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Yeah, assuming all things you have said being true, this is a false negative.
Most likely from hook effect, and mass spectrometry should solve the issue. There really isn’t a therapeutic window for Benzos, as it is generally symptoms driven. There are dosing guidelines though |
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I have printed off various reliable/ well respected resources to show him why a mass spectrometry test is warranted. I'm also taking in my bottle of medication. If they still won't do the MS test... :shrug: |
My suggestion is, if they are not doing what you are asking them to do (and from what I am understanding, this isn't like a very dangerous stuff going on), I would say find a different doctor.
Some doctors are better than others and may have a better understanding of your case. |
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The immunoassay often uses an antibody to oxazepam, a metabolite of diazepam and chlordiazepoxide.6,7 This antibody has relatively low cross reactivity with clonazepam and lorazepam and is therefore less likely to be detected reliably. This is a different lab, but this is what Aegis Labs says "A patient taking alprazolam, clonazepam, flurazepam, or lorazepam will not test positive for benzodiazepine metabolites on an Aegis report." https://www.aegislabs.com/resources/...l-update/dec19 |
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Well, one of the numerous studies I found that say that exact same thing. |
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https://www.google.com/url?sa=t&sour...J-clz4YxDQQ51S False positive rates for benzodiazepine immunoassays are relatively low (<5 percent). However, most benzodiazepine immunoassays used for screening are susceptible to false negative results. The false-negative rate for benzodiazepines in an immunoassay screen is approximately 25-30 percent, and is particularly problematic for clonazepam. One reason for false-negative clonazepam results is that the drug appears in the urine almost entirely as 7-aminoclonazepam, a metabolite that is not detected by many commercial immunoassay screens. A similar challenge exists for some other extensively metabolized benzodiazepines. Concerns about false-negative results in confirmation/quantitation tests for benzodiazepines also exist due to variation among laboratories in the cutoff concentrations (sensitivity), the actual analytes detected, and the sample preparation methods. Regarding sample preparation, some laboratory methods includes a sample pretreatment reaction prior to analysis that liberates glucuronide metabolites (e.g., hydrolysis). Hydrolysis pretreatment will improve detection of most benzodiazepines. Inclusion of multiple benzodiazepine metabolites will also improve detection of benzodiazepines in urine confirmation/ quantitation tests. |
Doctor flat said no to any other test. They have to follow the policies and procedures set by the administration. Anyone have any suggestions?
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Healthcare is ****ed up
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