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PostPosted: Mon May 24, 2010 4:52 pm 
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Hello All,

I have posted before and now i have a new issue. My suboxone dr is very strict and there are no exceptions with him. I got a bill from the lab the other day and called questioning what it was. Apparently my dr submits my urine to the lab for testing my subxone levels. My dr has me on a higher dose than what i am taking. He will only prescribe you weekly doses. My dr is very far away and some of his requirements are extreme. Anyway, we will be moving in two months to another state and i have been taking the extra suboxone and saving for my move. Kinda stocking up just incase i have the same problem (took over a month) to get to another suboxone dr. However, now i am terrified of this test he is doing on me. He had me taking 12mg a day last week and i still was only taking 4mg. I heard that anything over 4-6mg is just a waste because of the ceiling affect or something. Besides that low dose works for me. Does anyone know if this kind of test can tell my dr exactly what dose i am taking on a daily basis? Why are they doing that test? To see if i stopped sub to take drugs and then went right back on sub before my appt or something? Is this test accurate to your daily dose or just a round about figure that just tells them i have had suboxone in my system daily. I know honesty is the best policy, but this state is very complicated to find sub dr that are not outrageously priced. I can't afford this right now but i need the sub. Anyone that has knowledge of the urine testing and how it works, please respond. Have a great day. Thanks again.


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PostPosted: Mon May 24, 2010 6:28 pm 
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I'm not a Doctor or anything along those lines, but I know a little something about piss tests, being that I've took close to 200 in the past 3 or so years. With urine it's just usually to check for the presence not the level. To do anything but check if a drug is in your system would be hard to do with urine, and subject to argument. I don't see them being able to pull a level in your system out of urine, because the strength of what is in it could be altered by water and other liquid or food you ate. Your blood is more of a normal consistent mix of things, making it good to test because it shows what levels of what are going to your brain, but urine is waste and isn't being fed to body. Two people taking the same amount could have a difference in urine based on how effective your body is on removing stuff from your blood, it can also be different to the same person from very from hour to hour in terms of the level of something in it. That's my thinking anyway, if I'm wrong let me know, but I'm pretty sure. Like I said I'm no Doctor or scientist.


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PostPosted: Mon May 24, 2010 6:43 pm 
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Thanks DottaPro, I was thinking the same thing with the urine. How can they get such accurate levels with a urnine specimen. But when i called the lab company and asked her what the bill was for she specifically said it is for testing your suboxone levels. Then i called my dr's office and spoke with the nurse. I asked what this was all about because i cannot pay $125 a week for this test. The nurse said they use two labs that they send my urine off too. One lab test something she did not mention and the lab i got a bill from is testing for opiates levels and sub levels. The thing that has me worried is that the lab bill was $125 and that is the discounted price since self pay. A simple yes or no positive test would probably not cost this much...right? Maybe they can just tell if your levels jump dramatically and it is a more sensitive urine test to see if you have done any opiates earlier in the week? Not sure, but i hope i am right. I mean it is not like i am doing anything really wrong.....just saving some for my move and holding on to them. I guess some dr's might think that is wrong since i am not following specific dosing instructions. Anywho, thanks so much for your response. My appt is Wednesday. I will let you know how it goes.


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PostPosted: Mon May 24, 2010 7:28 pm 
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The way I would look at it is, you can not change the results by worrying. What you can do is be prepared to explain your self for either out come, having an explanation you feel comfortable with will help you not worry. If your confronted about your levels being low in your urine, I would bring up how could they get that information from your urine and being accurate even if you had a lot of water in your system, and also you could explain that you wanted to be sure what you felt from the suboxone, so for a couple days you took less to see how that felt to reassure your self the relief or side effects were from the suboxone. Some people might think that is wrong to do, but I see it as protecting your sobriety by maintaining a buffer of medication should the worse case happen. In the end do what you personally feel is write, and don't be afraid to be on the suboxone for as long as you need to get you where you need to be. Good luck on everything! :D


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PostPosted: Mon May 24, 2010 10:44 pm 
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I don't know the specifics of the test ...but I do know that when my Doctor does urine tests he says he tests for other drugs (obviously) and checks the levels of our sub. The reason he does this is to make sure patients are not diverting (selling) their medication and actually taking the dose they are prescribed. Like I said, sorry I can't help you with the specifics so I don't know how accurate the test is, but my doctors office does the same thing. I would be interested in knowing how this turns out if you can let us know. Hope everything works out for you.

