Question about some lab results

[TLO]

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.

[EPodolak]

Originally Posted by TLO

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

Yep, but barring the obvious and to save you another year of this thread may have to make other arrangements.

[dlphg9]

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.

[TLO]

Originally Posted by dlphg9

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.

Hey, thanks man.

[SupDock]

Originally Posted by dlphg9

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.

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.

[TLO]

Originally Posted by SupDock

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.

What's hook effect?

[SupDock]

Originally Posted by TLO

What's hook effect?

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

Better explanation than I could type.

[TLO]

Originally Posted by SupDock

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

Better explanation than I could type.

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.

[SupDock]

Originally Posted by TLO

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.

I’m afraid I don’t have any specific recommendations. You will likely need an appointment to plead your case, and either they will listen, or they will not.

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.

[dlphg9]

Did you get a chance to talk to anyone?

[TLO]

Originally Posted by dlphg9

Did you get a chance to talk to anyone?

Finally got to talk to the clinic manager. She at least seemed to understand my plight. I'm supposed go go in and meet with her on Monday

[jettio]

Originally Posted by 'Hamas' Jenkins

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.

Check out the big brain on Brad! You a smart mutha....

[TLO]

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

[dlphg9]

Originally Posted by TLO

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

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?

[TLO]

Originally Posted by dlphg9

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?

See the weird thing is that my number came back as 791 after they did the MS test last year.

[TLO]

Bump before this falls off the front page