Definitive Testing Detects Opioid Nonadherence

Definitive Testing Detects Opioid Nonadherence

The alarming results are clearly the result of erroneous drug tests, which seem to show huge percentages of patients misusing opioids. A previous post, Urine Drug Test Often Gives False Results, explains that the percentages of “misuse” are easily explained by the high rate of “false positives” on the most common urine drug tests.

Without an expensive lab test to verify these results, the conclusions are based on data that’s known to be faulty.

The article never describes what “definitive testing” they were using, but for 634,000 patients, they could not have used the gold standard, because a laboratory test that uses chromatography-mass-spectrometry, costs thousands of dollars.  

Definitive testing revealed if patients prescribed an opioid were adhering to their medication or taking another medication that had not been prescribed, going beyond the information gathered from point-of-care testing.

The study included urine samples from 400,334 patients prescribed hydrocodone as their only opioid and 234,273 patients prescribed oxycodone as their only opioid

The researchers screened each sample for

  1. codeine,
  2. morphine,
  3. hydrocodone,
  4. norhydrocodone,
  5. hydromorphone,
  6. oxycodone,
  7. noroxycodone, and
  8. oxymorphone.

If a sample tested positive for opioids, they underwent a mass spectrometry and were categorized into one of four groups:

  1. Positive for only the prescribed opioid
  2. Positive only for a non-prescribed opioid
  3. Positive for both the prescribed opioid and a non-prescribed opioid
  4. Negative for all opioids

Out of the 28,195 samples of patients prescribed hydrocodone that tested positive for other opioids,

  • 21.7% were positive for codeine,
  • 41.5% for morphine,
  • 37.9% for oxycodone,
  • 53.2% for oxymorphone, and
  • 51.4% for noroxycodone.

For patients prescribed oxycodone who tested positive for any opioid (n=182,823),

  • 87.7% were positive for only the prescribed opioid,
  • 0.2% for only a non-prescribed opioid,
  • 11.5% for both a prescribed and non-prescribed opioid, and
  • 0.5% were negative for all opioids.

Out of the 21,461 samples of patients prescribed oxycodone that tested positive for other opioids,

  • 11.3% were positive for codeine,
  • 38.1% for morphine,
  • 45.8% for hydrocodone,
  • 49.0% for hydromorphone, and
  • 57.0% for noroxycodone.

These seem to be exactly the kinds of errors the previous post warned of: “False positive results were detected over 41% of the time and false negatives over 31% of the time for oxycodone.

This is also why Dr. Fudin developed his drug-test interpretation app:
REMITIGATE, LLC | Dr. Jeffrey Fudin

Here’s an explanation of the app and how it can help:
App for better Interpretation of Urine Drug Testing

4 thoughts on “Definitive Testing Detects Opioid Nonadherence

  1. Doc Anonymous

    There is another issue that is very worrisome about this report. The author indicates that they tested for hydromorphone and oxymorphone. Neither of these is reported as showing up in the urine for people taking hydrocodone or oxycodone. That is just unbelievable.

    In many people, hydocodone is metabolized to hydromorphone. Thus a significant number of people who are legitimately taking hydrocodone will also show hydromorphone in their urine.

    Similarly, oxycodone is metabolized to oxymorphone. Thus a significant number of people who are taking oxycodone will also show oxymorphone in their urine.

    A I read this report, the author reports that hydoromorphone was NOT detected in the urines of people taking hydrocodone. And oxymorphone is not reported as being present in the urines of people taking oxycodone.

    Those scenarios are humanly IMPOSSIBLE. It means either the author is collecting inaccurate data, or their testing is simply not accurate. I would say that is incredible but then it seems that truth and validity are concepts that do not apply to the misinformation that is used to villify the legitimate pain victim.

    Liked by 2 people

    1. Zyp Czyk Post author

      The problem is that they are assuming all these people are not taking their meds but selling them instead. From my involvement in the pain community, it seems highly unlikely that so many people aren’t taking their meds when so many of us have trouble getting them.

      Liked by 1 person

  2. painkills2

    I found it interesting that out of those taking oxycodone, 87% were positive for only the prescribed opioid, while the statistics for hydrocodone show many testing positive for other opioids. I know it’s impossible to determine anything from these obviously flawed results, but it looks like oxycodone works a lot better than hydrocodone, leaving those who take only hydrocodone needing to supplement to manage their pain.

    It’s flawed statistics like this that allow the drug war to continue.


  3. Payne Hertz

    Now all we need is an explanation for why non-adherence should result in a sentence of torture. Once we get this may I suggest we reconsider the penalties for malpractice and medical fraud? Perhaps losing an eye or hand along with lifetime banishment to Antarctica would be proportionate to what we get?

    Liked by 1 person


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