positive urine tox!?

[RabarBar]

---

Members don't see this ad.

This is an unfortunate situation, Lynda19, hope the truth will prevail.

Urine drug tests - I can understand. However I was shocked by the policy of (The) Cleveland Clinic on smoking nicotine, is it even legal for them to do that in The land of the free ?
BTW - I took usmle step 3 today and , guess what, I had a question about exactly this issue - "... which of the following can give a false positive drug test ..." - pseudoephedrine, right ?

 

[lynda19]

Yes, Yes Pseudoephedrine!! 🙂)

ugh, no results yet but here's an interesting tidbit. At orientation, the physician in charge of reviewing my case had a presentation. Turns out he is director of the physician health/mental health services (I was never quite sure of his exact title). He talked about drug use & negative coping mechanisms to avoid during residency. Well this is what happened: He said physicians are more likely to use prescription medications. At this point, I could swear he had a clear shot of me in the audience, I could be wrong (paranoid?), BUT he turned away from me & added "...stimulants included." !!!!!! WTH?? 😡

I dont think he was giving me a shot-he doesnt seem to be malignant but I do think my case made him think of this example. Well, either way I was kinda upset. I am unable to stand up in the audience & proclaim my innocence & I felt very akward when he said that. I felt like I had to watch whatever expression I had on my face lest he analyze it.

Whatever. I'm still waiting for the lab results & I made some calls for attorney references.

 

[RussianJoo]

I would be very interested to know whether current match contracts specifically contain clauses about drug testing. I maybe an old timer, but I know for a fact I never signed any such thing back in the day. Regardless you run a fairly huge risk if it's keystone cop amateurs doing the collection and testing (which it often is..). Caveat emptor.

yep even to rotate at some hospitals they require a drug test.. times are changing.. we can't simply go on our word anymore...

 

[loveoforganic]

To the person that posted earlier about the GC hot plate degrading the pseudoephedrine to amphetamine, you'd be in the same position for a GC/MS since your analyte only gets fed into the MS once it passes through GC, would you not? I'm not sure what other methods they could use to isolate the analyte, presumably pseudoephedrine, (without danger of degrading it), but I don't see GC/MS over GC alone being a solution if that is in fact the problem.

HPLC, on the other hand, shouldn't degrade your analyte at all, and should be equally effective to an accurate MS. Pseudoephedrine and amphetamine definitely have different polarities and would elute at different rates. I'd push for an HPLC.

GL OP, hope it all turns out well.

 

[docB]

I would be INCREDIBLY concerned about this. This isnt hahaha-crap, this is "my career is essentially over" level of debacle. I run a lab, Ive worked in forensic tox facilities. If this rolls out bad for you, you will be essentially barred from ever getting a medical license in any state or foriegn country for that matter.

This statement is 100% false and ridiculous. Lot's of docs get in trouble with substance abuse problems. They might have to do some sort of rehab and take random tests, but to say you will "never get a license" in this or any foreign country is absurd.

She'd be better off taking advice from the vet students.

LA Doc00 may be over stating this a bit. As Octa points out you can have a long an fruitful career as a recovering user after you get clean and go through the deversion program. However I'm sure this isn't what the OP has in mind as it would require explaining the issue with every license and every priveledge application.

I think the thing to say that no everyone would agree on would be that if this results in some kind of finding that the OP were using or some form of diversion it would follow them forever and might decrease their competitiveness for some jobs. That's why many of us are recommending legal advice and not changing stories.

 

[lynda19]

I am sure there are plenty of docs who have gone through programs & have been allowed to practice medicine. BUt what about refusing to participate in a program assuming you are denying using anything. I have to think though, that eventually if a person is not using, there is SOME test to be done that can prove it, so maybe the point is moot? Unless you are claiming the sample was tainted (not my case).

 

[docB]

I am sure there are plenty of docs who have gone through programs & have been allowed to practice medicine. BUt what about refusing to participate in a program assuming you are denying using anything. I have to think though, that eventually if a person is not using, there is SOME test to be done that can prove it, so maybe the point is moot? Unless you are claiming the sample was tainted (not my case).

And that's the real problem. People who are clean have no problem. People who are using can do diversion. People who are clean but have a postivie tox get thrown into a Kafakaesque situation where they have to try to prove their innocence but have no real way of doing so and are told repeatedly that they should just admit to something because it's the easy way out.

