Drug Screen Positive For Amphetamine But I Didn't Take Any!

What do you do if you're a patient and your drug screen tests positive for amphetamines?  You swear up and down you've never even seen meth.  You don't know how to make it.  You don't know how to snort it or melt it.  You've never even seen it.  What do you do if your doctor sends you a letter releasing you from their clinic.   Here's one reader's experience.
I had been with my doctor for 17 years. She also treated my wife and mother. I went in for lab work to recheck cholesterol, sugar and urine tox because I was prescribed Norco for chronic back pain after a drunken teen hit me while  I was crossing a driveway. I have had numerous drug screens that I willingly submitted to but this time she called me and said that I was positive for amphetamine.  I've never taken it in my life. What's worse she let me go from her practice and wouldn't let me submit for a hair test in a month from the urine tox (in order to let it grow above the scalp). I knew it was worthless to repeat urine because of clearance. Now, the urine was sent for GC-MS (gas chromatagraphy mass-spectrometry) and it was still positive. Now I appear as a substance abuser when I'm not. I cannot explain why it is in my urine but I believe a hair test is my only way to gain my new doctor's trust because the trust has to run both ways. I can definitely see the doctor's point of view but I've never even smoked pot and I'm 44! Any advice on how to approach this with the new primary care doc? I want to be honest and have everybody's hands on the table. Suggestions?
Man.  GC-MS.  I haven't heard that abreviation for 15 years since I worked on my undergraduate chemistry degree. If I have any suspicion of drugs of abuse, recreational or prescription, I usually order a urine drugs of abuse screen. Ialso understand there are many drugs and even non pharmaceuticals that can interact with the drug screen assay to give a false positive screen.  I've seen the list.  It's pretty extensive. 

For many doctors, taking care of patients on chronic opiates can be a complicated process.  When I confront folks on really high doses of oral opiates requesting intravenous name brand drugs by name, I tell them they are physiologically addicted and  have built up an exceptional tolerance  as witnessed by higher and higher titrated doses of ineffective medication.  I tell them quick acting intravenous medication is not the solution to their problem.  It's a major part of their problem.    I recommend they seek drug counseling and psychiatric assistance as opiate dependence often involves comorbid psychiatric depression or other supratentorial disease processes.  Pain and the perception of pain is a highly emotional process.   What causes intense pain for some causes no response from others.  The solution is often multi modal in approach not simply more narcotics.

Frequently I'm told to get lost.  Occasionally I have patients who respond well.  I once had a patient send me a thank you letter for me playing hard ball and making them face their addiction head on.   But I've also had patients file complaints for not playing their manipulative games.  In your case, once the trust between you and the physician is lost, neither you nor the physician can continue  effectively in a broken doctor patient relationship.  It's time to move on.

Being open and honest is all you can do from a patient perspective to try and gain the trust of another physician.  Even if you're right and the physician is wrong, if the trust is gone, there is no sense in trying to hang on.  As long as the state and federal governments require licensed physicians to prescribe your opiate pain medications, you are at the whim of their decision.  If they don't want to deal with you anymore or don't want to take you on as a patient, you have no recourse.  Physicians can't be forced to see you any more than you can be forced to see them.  The relationship is a volunteered relationship.

By the way if you have good paying insurance you probably won't have any problem finding a new doctor.  If your drug screen tests positive for meth and it's a false positive, the real problem you should concern yourself with is nixing the false positive drug screen from your report.  Who knows, it might come back to haunt you in the future (applications, license, jobs).   By the way, most offices have to give you a reasonable time  to find another doctor, usually 15-30 days.   I suppose you could have had her pluck some hair on day 29.

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