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PostPosted: Tue Mar 04, 2014 12:04 am 
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My sub Dr urine tests me every few months with a dipstick cup. Of the last five tests, TWO showed oxycodone. He sent them to the lab and I was exonerated.
I asked to see the last lab report. I was positive for buprenorphine, norbuprenorphine, and NOROXYMORPHONE. The last is a metabolite of naloxone--AND of oxycodone.

This is very scary as I work in healthcare and could be subjected to random tests. I can't just tell them "oh that's a false positive from the suboxone I take every day" or I'll lose my job and worse.

We've all always been told sub doesn't cause false positive for other opiates. Well that's not entirely true. The dr said I'm his only patient this is happening to... Just wanted to get the word out on this. I take 16mg a day BTW, generic tablets.


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PostPosted: Tue Mar 04, 2014 12:32 am 
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Interesting... there are a number of articles out there about the cross-reactivity. Apparently it is almost impossible to absorb enough naloxone to get measurable amounts of noroxymorphone in urine http://www.clinchem.org/content/55/7/1434.full , but you are evidence that it can happen. I use point of care dipstick tests all the time, and I've never had a patient come up positive for both buprenorphine and oxycodone (in thousands of tests). But they use immune-assay technology, so I suppose it depends on the part of the oxycodone molecule that is detected by the antibody in the specific brand of test.

What I find interesting.... is that the cross reactivity is from naloxone, NOT buprenorphine. Everyone acts as if plain buprenorphine is SO much more dangerous to prescribe... when treating you with buprenorphine, instead of with Suboxone, would solve your cross-reactivity problem.

The folks at bluelight have a number of threads on chemical reactions that turn naloxone into noroxymorphone.... which happens to be a potent mu agonist!


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PostPosted: Tue Mar 04, 2014 12:57 am 
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I must have some very unusual metabolism or biochemistry. I think I will start spitting my saliva out after 20 minutes, in the hopes of ingesting less naloxone. Switching to subutex won't happen, my doc is devout believer in the debunked theory that the naloxone stops people from shooting it up. He also said the noroxymorphone was a buprenorphine metabolite and normal to see; but he didn't explicitly indicate if he'd seen it on other tests. I will share my findings and ask him that next time. The panel is a pretty complex opiate metabolite specific panel.

Leaving aside the positive oxycodone on the immunassay, have you ever sent for a GC/MS confirmation and had it come back with negative oxycodone but positive noroxymorphone?

Yes I found those posts about converting naloxone to noroxymorphone as well. Interesting, but those guys are always speculating about their Holy Grail -- loperamide to fentanyl. None of them ever accomplishes these feats (or if they do they're not posting it to the world). Noroxymorphone is a strong agonist with a half-life of 2-5 hours - that's longer than naloxone's half life! But it must be metabolized in such low amounts that it doesn't have noticeable effects.


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PostPosted: Tue Mar 04, 2014 7:15 am 
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Wow, this is a great post! I never knew that this was even possible.

I can recall having at least a couple people come here over the last couple years saying that they had gotten a false positive for oxy. I wish I had known this was a possible naloxone metabolite then so I could have given them the information.

Good stuff!

On another note, I have received one false positive in my time of treatment as well. But mine was for tramadol of all things! Is there anything that you guys know of that would have caused this one? It's not a big deal as this has been about two years ago and has never happened again. I was always suspicious that the doctor had somehow screwed up the test because it didn't show in the office, only when it was sent to the lab. But I've always been curious about how it happened.

Any ideas?

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PostPosted: Tue Mar 04, 2014 12:43 pm 
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Tramadol is not based off the classic opiate backbone like naloxone, buprenorphine, morphine, oxycodone, etc. The only opiate like characteristic is the tertiary nitrogen (the N with three carbon hanging off--every opiate/opioid has one).
Any chance you were on Effexor? Check Wikipedia for the chemical diagram of Effexor and that of tramadol... They are very similar.

Though at risk of going off topic I find it odd your Dr would even send a negative to the lab on the first place. Usually that's just done to confirm a positive on dipstick and is not cheap.


