What Substances Can Cause A False Positive For Phenobarbitol In Point Of Care Urinalysis

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I was recovering from bronchitis and a severe cold and had been taking over-thecounter anti-haistmaines as wel as flonase and/or afrin nasal spray. I was seeing a pain management specialist for severe arthritis and degenerative cervical disc disease with nerve impingement cauing severe pain to radiate down my arms and into my hands. I had always been meticulous about medications that were prescribed for this as well as other conditions. I have never abused drugs in any way and had an excellent history in terms of passing every random urinalysis which I had taken since the year 2000. I used to have to go to a hospital for the urinalysis. Then the doctor starting doine a point of care UA in-office which told him the results of the urinalysis before he even saw me for my 3 month check ups. At my 05-05-2010 test, he casually mentioned that I had tested positive for phenobarbitol and could I think of where, when, what ahd how of the alleged "phenobarbitol use. I have never taken norbeenm prescribed phenobarbitol for anything at anytime. In fact, I wasn't even sure what it would be prescribed for, other than it was extremely dangerous, was rarely prescribed and that he would have profound effects/side-effects--none of which I had ever experienced. The pain managemwent physician (who has a record of substance abuse himself for which he ,liost his license to practice medicine in the State of Montana as well has being forced to surrender his DEA license relative to his own substance abuse (he would write prescriptions for injuctable demerol/meperidine in the names of some of his patients (unbeknownst) to these patients, would go to various pharmacies and pick up the filled prescriptions himself and divert them for self-administration. In a 2 month period, he had writeen, filled and diverted 102 vials of injectable demerol which he lied about and kept concealed from Montana's Medical Quality Assurance Board until irrefutable information showed him to be lying. He often wou,d accuse me and other patients of abberant drug behavior as if hewere projecting his own behavior onto his patients. It took a while for me to figure this out (I did not know about his sanctions ion Montana until almost 2 years foll;owing my abrupt diosmissal from his practice.
At my 05-05-2010 apppointment, this doctor, in spite of myu alleged "positive" for phenobarbitol, wrote me the usual prescriptions (a 3 month supply) and nothing was further said about the point of care urinalysis, other than for me to say that it must have been a "false positive" and could he recheck the test and/or confirm it by sending it to an ousided lab for confirmation (i.e., a GC/MS test that would identify not just the classification of the drugs, but would actually pinpoint the exact drugs in my system. He didn't rerspond to my request and just told me to make my next 3 month appointment before I left. At my 07-28-2010, after I had waited in the waiting room one hour and 50 minutes foer my pre-scheduled appointment and another 25 minutes in the exam room for him to see me, he entered the room, furious with me and abruptedly terminated me from his practice for my alleged use of phenobarbitol. I asked him for a copy of the confirmation test (which he had not done), telling not only me but another one of my physicians of record that the test performed was like the results of a "finger-print" test and that there were no such thingsas false positives. I later learned that point of care urinalysis were prone to contamination, false positive, human error as well as problems in terms of chain of custody. Both my other physician and I requested the results of all urinalysis performed in both the hospital as well as the urinalysis done in the office--we never received this information in that no GC/MS tests were ever performed. I then asked for the name of the lab that had performed siad tests and again was stone-walled. The physician basically had abandoned me as a patient ni that he was prescribing strong medications to which I had developed a physical tolerance yet not a pstychological one. I am a 58 year old helathcare professional myself, hzaving practiced in the field for close to 35 years so was subject to the same State rules and regulations as was my pain management physician. Plus, I knew about "standard of care and knew enough medical terminology, etc. to pose a threat to this physician (or so he perceived). He would not give me a ereferral to another physician and made it extremely difficult to get another physician whom I had never seen before to trust me and to take me on as a patient at face value. I went through terrible physical withdrawal as a result of his abrupt refusal to write me any more prescriptions to at lest get me by until I could get into see another pain management specialist. The physician was also reluctant to release my medical records--finally, I had to have another one of my physicians request my records which he was again unwilling to do until threatened with legal action. I could see why when I saw my medical records. He had altered my records--he had done a cut and paste job, saying that he had prescribed me a three month supply of my medications when he had not,. There is another page in my records with the same date, saying that he had not given me the medications. AWhen I mentioned the discrepancy to the pain doct's staff, that there existed 2 versions of my written medical record regarding my 07-28-2010 visit0--one being one page in lenth--the other bein 2 pages, and that although dated the same, the reports said differenet things. They denied the fact that the report saying he had not given me any medications had been altered so that it would look like he had indeed covered me until I could get in elsewhere. Plus, he indicated that he had given me a printed list of referrals, which he had not and which were not notedd in the other report. Not only had this physician abandoned me as a patient, he committed insurance fraud in billing me and my medical insurance company for procedures not performed, for treating me for conditions tyhat did not exist, plus lying not only to me but my other physicians, putting me and my family in financial ruin by his false reporting, bullying, threatening me and lying to me, calling me a liar, drama queen, accusing me of aberrant drug behaviors of which I would never think of doint, let alone would such behavior even occyur to me to do in the first place. Only one who had actually engaged in such behaviorwould come up with these allegations. Needless to say, I am in the proocess of putting all of my; information together to file a clamim with the Washington State Medical Quality Assurance Commission as they are encouraging me to do in tht he has had several complaints filed against him, saying thtat he is indeed aqm impaired physician who is a threat to the general public in his wreckless behavior in the Pain Management Filed--a specialty of which there is a shortage of qualified physicians and one that is often a last resort for trusting and unsuspecting patients who have lived in pain, having become disabled, incapable of working and living on a limited income. Anyway, I was told by pharmacists and other physicians taht there are some over the counter cold medications (i.e., anti-histamines) as well as nasal sprays such as afrin or flonase thqt can cause a false positive in a point of care urinalysis test. Aere there any other substances that can cause such a false positive for phenobarbitol?

