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 Post subject: No Suboxone In System?!
PostPosted: Tue Jun 20, 2017 5:06 am 
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I just had the most discouraging doctor's appointment this afternoon. They took my urine as usual and when I was called back to see the doctor they told me that my urine was negative for Suboxone. I take 8mg a day. I usually break the pill in half and take half in the morning and half in the late afternoon so there definitely should have been some of it in my urine. The only thing I can think of is that I have been drinking a lot of water lately and I even asked if that might be the cause but they said even if that was the case the Suboxone should show up even a tiny bit but it didn't. The doctor even said go ahead and drink lots of water. I don't know but it turns out that now I have to go there twice a week and every day between appointments to dose in front of them! It will be interesting if, even having them watch me take my meds, if my urine still shows negative for Suboxone! It might be my metabolism. I've noticed that losing and keeping weight off has been a lot easier over the last few years. I've also been on Lisinapril for hypertension. But, even if I weren't taking my full dose since I take it every day it should show up positive! Anyway, just wanted to vent.

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PostPosted: Tue Jun 20, 2017 7:22 am 
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I'm very sorry skayda..

Obviously a ridiculous thing to have to go through. I've grown to hate the arbitrary power clinic doctors
hold. It's downright scary, and a compelling reason to keep a generous stash just in case left high and dry.

In fact, it was partly that issue that motivated me to find an addiction psychiatrist. It's the same money and he spends half an hour with me instead of 5 minutes. I don't need or want all that time as it happens, but the benefit is you get a chance to build up a more trusting relationship. I also think such doctors have a less suspicious mind-set.

Again, my sincere sympathies. Hoping it's quickly resolved. I'm guessing one of our docs might chime in on this to explain how this might happen. Of course none of these tests to my knowledge are perfect.

p.s. Have to add that's a very sweet, very nicely rendered picture!


Last edited by godfrey on Tue Jun 20, 2017 10:31 am, edited 1 time in total.

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PostPosted: Tue Jun 20, 2017 10:22 am 
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There is a silver lining... You were not accused of diverting and immediately discharged, which has happened.
You are being given an opportunity to show that you are taking the buprenorphine as prescribed, although I would probably do it but once or twice and then move on.
You could ask for a quantitative analysis. Your sample would be sent to a reference lab where they would test for buprenorphine, norbuprenorphine (a metabolite that hangs around for awhile) and naloxone, which also tends to hang around for awhile.
I don't have a good explanation why you would test -. I have someone who currently is on 0.5 mg twice a day and she is still +. Yesterday I saw a new person and they had not taken any for 10 days and he was still +. Also with morphine (heroin) THC and Benzo, all being used because they were in withdrawal after a short stay in treatment. Another sordid tale of an addicted person being poorly treated and not having anyone to help them navigate our fractured messed up system.
Might be as you state, metabolism and hydration.
Godfrey is correct, the tests are not perfect, that is why I use them only as a guide, and will try to find ways to confirm.


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PostPosted: Tue Jun 20, 2017 10:23 am 
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Hey Skayda!

I think a lot of us in buprenorphine treatment are scared of something like this happening to us. As addicts, most of us are trying to earn trust bk that we destroyed during active addiction. To have someone think that we aren't doing what we're supposed to be doing, and we are doing what we're supposed to be doing, it's frustrating I'm sure! I guess I would have fainted if my doctor told me that :) (kidding).

I think ur doctor is pretty cool honestly, to give u a chance to prove ur doing what u say ur doing. Dosing in front of him or his nurse would be a great way to show ur doing exactly as ur supposed to be.

I'd keep drinking lots of water just like u were doing before this last drug screen, that way if it shows again that u still don't have buprenorphine in ur system, u have been dosing in front of him and he can maybe help determine why ur bupe isn't showing up in ur tests. Did that make sense to u lol?

Godfrey, my doctor is a psychiatrist too, I sure wish I could see him for 30 minutes. In any clinic type setting, it zaps time away from patients. I wish I could see him in an office setting instead a clinic setting. I definitely hear what ur saying about that.

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PostPosted: Tue Jun 20, 2017 10:41 am 
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Thanks Jenn, and you make a good point about the guy at least not shutting skayda, down. Doc also makes that point. I really can't quarrel too much with the way he's handling it. A test coming back showing no bupe must be rare, so pretty compelling from the clinic's point of view.