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PostPosted: Tue May 25, 2010 9:31 am 
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My understanding is urine tests are for existence only, not levels. Blood tests are more accurate for levels.

However, I am no expert on this.


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PostPosted: Sat May 29, 2010 11:28 am 
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I think the term "levels" is kind of a misnomer. Googling around, I can't find a single service that will confirm opiate intoxication level from urine. Everything I'm finding just tests for Opiates. That said, they do test for "levels". Studies have shown that ingesting as little as 25g of poppy cake will cause your urine to show as much as 100-300ng/ml (depending on what study you ready) of morphine. This means that a number of the "dipstick" tests would register positive for opiates. Normal procedure would then be to test for your actual opiate "levels" to see if you had a real or false positive. Again, depending on where you are reading, you'll see this secondary screening look for 2000-4000ng/ml of morphine, ergo the "levels".

From the UK's Independent Drug Monitoring Unit (IDMU):
Quote:

Meneely found that ingestion of poppy-seeds (25g) in cakes generated opiate-positive urine tests (300 ng/ml cutoff levels), although "no subjects were found to exhibit symptoms of opiate impairment." In the USA, workplace testing cut-off levels for morphine were increased from 300ng/ml to 2000ng/ml in November 1998, to avoid false positives arising from medicinal codeine preparations and poppy-seed foodstuffs. By contrast, the legal limit of plasma morphine for driving under Belgian law is 20ng/ml, equivalent to 10ng/ml in blood, levels of 500ng/ml were found in saliva.
3 Opiate Pharmacokinetics



As an aside, there are several dipstick tests that won't show positive at lower levels of morphine, thereby eliminating the possibility of a good number of false positives. I have no idea how widely used these are relative to the dipstick tests that WILL show positive at lower levels because obviously the dipstick tests that have this problem don't exactly print "Now with false positive potential" on their literature. It is kind of like trying to prove a negative....the only companies that address this issue are those that have "negated the effects of most false positives". I would think most establishments have a policy of sending any positive sample off for more detailed testing if they are doing testing the initial dipstick test in-house.

There is also the physiological aspect to consider. If I'm prescribing Subs and am worried about the DEA coming down on me if and when I have a patient that diverts, I'm certainly going to talk up the fear factor related to the urine tests. This is kind of like the flight attendants that worry about FAA fines for not policing seat belts enough during take off and landing doing a PA saying, "Our seatbelt monitoring system currently shows that 16 seatbelts are unfastened. We will not be able to leave until all sensors register seatbelts are fastened". Obviously no such system exists or could possibly exist, but the threat of such a system is enough to compel most passengers to comply for fear of getting in trouble.

So I would imagine the use of the word "levels" is just related to the weirdness of medical vernacular. I'm by no means a doctor of course.


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 Post subject: update?...
PostPosted: Mon Jun 07, 2010 11:55 am 
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So, how did it go? Have you done the tests yet?

First of all, even if your doc catches you taking less than prescribed, you can just come into his office and present your "stash" as proof that you're not selling your pills, just stacking them up for your move, since you'll be probably too busy during the first week to look for a new doc, find a clinic and arrange a payment plan with your entire house on your back :) But even if your Doc is still mad and wants to take them extra pills away... maybe you should try to find a clinic in that other state and set an appointment in advance, and then ask your Sub doc to transfer you, so your next Sub script will be waiting for you when you arrive. And ask for some extra couple of pills for the days you're gonna be on the road.

