Meth! Jeez!

I had an incident where my drug screen came back positive for Adderall, which I was not taking. I found a couple of studies that said bupropion and trazodone may cause false positives & I was Rx'd both. My psychiatrist had to fucking write a letter for the pain clinic (this fuckin guy again) verifying that was possible. Luckily, my psychiatrist had a couple of other patients that had the same thing happen.

 

[LucidSDreamr]

Meth! Jeez!

I had an incident where my drug screen came back positive for Adderall, which I was not taking. I found a couple of studies that said bupropion and trazodone may cause false positives & I was Rx'd both. My psychiatrist had to fucking write a letter for the pain clinic (this fuckin guy again) verifying that was possible. Luckily, my psychiatrist had a couple of other patients that had the same thing happen.

This is one reason why lcms confirmation is actually useful. No false positives where one drug masquerading as another drug. Only false positives from all the lab personnel having no idea how to read lcms data and relying on software

 

[kris66]

Meth! Jeez!

I had an incident where my drug screen came back positive for Adderall, which I was not taking. I found a couple of studies that said bupropion and trazodone may cause false positives & I was Rx'd both. My psychiatrist had to fucking write a letter for the pain clinic (this fuckin guy again) verifying that was possible. Luckily, my psychiatrist had a couple of other patients that had the same thing happen.

I was on Midrin for my migraines at the time, and it contains isometheptene and dichlorphenazone, so maybe one of those ingredients triggered the false positive? That or the Zantac I was taking before they took it off the market. I still would like to know what triggered it.

 

[4DQSAR]

This is one reason why lcms confirmation is actually useful. No false positives where one drug masquerading as another drug. Only false positives from all the lab personnel having no idea how to read lcms data and relying on software

I don't think standard LCMS alone wouldn't discriminate dextromethorphan from levormethorphan which IS an opioid.

I'm pretty sure NMR wouldn't spot it either. It would require polarimetry.

I am aware that a number of more modern techniques are now also able to spot enantiomers but I'm uncertain if they are generally applicable. All seem to have specific limitation such as growing a crystal of the compound or so forth.

I did a quick Google for dextromethorphan and I understand that they appear to rely on the two drugs being metabolized at different rates.

https://sci-hub.st/10.1007/s00216-011-4707-y

It's mad that someone got funding to work out such a test, but if you start dragging in tests for the chirality of one medicine at a time, that would be costly.

I would also argue that due to every person having genetic differences, it's hard to know if outliers exist who would present different rates of metabolism. I am reminded that people of African-American ancestry are often 'super metabolizers' which may be why 'lean' is popular among certain groups. I was gutted to learn DJ Screw had died from a 'codeine overdose'. Possibly his liver was converting almost all of that codeine into morphine.

Has nobody sat these people down and explained that there are still literally tens of thousands of novel compounds of every class of psychoactive that the determined abuser might be pushed into using but that these novel compounds are largely untested in man and so would represent the greater risk?

Recently I talked to a retired prison officer who noted that MDTs had been a disaster in UK prisons. Before then convicts would smoke a bit of puff and have the odd drink. So chilled prisoners who don't cause hassle. Now UK prisons are infamous for the most obscure RCs turning up to avoid MDT detection. It's turned out very badly for everyone concerned.

I just think the US system is geared towards making money and controlling people. I'm sorry to say this but it looks like fascism from where I'm sitting. British people have an abiding liking for US citizens - we just think some of your politicians are mental. So please don't take it as an insult to you guys.

 

[LucidSDreamr]

I don't think standard LCMS alone wouldn't discriminate dextromethorphan from levormethorphan which IS an opioid.

I'm pretty sure NMR wouldn't spot it either. It would require polarimetry.

I don’t think polarimetry would work on such a dilute and dirty sample matrix as urine. Chiral stationary phase would be used on the lcms do differentiate the two.

On a regular stationary phase You couldn’t discriminate those two just like you can’t discriminated between pure D meth vs pure L meth (used inhalers OTC).

Levormethorphan is so rare that it’s never even tested for or assumed someone is using it. You also “fail either way” whether it’s dxm or levormethorphan because both are considered drugs of abuse so there is no reason to differentiate, the patient is getting in trouble either way.

With L meth and D meth though, since L meth is a nasal inhaler and not a drug of abuse, these labs use a chiral stationary phase to confirm that the meth contains no D meth before they accuse the person of doing meth.


I wonder if with levomethorphan and dxm you could also avoid chiral lcms by just looking at the metabolites. The proteins that metabolize them are chiral themselves and likely metabolize them both differently. This is a guess though I havnt actually looked into the answer. L meth and D meth are so similar spatially that they both metabolize to amohetsmine so it wouldn’t work there

 

[4DQSAR]

@LucidSDreamr - so... is that why the US is such a huge market for shady RCs?

Sheer madness.

BTW Yep - your chemistry is spot on but the fact that someone devised a specific test to me is a sign. If you can get funding for THAT, likely you can get funding to detect almost anything.

BTW levormethorphan is around M potency and long acting. A good pain medication BUT too subject to abuse I assume.

 

[Gaz_hmmmm]

Hi!

It sounds like you in the USA.
As people have stated buy some kratom, red vein and Maeng Da if you can, it's generally the best for pain and opioid maintenance.
There are other stronger red vein types but it varies between seller's and the majority normally sell the Maeng Da type.

There are sites in the US that sell mitragynine and 7-hydroxymitragynine in pill and powder forms and both are opioids found in Kratom.
They could help you too.

If you have a garden that isn't over looked by nosey neighbours or live in the sticks you should look in to opium, it's easy to grow.