It's just that when we're confronted by something like that, and we know that we're innocent, it's painful. And we hear too many stories of patients being cut off without warning and no second chance.

I don't see who benefits when an addict is sent out into the street without the medication he/she needs to stay sober. . Ok, so if someones obviously diverting his meds, that's different.

I see both sides.


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PostPosted: Wed Jun 21, 2017 9:56 am 
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More and more, insurers will not cover buprenorphine unless I submit the results of urine tests. I have patients who have been stable for years, so I don't check monthly urine tests (I thought we were supposed to try to reduce unnecessary health cost?!). But insurers will ask for the patient's drug tests for the past 3 months.

When that happens, I typically do a point-of-care immunoassay test. Those have high accuracy for detection of many substances, but they don't provide drug levels. Some insurers will not accept them, and instead demand a test with levels and breakdown products. Some patients have policies with deductibles on everything but medications, so the insurer is essentially requiring those patients to pay several hundred dollars out of pocket.

I have no power in those situations, and I am annoyed that the professional groups for addiction doctors have not taken a stand. The insurers are making decisions that should be left to the doctors working with patients. You don't see that level of 'oversight' in other medical specialties.

Beyond that, I don't see why the results of drug tests are the insurer's business. If a patient tests positive for heroin, he/she still needs the script for Suboxone! And whatever the result of the test, it is MY decision over how to proceed. If a patient uses cocaine, do insurers have the right to deny coverage for buprenorphine? Or should that decision be left to the doctor? If it is my call, why does the insurer need the information?

In med school I was always taught to 'treat the patient, not the lab result'. I realize that some people do the wrong things with their medications. But I wonder how many people have been punished for things they didn't do?


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PostPosted: Thu Jun 22, 2017 2:20 am 
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docm2 wrote:
There is a silver lining... You were not accused of diverting and immediately discharged, which has happened.
You are being given an opportunity to show that you are taking the buprenorphine as prescribed, although I would probably do it but once or twice and then move on.
You could ask for a quantitative analysis. Your sample would be sent to a reference lab where they would test for buprenorphine, norbuprenorphine (a metabolite that hangs around for awhile) and naloxone, which also tends to hang around for awhile.
I don't have a good explanation why you would test -. I have someone who currently is on 0.5 mg twice a day and she is still +. Yesterday I saw a new person and they had not taken any for 10 days and he was still +. Also with morphine (heroin) THC and Benzo, all being used because they were in withdrawal after a short stay in treatment. Another sordid tale of an addicted person being poorly treated and not having anyone to help them navigate our fractured messed up system.
Might be as you state, metabolism and hydration.
Godfrey is correct, the tests are not perfect, that is why I use them only as a guide, and will try to find ways to confirm.


Yes, that is a silver lining. I've heard the horror stories. Oh, they do check for all that in your pee; the metabolites and everything in the office. They have their own little lab there. The NP I saw who read the negative results just immediately put me on pill count and observed dosing but the next provider I saw looked at my chart and said well, you're only negative one time your results show the Suboxone is in your system every other time you've been here so I would chalk it up to drinking too much water that day. I'm thinking after my next few appointments it will be okay again and I won't have to do the pill counts and observed dosing anymore. Especially since it was only negative once in two years.

Yeah, it's a tough world for addicts trying to get better. Thank goodness for good, knowledge healthcare providers!

Thank you!

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PostPosted: Thu Jun 22, 2017 2:35 am 
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jennjenn wrote:
Hey Skayda!

I think a lot of us in buprenorphine treatment are scared of something like this happening to us. As addicts, most of us are trying to earn trust bk that we destroyed during active addiction. To have someone think that we aren't doing what we're supposed to be doing, and we are doing what we're supposed to be doing, it's frustrating I'm sure! I guess I would have fainted if my doctor told me that :) (kidding).


I can't really blame them for erring on the side of caution. They can get into trouble too if we mess up. And not to mention addicts have a tendency to lie first ask questions later lol.

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I think ur doctor is pretty cool honestly, to give u a chance to prove ur doing what u say ur doing. Dosing in front of him or his nurse would be a great way to show ur doing exactly as ur supposed to be.


I totally agree! That's why I said "Sure! No problem!" when they told me about having to do it. It will help prove my innocence. Someone who's sharing or selling would try to get out of that arrangement.

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I'd keep drinking lots of water just like u were doing before this last drug screen, that way if it shows again that u still don't have buprenorphine in ur system, u have been dosing in front of him and he can maybe help determine why ur bupe isn't showing up in ur tests. Did that make sense to u lol?