Btw, is he the ONLY doc in your state? have you tried looking for other Sub prescribing physicians, or you just ended up stuck with him... You don't have to put up with this, you know... being prescribed weekly amounts - and probably charged for weekly follow-ups, instead of monthly like all the normal docs do, - and having to pay out of pocket for an expensive lab test without ANY WARNING!!! you know you cannot legally be forced to take a drug test. i mean, they threaten to kick you out of the program and all, but if you say "no" and you're not under arrest - well, they can't make you. Most of our Sub docs will prescribe you whatever dose you say you're comfortable with, and they give you at least a month worth. And they don't require constant checking-in, proof that you're not selling, etc. They do drug-test us, but it's a urine test, I did two of them and till now was not asked to pay for neither. You dont have to put up with this unnecessary nazi sh!t if you can choose another doc!

Now, I do realize we addicts need some control and discipline. But this - weekly follow-ups, spectrum lab tests that are forced on the patient financially without him consenting or even knowing that he's gonna be charged the full cost, and especially this outrageous demand to keep his level up even though he's clearly comfortable with a much lower dose - considering the cost of each pill is 6-8$! - I'm sorry, but this borders on abuse. Somehow I have a suspition that this patient is also not on any state-assisted medical plan, he either has a private ensurance with humongous copays or, like me, pays every penny out of pocket. I don't know how the finances and medicine canoodle, exactly, and I don't want to imply anything, maybe your doc is just strict or somewhat prejudiced against drug users, or following some latest state-imposed regulations - this is much more likely than, say... oh man, I really don't want to offend anyone, so I won't say anything that'll probably sound stupid and ignorant to someone in medical billing :) It's just I don't see a lot of patients who has a state assisted med. plan in my doc's office, and also, many listings (more than 50 in our area for Sub docs alone) alongside address and phone number write in bold - "Private insurance or self-pay only" or smth like that. I wonder why.

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PostPosted: Mon Jun 07, 2010 1:34 pm 
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I have to qualify these comments by saying to 'us patients' that urine tests are for our own good, recognizing the way that addiction works. And for doctors, they should be used with the purpose of improving patient care, and NOT for the sake of playing 'gotcha' and tossing people to the wolves.

There are now a number of labs doing 'quantitative testing,' where actual urine levels of substances are determined. The reason is obvious; if the goal is to make sure a person is taking their buprenorphine (or their methadone or oxycodone, say, in a pain treatment program), it does little good to just check for 'positives', as the person could simply take a small amount of the substance (and selll the rest-- which is one area of concern). i had a lab doing it for my practice for a short time, until I discovered the obscene fees they were charging patients-- $600-$1200 dollars per test! When I dumped them, their response was 'but all the doctors are doing it!!' THAT type of outfit is a scam; the tests can be done at a much lower cost. All quantitative labs try to use the patient's body weight, age, and other factors (like medication use) to compare patient urine results with 'average' urine levels for certain dose ranges. They take the concentration of the urine into account as well, so that their expected levels are much lower in dilute specimen than in a concentrated urine specimen.

The results cannot be used with a huge degree of certainty, but they do provide a little more information than a simple positive or negative dip stick-- which costs about 3 bucks per test! To be honest, there is not enough knowledge about all of the factors that determine urine levels to absolutely tell a patient 'you are not taking your full dose.' I doubt, for example, that urine levels would hold up in court to say whether a person is on a large of small dose of a drug. But a doctor might still use the results to try to get to the truth. And for the original poster, while I understand what you are doing, I urge caution-- we relapse or get into other trouble by doing a series of small, dishonest or unethical things, so that we don't really notice the problem until we are already too deep to easily get free. This might be one of those examples, taking your use of buprenorphine 'underground' while rationalizing why it is ok in THIS circumstance. I encourage people to always strive to live above reproach, and out in the open. Keeping secrets affects our personalities in ways that are hard to notice, but that add up over time.