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PostPosted: Tue Mar 04, 2014 10:08 pm 
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Tell me about it...my insurance was getting charged around $500 bucks every month for that stupid test! I never understood exactly why he felt it so necessary to do such an expensive test every single month on every single patient. He claimed he was doing it to keep track of the quantities of suboxone in the patients system. But I know from reading here that these tests are rarely accurate. And, the fact that I was very rarely taking the proper dose during the end of my treatment and taper schedule with this doctor tells me that statement is true. My gut says he was making some pretty good money off of it, but obviously I'm not sure.

Speaking about the Effexor, I was taking Pristiq at the time. From what I understand, these two drugs are essentially the same. Effexor being venlafaxine, which is broken down by the body into desvenlafaxine. While Pristiq starts out as desvenlafaxine, saving your body the extra step of breaking it down. Could that cause the issue? If so, I wonder why he didn't mention it? As I said, it's never been an issue again, and I'm now taking Effexor 75mg daily. I'll definitely keep this in mind in case the issue ever comes up again!

Thanks again for the great thread!

Q

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PostPosted: Tue Mar 04, 2014 11:53 pm 
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Hi JB,

Maybe, just maybe you could look at taking less suboxone. I have not read your whole story but it might be worth it in your situation to take less sub. 16 mg is quite a bit, on what I understand way above the ceiling effect for anybody. Its just simple thinking but maybe with less suboxone in your system maybe these tests won pick it up? I have heard of many people going from 16mg to 4mg with very little to no withdrawal issues. Its just a thought, trying to help. Maybe you could "test the waters" so to speak. I hope everything works out for you.


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PostPosted: Wed Mar 05, 2014 3:06 pm 
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qhorsegal2 did I call that one or what ;) Now, I don't know if effexor is known to cause false positive for tramadol or not - some googling may tell. But it may be the reason.


Justdoit4u yep, I'm considering lowering my dosage. I've been on 16mg for about two years. The constipation is brutal, and in that time I've acquired hypogonadism aka very very low testosterone and symptomatic for low T (no libido, no erections, no energy, etc). Dunno if it's related to the sub or not as my brother also got hypogonadism at the same age. Testosterone replacement worked AMAZINGLY well, I felt alive again, but made me infertile so I had to stop. Now I'm living with no libido yet trying to have a baby.... :(

My Dr is not one to push lowering on his patients - he says "there is no honor" in going for a lower number just for the sake of a lower number. He believes people should take the dose they need to control cravings. He's a good man, genuinely cares and advocates for addicts. He accepts insurance and only charges the normal co-pay. Next month I'll talk to him about my findings and concerns and see about dropping. I'm sure he'll be fine with it and I'm sure it won't be difficult.


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PostPosted: Wed Mar 05, 2014 3:25 pm 
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JB,
Cool about your doctor. You and him my be pleasantly surprised on how your cravings can be under control at even a lower amount. Again, everybody is different, whatever is best for you and your sobriety.

I just typed up on a thread yesterday on how good I feel with exercise, nutrition, some vitamins, meetings, and seeing an addiction counselor. Was able to reduce my dose with no issues. My main concern is to not have any cravings and so far so good. Anyway, good luck on everything including that baby!!!


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PostPosted: Thu Mar 06, 2014 12:42 am 
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JB,

I think we need to immediately clone your doctor and place at least 3 of him in every county in the country!!!! He sounds fabulous!

Yeah, you totally called it. I'm happy to have this information moving forward.

It sounds like you're in a tough spot with your baby making mission. I sure hope you find an answer soon. I remember those days, trying to make a baby...it's not always easy even if you DO have a good libido! :shock: I guess you just have to stay on top of it...or get crackin'...or....okay, I'm done with the bad puns. :lol:

Honestly, I'm not trying to make light of it. I know how hard it can be when you are dealing with infertility issues. I hope that's not the case for you guys. I hope to see an announcement soon saying that you have a precious little one on the way!

Q

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