There was an interesting case here in Vagas a while back where a doc pled no contest to charges of cocaine possession. The coke was found in his car so his lawyer advised his to plead no contest because he felt he could not win an acquittal. The doc then went to the med board in an effort to keep his license. The board put him in the state diversion program. However step 1 of the diversion program was to admit that you have a problem. The doc maintained that he didn't have a problem other than poor judgement about who he let in his car. He eventually sued the medical board and the diversion program saying that they had slandered him by trying to force him to say he was a drug addict.


http://www.reviewjournal.com/lvrj_home/2003/Sep-27-Sat-2003/news/22250559.html

http://www.reviewjournal.com/lvrj_home/2004/Oct-14-Thu-2004/news/24992611.html

http://www.drug-rehabs.org/con.php?cid=5224&state=Nevada

 

[NotAProgDirector]

The second article you list paints a very different picture of the story:

Dr. Kurt Buzard's arrest for cocaine possession after leaving his Las Vegas office on a hot August night in 2003 wasn't his first drug bust.

The ophthalmologist also was arrested for cocaine possession in Colorado in December 1985. He disclosed the arrest when he applied for a medical license in Nevada in 1986, but he said he stopped using drugs after his arrest.

(text skipped for brevity)

... 17 years later when Buzard was arrested while wearing a dog collar, scantily dressed in underwear and almost incoherent from cocaine use.

Buzard and an unidentified woman reportedly had shared cocaine in his office and she was driving his car when a police officer stopped them for a traffic violation, official records said.

People have the right to wear dog collars and underwear. I'm not sure I understand why you would want to do that, but to each their own. You do not have the right to use cocaine, and certainly not drive a car while on cocaine.

I'm sure there are two (or more) sides to this story, and it's anyone's guess who is right. That being said, if he has two arrests for drug possession, my money is on a real drug problem.

 

[Winged Scapula]

The second article you list paints a very different picture of the story:



People have the right to wear dog collars and underwear. I'm not sure I understand why you would want to do that, but to each their own. You do not have the right to use cocaine, and certainly not drive a car while on cocaine.

I'm sure there are two (or more) sides to this story, and it's anyone's guess who is right. That being said, if he has two arrests for drug possession, my money is on a real drug problem.

IMHO, just look at the mug shot in the first article. He may not be on cocaine, but he looks a bit under some influence.

 

[BADMD]

To the person that posted earlier about the GC hot plate degrading the pseudoephedrine to amphetamine, you'd be in the same position for a GC/MS since your analyte only gets fed into the MS once it passes through GC, would you not?

Labs should use a lower injection port temperature to avoid this problem.

 

[loveoforganic]

I know what they should do, but if you're asking for a GC/MS from the same lab, they're probably going to have the port set at the same temp as it was for the GC alone and fry the pseudoephedrine again.

 

[docB]

The second article you list paints a very different picture of the story:



People have the right to wear dog collars and underwear. I'm not sure I understand why you would want to do that, but to each their own. You do not have the right to use cocaine, and certainly not drive a car while on cocaine.

I'm sure there are two (or more) sides to this story, and it's anyone's guess who is right. That being said, if he has two arrests for drug possession, my money is on a real drug problem.

IMHO, just look at the mug shot in the first article. He may not be on cocaine, but he looks a bit under some influence.

Oh yeah. I'm not trying to use this guy as an example of someone who was wrongly accused. I should have been more clear. I'm using this guy as an example of how weird things can get.

 

[Winged Scapula]

Oh yeah. I'm not trying to use this guy as an example of someone who was wrongly accused. I should have been more clear. I'm using this guy as an example of how weird things can get.

Of course, you have just violated the rule, "what happens in Vegas..."

 

[docB]

Of course, you have just violated the rule, "what happens in Vegas..."

'Course since the doc in question and I live here that doesn't apply to or help us at all.

It'd be nice if it did though because this incident (dog collar, cocaine, hooker, etc.) is pretty much par for the course around here.

 

[BADMD]

I know what they should do, but if you're asking for a GC/MS from the same lab, they're probably going to have the port set at the same temp as it was for the GC alone and fry the pseudoephedrine again.