That said-- I hope things work out OK.


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PostPosted: Wed Jun 09, 2010 4:50 pm 
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Just an update.....My dr has not mentioned anything to me about my suboxone levels. I know he has recieved the results but has not yet questioned my levels. when i went for the visit i did discuss with him that his office was doing their urine test and sending them off to two different laboratories and the bills were coming through at 500 dollars a week!!!! The dr. was very upset about that and asked the administrator to come in to discuss whey they are sending urine of to seperate labs and billing was outrageous. I do have insurance through the military and hopefully they will pick this up. Thus far they have not paid a bill...time will tell. I live in a very small town and researched many sub dr's within a 70 mile radius. Some that i called that were fairly cheap were full and i was put on a waiting list, others prices were just out this world and impossible to come up with that kind of money up front. Finally i called my dr and he is the ONLY one is my state that takes insurance for a sub program. I was so excited and decided to go with him, only to find out that he is not a provider with my ins company so now i am getting bills for my weekly required office visits. The good news is he does allow pmt plans and that is why i continue to go there. Also, we are moving in 6 weeks to another state so starting in a new program is just useless at this point. Besides i did call some of the other sub dr's back and asked them if i could just transfer and not go through all the cost of initial visits and assessments and they said no. Mathan-i am not certain what you are getting at in your last paragraph. Are you rererring to me. By the way i am a girl. I am sorry if anyone thinks what i am doing is wrong. I did tell my dr at my visit that i thought one pill would work fine for me but he still gives me one and a half. I also have told him that i plan on weaning when i move. I was just saving these extra bits so when i move i can focus on weaning down and not have to go back to a sub dr in my new state. With that said, i am still open to researching sub dr's in my new state so i have a back up. Also, if i may add that my dr does require weekly visits and there is no way around it. He is also adiment about the weekly urines. That is how he does it and he will only give you a weeks dose at a time. Mathan, i am not sure if you were making judgements and bashing me a little, but i do appreciate your advice and honesty. I am sorry if anyone here thinks what i am doing is wrong. I am only trying to save a little for my move. I have no desires to sell or do anything illegal with these pills. My intentions were harmless or so i thought. i do believe in honesty and i really am a very good person i just don't feel that this dr will understand and he is very hard to talk to. Thanks to everyone for all your answers and concerns. I appreciate all your advice. Take care.

PS>.Thank you Dr. Junig for responding to me so quickly that night. I appreciate all you do for everyone and this website. Thanks


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PostPosted: Wed Jun 09, 2010 5:25 pm 
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Mathan,

I just read your post again and understand it more clearly now. Sorry for the mix-up. I believe you were referring to my dr. Thanks for caring and writing. Have a great day. :lol:


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 Post subject: suboxone levels
PostPosted: Thu Jul 22, 2010 9:58 am 
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I have the same concerns about my suboxone levels. I am saving my suboxone because I am going to lose my insurance soon. I was urine tested yesterday and my levels should be considerably lower than they should be. I was wondering if you take more suboxone a couple of days before the test will your levels be higher. Has anyone tried that before.


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PostPosted: Sun Aug 01, 2010 1:25 pm 
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Hello Ruthie,

I have not been on the suboxone forum for a couple of wks. Been very busy lately. I did want to respond to your question. I was prescribed 12mg of sub a day. I would take between 4-6mg a day, but the day of my appt I would take 8mg. That way I had a dose in me that was closer to my prescribed amount. I think there were a couple of times I also took 8mg the day before too. Not sure of your mg difference, but I was never questioned by my dr regarding levels. I agree with others too, how can a urine test really be that accurate. I stressed so much about this, but was never an issue with my dr. I am so glad I had saved some because I had to quit the program (long story) and it took me over a month to find a new dr. Hope everything works out for you. I think it is always a good idea to have a little extra on hand for emergencies. I know honesty is the best policy so I don't want to really encourage it, but for me that is what I did and fortunate to have that back up when i did indeed need it! Take care!