Get the book 'Opium for the Masses' by Jim Hogshire. It's a how to guide on how to grow and use opium, along with poppy pod tea, poppy seed tea and has historical info on opium, about ten opioids that are commonly used in the USA and also how to extract morphine and make diamorphine/Heroin.

Get the second edition, it's about 70 pages longer than the first.

If you can't grow it look for it growing locally by other people ornamentally and other 'liberate' it or ask them if you can please have the pods once they've dried out.

 

[4DQSAR]

BTW the fact you 'fail both ways' might suggest that chiral tests do not exist for the morphinans?

I mentioned that there were emerging methods but each had limitations. If it's just a chiral amine, there IS a specific test that isn't too complex (costly).

But the fact remains that if you really want it, their will always be a 'next' RC that will evade testing.

I guess fentanyl has quite a short half-life. So was that a driver in it becoming the only opioid on the street? I've read some nitazenes last 12+ hours and I haven't heard of them turning up much in the US (at least not yet - hope they don't) but one presumes the detection time for such a compound would be much longer.

It just sounds like fascism. The state and industry are colluding to control and abuse the people. I'm almost sure you guys even wrote an ammendment to deal with that situation. I'm not defending the actions of Luigi Mangione in any way as if nothing else, they replaced the CEO next day so it was pointless. But COULD it be a defence? I honesly do not understand US law so it my questions is asked in good faith.

 

[LucidSDreamr]

BTW the fact you 'fail both ways' might suggest that chiral tests do not exist for the morphinans?

I’m sure they do in the literature if you search scholar. It would be very simple to just copy it and run it in a clinical lab if you wanted. Or just developing it from scratch would be very simple.

But it would be super easy to separate those two on a chiral column because they are so different spatially because an entire bridged system is occupying different space.

Chiral columns you can easily separate acyclic epimers where the only difference is an epimeric methyl group ….way less of a spatial difference than the bridges systems of morphans.

 

[LucidSDreamr]

@LucidSDreamr - so... is that why the US is such a huge market for shady RCs?

No, most people in pain management aren’t drug addicts and are totally unaware of it.

Even among the drug using population (this would be the people in rehab) most are clueless as to the RC scene. Sure some RCs make it big and start ending up on these lab tests (MDPV, methylone are examples) but from what I’ve seen an RC usually doesn’t end up on the lab tests until like a decade after it came to prominence and it had to be a super popular RC. Usually it’s totally out of circulation by the time it ends up on tests. It’s scheduled, unavailable, and the scene has moved onto new RCs by then. Common drug user/chemist Win.

I’m sure if someone knowledgeable in RCs could be in rehab getting tested and have an array of RCs of every class to get high off and evade tests….but this type of drug user is extremely rare to be that saavy. Most people on bluelight are in the know…but most junkees are pretty stupid when it comes to knowning about drugs.


I think the RC market is huge in the US because dealers know about RCs and just sell any stim as meth/molly and any opioid as fetty and any RC benzo pressed into bars as xanax to the clueless junkee masses; they never know the better.

 

[LucidSDreamr]

If I only take it occasionally, do you think I could I get away with saying it was for a cough?

I don’t know. Just say you took NyQuil if it ever happens and didn’t know it was in there.

But if you have a piss test only once a month at a known time you can take it early on in the month since it will only stay in your system for a week max

 

[4DQSAR]

I think the RC market is huge in the US because dealers know about RCs and just sell any stim as meth/molly and any opioid as fetty and any RC benzo pressed into bars as xanax to the clueless junkee masses; they never know the better.

I mentioned this elsewhere. Pills and powder is what the average user expects to the idea of making 'windowpanes' of some highly potent compound would have them asking 'WTF is this' and 'HTF do I use this'.

But the fact that cafentanil has ended up in samples of fentanyl isn't a surprise to me. Grisham's law will always make the cheapest-per-dose compound the winner. I think the day papers and patents for the stuff turned up, people have conducted thought experiments and concluded it was certain to end up on the street.

Misrepresenting a product is just one way that so much harm results.

That's why I suggested that it would be better to allow adults to buy stuff from their pharmacy and have the DEA police the quality and quality of the stuff being sold. That way we get less harm but we don't see the DEA issuing what I consider to be insane requirements. With that model, nobody gets their rice bowl broken. I can't think of a better solution if you have a large government agency devoted to the control of drugs. I have no idea if fentanyl was a cynical way for the DEA to get more funding but I know of a class that is possibly even cheaper to make then fetanyl, has only one controlled precursor (and that can easily be side-stepped) and would be as simple to produce and interestingly, that last step is the same as the last step in fentanyl synthesis. I figure you know which one I mean. But if they can't stop fentanyl or nitazenes, I figure they can't stop all of the others so for now fentanyl (and derivatives) are still the cheapest to produce on a per-dose basis.

 

[jasperkent]

...Republican idea right now is adding a work requirement to Medicaid.

Those goddamned assholes.

I don't know if they are truly evil or just plain stupid. The whole.point of Medicaid is to provide a safety net for people who can't work.

 

[jasperkent]

Nicotine! The ultimate gateway drug.

It was for me, no kidding.
At age 12 I didn't know how to get weed but I got a buzz off a Marlboro.
By 14 I was a pack-a-day smoker.

 

[jasperkent]

Luckily the Dr believed me, but what about the patients who have a false positive and their doctors don't believe them?

When I was on methadone, I once got a false positive for heroin. I challenged it and they did a more rigorous test-- on the condition I'd have to pay for the more expensive test if it came back positive.

It was negative, as I knew it would be.
I was a very compliant methadone patient.