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Question about some lab results
www.chiefsplanet.com is where I head to get all of my medical questions answered! (Seriously though I know we have some people here knowledgeable about this stuff)
Went in to do my yearly drug screening due to me taking a benzodiazepine on a regular basis about a week ago. Got the results a day later along with a call from my doctor saying that my test came back negative for benzos. They asked me if I had been taking the medication as prescribed, which I have. They said no big deal, we'll just redo the test. Did the sample again yesterday, and again it was negative. The doctors office isn't open today so I'm not sure what the deal is. Anyone know why I'd be coming up negative on the screening? Klonipon is the drug, if that helps any. |
It sounds to me like you have a low-value superpower of repelling benzodiazepine. Did you get bitten by a radioactive pharmacist recently?
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Clonazepam should take 1-2 weeks to clear your system. If you're taking it daily, it should show up. That's really weird.
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Do you know what type of testing was used? Just the cup with a line or put in a machine? Maybe something is wrong with the tests or the tech isn't seeing the positive line.
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(Through Quest) |
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https://delphihealthgroup.com/benzod...testing-guide/
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I'd check with the pharmacy you bought the prescription from. Maybe they have a bad lot.
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Your pharmacist is stealing the real ones to sell on the street or use themselves and giving you placebos instead. Mystery solved!
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Congratulations... You're pregnant..
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Will doing an 8-ball of coke tonight show up on a drug screen Monday morning?
Asking for a friend. |
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He's voting the Biden/ Harris ticket so you don't know how stupid he is.
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If the drug was manufactured in China there's a good chance it's just an estrogen pill. You've been Chinked.
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Klonopins wouldn't even be worth the risk of selling. They aren't very valuable. Also no doubt in my mind TLO uses them. It seems like I have learned a bit about him in the Covid thread.
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Are you drinking a ton more water recently? It's rare, but dilution can cause a false negative. If not that; machine, test, or taking bad meds. If its the test or the machine it shouldn't be just your test failing.
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Considering the lab tested twice I would lean towards the first test being correct as well. So you feel they are effective as they always have been? |
Someone replaced your meds with tictacs and sold them to that wild-eyed guy behind the Savealot
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What is your dosage and how frequently do you take it?
What other meds and supplements do you take? |
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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. |
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I talked to one of the nurses at the doctors office this morning. She said the cutoff the lab uses for a negative/positive test may be set too high. She's going to order a test that has a lower cutoff and see what kind of results we get. |
1.5mg isn't a low dose.
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I don't think there's anything wrong with the medication itself. I'm fairly certain I'd know if it wasn't working. (Bad batch, etc) There's no recalls out that I can find anywhere. |
I've done some research, reading what medical literature I can find. Klonipin in particular seems notorious for giving off false negatives.
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Immunoassay methodology isn't very reliable when it comes to UDS. They have can easily have false positives because they are picking up the structure of the molecule and if someone has taken something similar in structure then it may flag as positive. Im not sure why they don't pick up clonazepam, but I had read that they have false negatives ~30% of the time with benzos.
See if they can just call into Quest and have then do the mass spectrometry for Benzos and that should pick it up. |
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probably using wal-greens. They always give me weird shit. Like I needed a benzo and they gave me caffeine pills
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3rd try - finally came back positive. They ran some kind of specialized test and it picked it up.
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DRUG MONITOR, BENZO, QN, URINE AlphahydroxyalprazolamNEGATIVE 25 ng/mL AlphahydroxymidazolamNEGATIVE 50 ng/mL AlphahydroxytriazolamNEGATIVE 50 ng/mL Aminoclonazepam710 H 25 ng/mL HydroxyethylflurazepamNEGATIVE 50 ng/mL LorazepamNEGATIVE 50 ng/mL NordiazepamNEGATIVE 50 ng/mL OxazepamNEGATIVE 50 ng/mL TemazepamNEGATIVE 50 ng/mL |
Back to the same god damn problem as last year around this time. The nurse called me and had an attitude about me not taking my medication as prescribed. Told her the story of last year and about needing a more specialized test. According to them, that test is no longer available and I need to come back in and repeat the SAME test that is reliably giving me false results. I tell them I don't want to keep paying for labs that I know are going to come back as negative.
What a shit load of ****. |
I suspect your girlfriend is involved. Urine or pills are tampered with.
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People with knowledge of lab work.. I need your help. I followed up with the nurse, and was told I need to repeat the same test, and if it comes back negative, I will either
A. Be discharged as a patient B. Be taken off the medication. I drove out to their office and spoke with them in person and got the same nurse I talked to on the phone. I told her I would take any test they wanted to give me, but that I've been through this before, and that repeating the same test would very likely result in a false negative. I asked to speak to my psychiatrist. Not in office. Asked to speak to the clinic manager. Not in office. She's going to relay my concerns to the doc and the head of the lab department tomorrow though. Is there ac specific test I should request to have done? I did verify through Quest that the test that finally gave me the right results last year is no longer offered in this area, though it's offered in other parts of the country. |
Bump for the night crew
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Not sure what to tell you but I would have killed for that skill in my younger years
(The ability to take drugs and piss clean that is) Monitor your pills to make sure nobody is swapping them out for placebo. Try a different pharmacy. See if you can get on steve wilcos show, he can help get to the bottom of this. I was able to quit taking alprazalam years back and I'm grateful for it, good luck! Oh, you might try drinking less water the day you are going to be tested, have seen where if you drink a lot of water it can **** with results |
dlphg9
Fat Elvis Hammas Any of you guys around? |
Are U a hypochondriac? I’ll let U in on a little secret. Nobody gets out of this alive.
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Could you go to the office for a week each day and take the pill in front of them, then do the test to show them? Just a thought from a laymen that takes no drugs...
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Pretty sure you're supposed to poop in the box and mail it back.
You're welcome. |
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If you were able to identify the issue last year and the same problem arises, then it is almost certainly the same issue given that you were redirected back to a problematic test. Half-life of elimination is variable for clonazepam, anywhere from 17-60 hours. At the low end of the spectrum, a drug with a 17 hour half life would take 85 hours to clear roughly 95% from your body. At the high end, it would be 300 hours, so almost two weeks. I'd also add that the office threatening to withhold your prescription for a benzo is a dangerous precedent given that acute withdrawal can precipitate a seizure. |
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Tomorrow hopefully I can talk to the doc, or someone else that will actually listen to what I have to say. |
After reading this thread and doing some Dr. Google research, I have come to this conclusion.
You haven't drank enough antifreeze, you for some reason seem to be avoiding AIDS trees, dumpster fires, Billay, and butt****ing morons. I suggest you up the dose on all the fore mentioned. Also you are gay. Possibly pregnant |
Could you request a different similar med that tends to show up like it's supposed to?
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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. |
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Perhaps hook effect is creating the EIA issue. |
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Better explanation than I could type. |
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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. |
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The suggestion of having them witness you taking your medications is a good one. You could also offer to have a blood test done, rather than urine False negative BZD testing is not uncommon. |
Did you get a chance to talk to anyone?
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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 |
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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? |
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Bump before this falls off the front page
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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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