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PostPosted: Mon Aug 09, 2010 4:16 pm 
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They can definaltly tell whether you are taking them or not. I just met with my suboxone workier that I see every month. She showed me the level results of my past urine test. It's broken down into 2 catorgories The top level shows how much suboxone is in your system the second level show how much the suboxone has built up in your system. She explained that the bottom level should be 4 times greater then the top level. I asked if she knew how far back it goes for the build up level and she didn't know. She definatley knew I was not taking them as prescribed. She said that if my levels stay low they would lower my does. I'm currantly taken 2 8mg/2mg per day. Some days I just plain forget. I usually try to take 2 per day for the 10 days before my appointment and 1 per day for 10 days before that. I'm pretty consitant with how I take it but that's not what the test showed - my results were all over the place. I don't want my does to be degressed so I am now taking them as prescribed. Where I go they do the quick test before my appointment that test just tells if you have any other drugs in your system and if the suboxone is in it. My worker also told me that they have a certain cup for the people on suboxone. Then there is a routine cup that the use for standard drug tests. After that they send the specimen to a lab to test for the levels. I don't smoke pot but twice I've come back dirty from second hand smoke. The second time all I did was smell my friends coat and it came back dirty. Also, I came back dirty for benzo's one time and I had taken 3 valiums 3 weeks befor being tested. I had my bottom teath taken out and I was afraid I wouldn't sleep I was in so much pain so my friend gave me 3 valiums. I was shocked that it showed up. I think suboxone is a miracle drug and don't want to do anything to jeopordize being in the program. I hope this info helps someone!


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PostPosted: Mon Aug 09, 2010 5:41 pm 
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Hi janjan. I wanted to welcome you to the forum. I hope you find us informative and supportive. Thanks so much for sharing your experience. I'm sure what you've learned and told us about WILL indeed help others. It's very interesting, because I personally wasn't aware of testing like that which you described. Again, welcome and I hope you stick around and post often.

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PostPosted: Thu Aug 15, 2013 1:56 pm 
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I am on a suboxone program and I get my levels checked. I was on 4 s now I'm on 12s but I only take 6 Mgs a day. I get my levels checked. And I also see him every 2 wks. I'm not understanding y that now I got upped my levels are not going up?! Which makes me look like I'm selling them and I need my meds so now he says he wants to put me back down to 4 s and I feel like ill relapse on 4 s. has anyone ever had this problem or how do I get my levels to be right before I see him n the next 2 weeks?? I sometimes take more than I should even or less other days. I just don't get it would it be cuz I have a high tolerance? Does it not work the same if u r shooting them once or twice a week? Like maybe once a month!? I need some help or advice.. The 6s really aren't even the greatest I could be on a full 12 a day.


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PostPosted: Thu Aug 15, 2013 2:17 pm 
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Hi Mindy,

I posted already to your other one not knowing this thread existed. The thread has excellent advice and also one from a physician.

We always encourage being honest with your doctor. Tell him/her that you are feeling cravings on the dose you're on. Most likely you'll be upped in dose until you feel stable again. That is the purpose of Suboxone, to stop cravings and allow the addict to experience a life w/o chasing your drug high.

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PostPosted: Thu Aug 15, 2013 3:14 pm 
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I have worked in Pathology for 15 years. The drug screens we get are just qualitive not quantitative. Ie positive/negative as opposed to the level of drug in specimen. It is very difficult and expensive to do the levels. Even if labs can test for Bup levels they may have to be done in blood , not urine if anything. Not a routine test. Would probably have to go to specialised lab.
Not sure if there aren't new tests but am 100% sure urine drugs screens are just positive/negative only.


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