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I have to apologize, but the lack of the usage of paragraphs in your post makes it very difficult to read and I was unable to go over the entire thing and extrapolate all of the information.

As to the false positive, no I haven't been able to find anything you listed, including over the counter cold medications that are known to cause false positives for Phenobarbital. They can for various other substances, but not for this barbiturate.

https:/­/­www.medschat.com/­wiki/­Phenobarbital/­

Are there any other questions or comments?

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HELP!!!!!!!!!
PLEASE HELP ME IN DETERMINING WHAT COULD HAVE CAUSED A POINT OF CARE URINALYSIS TO SHOW A FALSE POSITIVE FOR PHENOBARBITOL? ( THIS OCCURRED ALMOST 2 YEARS AGO); however, I feel compelled to clear my record in that I have never used phenobarbitols, having always been responsible and meticulous about the medications that have been prescribed for me. I have never used illicit drugs.

At the time of this episode, I was going to a pain management physician who I had inherited from my previous pain panagement physician/anesthesiologist who was forced to retire medical reasons. For over 4 yeasrs, my initial physician and I shared a good doctor-patient relationship based on honesty and trust. I was sorry to lose him as I consideered him to be one of the best physicians by whom I had ever been treated.
From the get go, I was never comfortable with the pain managemen physician who replaced him. Red flags startedto go up all over with each subsequent visit. Instead of paying attention to my initial gut level feeling, I let my intellect over-rule my better judgment. Plus, it was difficult to find andd be accepted into a pain management clinic in that it is a speciality where in there is a shortage of compassionate and qualified health care professionals and it takes time to build a relationship based on trust in an area wrought with potential for abuse, both by patients as well as by their providers.

