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PostPosted: Tue Aug 04, 2015 4:25 am 
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Hey guys! I am FREAKING out right now and very confused about a letter I got from my insurance denying payment for anymore of my suboxone (actually Zubsolv) because the last TWO drug screens have been CLEAN of EVERYTHING!! Now im being questioned if im even taking my meds or selling them!!!!! I get 3xday but only take like 1/2-1 each day. This could get me in some VERY SERIOUS trouble! Does anyone out there have any possible answers about why or how I can explain this? The doctor and insurance both want explanations but I have no idea how it can just VANISH... TWICE! PLEASE HELP EXPLAIN


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PostPosted: Tue Aug 04, 2015 1:59 pm 
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I am taking psychopharmacology of drugs and alcohol. right now for a masters in addiction studies and we just got through the chapter on opiates. One section in this chapter is called Genetic Opioid Metabolic Defects (GOMD). Opiods have to be metabolized in the body in order to do what they are supposed to, which is to reduce pain, or in bupe's case, to block cravings and prevent withdrawal

There are two primary ways that opiates are metabolized in the body. These metabolic opiate pathways are called CYP 2D6 and CYP 3A4 isoenzymes. (I'm pretty much quoting from my text book, which I will cite at the end of this post.) There are current estimates that 20 to 30% of people taking opiate medications have a defect in one of these enzymatic pathways. In some cases the enzyme is too active and the opioid is metabolized too quickly. In other cases the enzyme is either missing or inactive, which can cause a build up of opioid in the blood because it is not being metabolized. This problem can induce respiratory depression and cause overdose.

But we want to focus on whether you may be one of the people who has an enzyme that metabolizes your dose more quickly than usual. There is a Dr. Tennant who has done a lot of research in this area and he says that there are ways to diagnose these defects. So far I haven't found info about them, but we get variations of this question all the time and this could be one legitimate explanation!

I found this: Interpretation of Unexpected Negative Result
‚óŹNon-compliance
‚óŹAlternative interpretations:
-Assay does not detect that opioid
-Adulterated, dilute or substituted urine
-Genetic polymorphism in opioid metabolism and
transport: CYP, UGT, P

-glycoprotein
-Altered pharmacokinetic

Found at: http://www.nmhr.org/retreat/2014/6-805a-m.pdf

I'm doing some more research on this, but I wanted to let you know about one possibility.

My text book is Julien's Primer of Drug Action, Advokat, Comaty, Julien, 2013, Worth Publishers. p. 309

Amy

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PostPosted: Tue Aug 04, 2015 2:07 pm 
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Also, there are different doses of zubsolv. Are you taking 1.5 of the 1.4 mg tabs, or the 5.6 mg tabs? Ask to be tested again and take your regular prescribed dose 24 to 36 hours before the test, then again at 10 to 16 hours before testing. Even if you are a fast metabolizer, you should have a certain level in your urine from that.

Another idea is to tell the doctor that you've been taking 1.5, bring in your extra zubsolv from not taking your complete dose to show that you haven't been selling them. Ask to take your 1.5 in front of the doctor and then come back the next day to do a urine screen. Then they will know that you're not lying.

It could also be that they are finding small amounts of metabolized bupe in your urine, but it doesn't reach the amount that should be there if you are taking the prescribed dose. Since you're not diverting your extra bupe you should be able to bring in the extra that you've saved up. Good luck!

Amy

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PostPosted: Wed Aug 05, 2015 5:11 am 
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Thank you very much for putting so much thought and time into my issue! To add a twist I spoke to my life coach/counselor (independent of sub dr) and well she didnt seem surprised of my negative results due to this ALL IN FOR CLEAN lifestyle and sugar free toxin free diet and exercise plan she has had me on for the last 2 months (yes the two "false negative" months) of which the first and third week of the month im supposed to totally juice (my appts with sub dr are ALWAYS in the first week of the month). She advised me to take them the cleanse booklet with my meal / juice/ etc tracking and whatever is left of my script straight to their office 1 1/2 hr drive away and put them intouch with her... Im still TOTALLY SCREWED with my insurance refusing to pay for anymore Zubsolv being "I was not correctly taking them" ...... GRRRRR!!! Do y'all think shes right?I dont ffeel quite ready to quit taking the bupes and DEFINITELY cannot afford full pharm price! I NEVER thought twice about "cleaning my life and body" I seriously thought I was doing something very good and now look at the BS its gotten me into. Btw: I started suboxone the first of January and switched to Zubsolv 5.7 this makes the 3rd month (which btw will probably show up negative too! OMG!! How do I get out of this cluster f&@k ???


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