Originally Posted by TLO (Post 15849789)

I mean, maybe? Or they could just order the test that will give them the results they are looking for.

Originally Posted by dlphg9 (Post 15849820)

Just tell them to do a test that uses mass spectrometry, because with most drug screens they just test it using an immunoassay method and if there is a positive for some type of drug such as benzos, then they will use mass spectrometry to verify the type of benzo. The problem in your case is that the immunoassay isn't picking it up, so in there mind there is no reason to use MS.

So if you want you can call quest for them and ask what test they should order, so that it just bypasses IA and uses MS. IME most medical assistants are pretty god damn clueless as to what test they need to order and routinely **** things up.

Also next time you see your doctor I'd tell them how she was treating you and how she was acting. That shit is so frustrating, those MA's are such snooty bitches alot of the time and just love judging patients and acting like they know everything.

Originally Posted by dlphg9 (Post 15849820)

Just tell them to do a test that uses mass spectrometry, because with most drug screens they just test it using an immunoassay method and if there is a positive for some type of drug such as benzos, then they will use mass spectrometry to verify the type of benzo. The problem in your case is that the immunoassay isn't picking it up, so in there mind there is no reason to use MS.

So if you want you can call quest for them and ask what test they should order, so that it just bypasses IA and uses MS. IME most medical assistants are pretty god damn clueless as to what test they need to order and routinely **** things up.

Also next time you see your doctor I'd tell them how she was treating you and how she was acting. That shit is so frustrating, those MA's are such snooty bitches alot of the time and just love judging patients and acting like they know everything.

Originally Posted by SupDock (Post 15849947)

I’m sure it can be done, but I’m not aware of a drug screen that starts with mass spectrometry.

Perhaps hook effect is creating the EIA issue.

Originally Posted by TLO (Post 15849954)

What's hook effect?

Originally Posted by SupDock (Post 15850018)

https://en.m.wikipedia.org/wiki/Hook_effect

Better explanation than I could type.

Originally Posted by TLO (Post 15850183)

Mr. Doc,

Do you have a recommendation about how I could go about speaking to the nurses or my doctor about my concerns? I feel like I'm not being listened to, and it's incredibly frustrating.

Originally Posted by dlphg9 (Post 15852872)

Did you get a chance to talk to anyone?

Originally Posted by 'Hamas' Jenkins (Post 15194265)

There are a lot of variables in a drug test. He can still have it in his system and not have enough of the metabolite to spike a positive test. This can be exacerbated by other drugs or supplements one takes. Clonazepam is a CYP3A4 substrate, of which there are many inducers (phenobarb, carbamazepine, oxcarbazapine, rifampin, phenytoin, smoking). Inducers can cause a person to clear the drug much faster than they would under normal physiological conditions.

Have your pills recently changed color or shape? It's possible the pharmacy gave you the wrong medication--for example Clonidine instead of Clonazepam. If not, the pharmacy would be able to tell you the lot number of the mediation and the supplier. Should others have similar issues, they would need to institute a recall due to adulteration, as clonazepam is primarily used for seizure control, and prompt withdrawal will cause exacerbations and potentially status epilepticus.

Originally Posted by TLO (Post 15888009)

Still having trouble with this. They don't want to order the MS test for some reason.

On another note, is there a set therapeutic value for 7-aminoclonazapam? It seems like the ranges can be anywhere from 25ng/ml to 10,000 mg/ml

Originally Posted by dlphg9 (Post 15888092)

So I'm not sure about a set therapeutic level for it, but im thinking your issue is that for some reason your body isn't disposing of much Clonazepam through your urine and so it keeps the amount lower than the threshold for a positive on the IA testing, which for Quest is 100ng/ml. So even if you have the Clonazepam in your urine the tests sensitivity can't pick up that small of an amount.

This is the test you need

CPT code - 39389

https://testdirectory.questdiagnosti...9389&cc=MASTER

This test however is MS and has a sensitivity of >25 mg/ml. That's why it picked it up on your test last year.

I'm not sure why they are being difficult and not doing the MS. Is it an insurance thing?