Actually the doctor I saw today said it probably was the water. Especially when all my other levels came back fine and have been for two years now! Lol!

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Godfrey, my doctor is a psychiatrist too, I sure wish I could see him for 30 minutes. In any clinic type setting, it zaps time away from patients. I wish I could see him in an office setting instead a clinic setting. I definitely hear what ur saying about that.


I wish I was seeing a psychiatrist as well but unfortunately I never know who I'll be seeing or if I will be seeing someone irl or via the internet. There are so many different doctors and nurse practitioners at my clinic that I haven't even seen the same one twice and forget about learning names! You spend about five minutes with them as they go through your pee test results, ask if you've taken any other drugs, have feelings of hurting yourself or others, ask if you're in counseling, your dosage and that's pretty much it. They read these from a script they've been provided. Then we are shuffled out the door for the next patient.

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PostPosted: Thu Jun 22, 2017 2:42 am 
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godfrey wrote:
Thanks Jenn, and you make a good point about the guy at least not shutting skayda, down. Doc also makes that point. I really can't quarrel too much with the way he's handling it. A test coming back showing no bupe must be rare, so pretty compelling from the clinic's point of view.

It's just that when we're confronted by something like that, and we know that we're innocent, it's painful. And we hear too many stories of patients being cut off without warning and no second chance.

I don't see who benefits when an addict is sent out into the street without the medication he/she needs to stay sober. . Ok, so if someones obviously diverting his meds, that's different.

I see both sides.



Yes, you make very valid points. I can see both sides as well. However frustrating it is at least they're giving me a chance to prove myself. The doctor I saw today thinks it was too much water that caused the negative reading especially when it's the first and only one I've gotten in two years.

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PostPosted: Thu Jun 22, 2017 3:01 am 
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suboxdoc wrote:
More and more, insurers will not cover buprenorphine unless I submit the results of urine tests. I have patients who have been stable for years, so I don't check monthly urine tests (I thought we were supposed to try to reduce unnecessary health cost?!). But insurers will ask for the patient's drug tests for the past 3 months.


I think that's one of the reasons we have UAs at the place I go to but they will test you every time you come in even if you were just tested yesterday or don't even have an appointment that day. I came in to do my first observed dosing and pill count but the pharmacy hadn't gotten my script yet so they just took my urine and since it was close to closing time they had me come back the next day for the observed dosing on my second day of my new script. Another weird thing they do is they have a new policy in place in which if you have to change a set appointment due to any reason at your next appointment they give you a breathalyzer test. This makes no sense to me. It's not as if you can gauge alcohol levels 24 or more hours later with a breathalyzer! Lol!

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When that happens, I typically do a point-of-care immunoassay test. Those have high accuracy for detection of many substances, but they don't provide drug levels. Some insurers will not accept them, and instead demand a test with levels and breakdown products. Some patients have policies with deductibles on everything but medications, so the insurer is essentially requiring those patients to pay several hundred dollars out of pocket.


At the clinic I go to they have a mini lab that tells them all sorts of stuff about your pee even down to creatinine levels. I don't know how much it all costs as I've never been billed for either the urine tests, the doctor visits or my prescription so I guess I am pretty lucky. I'm on state insurance, too. It used to be so frustrating as they would have those prior authorizations every time your doctor changed your script but now they've done away with that and it's a lot better.

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I have no power in those situations, and I am annoyed that the professional groups for addiction doctors have not taken a stand. The insurers are making decisions that should be left to the doctors working with patients. You don't see that level of 'oversight' in other medical specialties.

Beyond that, I don't see why the results of drug tests are the insurer's business. If a patient tests positive for heroin, he/she still needs the script for Suboxone! And whatever the result of the test, it is MY decision over how to proceed. If a patient uses cocaine, do insurers have the right to deny coverage for buprenorphine? Or should that decision be left to the doctor? If it is my call, why does the insurer need the information?

In med school I was always taught to 'treat the patient, not the lab result'. I realize that some people do the wrong things with their medications. But I wonder how many people have been punished for things they didn't do?


Yes! i totally agree with everything you've written here! It's so infuriating when financiers and politicians dictate the healthcare. And the NP I saw who read my pee results was just like your guilty until you can prove otherwise because the lab test said so! She did not actually say this but her vibe did. :(

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