Hence why the original poster needs to find out how the test was done and if it met the appropriate standards. If the sample truly shows a false positive, then then the method will need to be attacked. Straight GC should be able to tell the difference between pseudoephedrine and various amphetamines, if done appropriately. The OP needs to know if it was done appropriately.

 

[lynda19]

Hence why the original poster needs to find out how the test was done and if it met the appropriate standards. If the sample truly shows a false positive, then then the method will need to be attacked. Straight GC should be able to tell the difference between pseudoephedrine and various amphetamines, if done appropriately. The OP needs to know if it was done appropriately.

I agree. Everytime I ask about the testing methods & what type of test, I dont get a direct answer-just "they dont believe it could have been caused by PE." Which is why depending on these next results, I think an attorney can better force the issue.

 

[NotAProgDirector]

I hate to point it out, but GC/MS (or LC/MS) is really considered a virtually "perfect" test. Urine drug ELISA is to fingerprinting as GC/MS is to DNA sequencing. If DNA at the scene of a crime is sequenced (or whatever it is they do to DNA for this purpose) and it matches you, you were basically there. Arguing that DNA testing has false positives just doesn't work anymore, because matches are now in the 1:1 million+ range.

Tox labs consider GC/MS similar. There simply aren't (according to them) any false positives. Using Google and pubmed I couldn't find a single, documented example of a flase positive GC/MS test, plenty of false positive urine ELISA's. From a testing lab:

False Positive Results: The following is a list of prescription and over-the-counter drugs that can cause false positives for methamphetamine on an immunoassay screen test (the list is not comprehensive and the following drugs are found in a large variety of medications). These drugs will NOT test positive for methamphetamine or amphetamine by LC/MS/MS.
Ephedrine Pseudoephedrine (Sudafed) Phentermine
Fenfluramine Phenylpropanolamine (PPA) Propranolol
Phenmetrazine Thorazine (Chlorpromazine) Mephentermine
MDMA (ecstasy) Methylphenidate (Ritalin) Bupropion
Mahuang Tea (or tea made from plants belonging to the ephedra family)

You certainly can get a lawyer should you retest positive, and probably should, but I think it's going to be hard to prove that their testing is somehow faulty. You would need scientific proof that running a urine specimen with pseudoephedrine in it through a GC/MS with the port temp set high somehow alters the test.

 

[BADMD]

I hate to point it out, but GC/MS (or LC/MS) is really considered a virtually "perfect" test.

That is not correct. A properly run and interpreted GC/MS maybe, but variations in injection method, column factors, characteristics of the library, extraction and derivation, computer based pattern matching, plus others, can all change how the peaks come off the column and how they are matched to the substance library. An inexperienced lab can incorrect create a match if it is not performed properly.

As for false positives, most are contained in text books as pitfalls in analysis. Here is one report, however: http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

 

[NotAProgDirector]

As for false positives, most are contained in text books as pitfalls in analysis. Here is one report, however: http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Nice pick up. I should amend my statement. "GC/MS is considered a 'perfect test' by the medical community". Perhaps that reliance is not well founded. regardless, this gives the OP an argument to refute this. The costs and time involved in refuting the finding may not be worth it, however. But I certainly agree with fighting it on principle.

 

[lynda19]

Cant believe I still dont have any results yet! Just short of 2 weeks now. Well, I happened to see my PD & he wasnt aware of the situation. He said "dont worry, it'll get straightened out" & seemed pretty authoritative & genuine when he said it. His expression was kind of smirking a bit, as if he thought this was crazy. I felt as if he was on my side of it. The way he reacted reduced my stress a bit, so we'lll see.
Still waiting...

 

[LosingStreakers]

Cant believe I still dont have any results yet! Just short of 2 weeks now. Well, I happened to see my PD & he wasnt aware of the situation. He said "dont worry, it'll get straightened out" & seemed pretty authoritative & genuine when he said it. His expression was kind of smirking a bit, as if he thought this was crazy. I felt as if he was on my side of it. The way he reacted reduced my stress a bit, so we'lll see.
Still waiting...

I trust you have spoken to a attorney by now?

 

[Tigerz_Fan]

I trust you have spoken to a attorney by now?

A new thread has already been started stating that the results are negative.