Regardless of the warning signs, I continued to see this "inherited" doctor for another 3 years. During that timre I endured numerous episodes wherein he would call me names, accusd me ofl habitual lying, over-dramatizing, making up stories to garner sympathy from others so as to keep my flow/intake of narcotics steady, etc. He also accused me of "doctor shopping" as well as diverting and /or selling my prescriptions for cash. I was called an incompetent mother, worthless as an exployee as a registered dental hygienist and o aberrant drug behavior--the likes of which I would never even dream of doiing nor could I imagine that anyone else in their right mind would even think up, let alone actually behave in such a way unless they themselves had participated in such behavior. I waa like-wise accused of "doctor shopping", and diverting/selling the medications prescribed for me for cash.. This man would literally fly into rages, fluctuating on a dmie between Dr. Jekyll and Mr. Hyde. I couldn't think of anything I ever said or did to provoke him, but as time went on, I felt like I was "Alice" out of the storyboook/movie "ALICE IN WONDERLAND", FALLING DEEPER AND DEEPER DOWN THE RA"BBIT HOLE INTO THE INSANITY AND ABSURDITY OF THE "MAD HATTER'S REALITY. EVENTUALLY, reality and clarity set in when I realized that I WAS NOT THE ONE WITH THE PROBLEM--it was the physician himself who had a major personality disorder, rendering him unfit to practice medicine, especially in the speciality of Pain Management (since he had an irrefutable history of substance sabuse himself which cost him not only his license to practice medicine in another state as well ass forfeiture of his DEA license. How he could just pick up and move to another state and pick up where he left off is beyond me and causes pause for thought on how these "licensed physicians" with such a history are screened from state to state. Are there no cross checks?
Needless to say, one day, I went in f or my 3 month meidcation evaluation and was asked to do an in-officxe, POINNT OF CARE UA. Before this, all patients were referred to an outside laboratory in the hospital adjacent to the physician's office. The specimen was collected there and the physician as well as the patient received an official print out of the results. The method of testing was via GC/MS.
I have been licensed to practice as a health car professional myself for over 35 years and am expected to abide by the same set of rules and regulations/guidelines as are physicians. I don't have a license to practice medicine, however, I am familiar what is appropriate "STANDARD OF CARE" as well as being familiar with various procedures and terminology--at least more than a layman would have.
It is my understanding that a POINT OF CARE URINALYSIS is a quick, cost-effective screening test for various CLASSIFICATIONS OF MEDICATIONS. The drawbacks are that such cursory UA's are projne to contamination, false positives, proficiency of the person who supervises and collects the specimen from the patient (often the receptionist), possible issues with chain of custody, tampering, etc. The main advantage is that witin minutes of receiving the specimen the physician has an idea of any irregularities that may be indicative of drug abuse.
If a test shows the "POSSIBLE" presence fo a drug classifcation that shouldn't be there, it is ethical conduct to verify this result by sending the specimen to a reputable outside laboratorty for a CONFIRMATION TEST--A GC/MS--the result of which not only indiciate the CLASSIFICATIONS of a drug group that may be present, but can breakdown and isolate the molecules of SPECIFIC DRUGS--not just their classifications. The GC/MS acts lke a fingerprijnt in that the results are infallible and helkp to rule out false positives that may turn up in a POINT OF CARE UA.
The day of the POINT of CARE test wherein my test indicated the possible preseence of phenobarbitol, the physician was well aware of the results prior to seeing me for my apppointment. He failed to mention the resultsof the test, which he kept recorded on a handwritten piece of paper--this was the official "result format". After reviewing the results and saying nothing about the "phenobarbitol", he preceeded to write out 3 months worths of prescriptions and insturcxted me to make another follow up appointment in 3 months which I invariabley prebooked before I left the office.
Three months latter, after wAITING FOR AN UNPRECEDENTED TWO HOURS IN THE WAITIJNG ROOM AND ANOTHER 25 MINUTES BEFORE HE ENTERED THE EXAM ROOM, he flew in the room in a rage, abruptly telling me taht he would no longer treat me as a patient, dismissing me without assisting mein finding another physician to take over my care and without writing out any prescriptions to geet me by until I could find someone myself. His treatment "wreaked of abandonment", hurling me into 4 weeks of hell, as I struggled throgh horrific physical withdrawal symptoms on my own. I had requested that he repeat the test and /or do A CONFIRMATION TEST, sending the actual print out of the results to me as well sa to my primary physician. He refusede, saying that he did all of his UA testing via the GC/MS method. Well, if such was the case, how was it that he had the results prior to actually seeing his patients for their 3 month medication evaluations (I was not the only patient that he had done this to). After several phone calls and letters sent by certified mail, requesting THE ENTIRETY OF MY MEDICAL RRECORDS, INCLUDING ALL ALB RESULTS AS WELL AS TE NAME, ADDRESS AND PHONE NUMBER OF THE SAID LABORATORIES THAT DID HIS GC/MS TESTING. OF COURSE, WE NEVER RECEIVED A RESPONSE BECAUSE HE NEVER DID ANY INITIAL DRUG SCREENING VIA GC/MS NOR DID HE VERIFY any questionable results or possible false positives IF indicated by the POINT OF CARE UA's. Hence, I had no recourse since the original speciment had been discarded on thedayof its collrection--it was my word against his until he failed to send my medical records as requested. When he finally did, there was a discrepancy between the copy I receivedand that which my primary physician hadreceived--the pain management physican had ACTUALLY ALTERED/FALSIFIED/DESTROYED SOME OF MY MEDIAL RECORDS AND DID NOT SEND COPIES OF ANY LAB RESULTS. pLUS, WE CAME TO FIND OUT HE HAD BILLED MY INSURANCE COMPANAY FOR PROCEDURES AND FOR MEDICAL CONDITIONS THAT I DIDN'T HAVE, opening him up to criminal charges of insurance fraud. There were a number of ofher issues for which he is under investigation by this state's MEDDICAL WQUALITY ASSURANCE BOARD, including practicing medicine as an impaired physician.
When this false positive incident occurred years ago, I asked several health care professionals inclusiding pharmacists and my other physicians of record what medications may have caused the false positive for phenobarabitols. At the time, I was told that flonase and/or other nasal sprays such as afrin could be the culprits as could over-the-counter cold medications/anti-histamines, especially sudafed containing efedrine. Web searches at that time confirmed the fact that flonase was probably the medicatoins that would have caused the POINT OF CARE URINALYSIS to result in a false positive for phenobarbitol. Now, that I am supposed to testify and provide detail information to the MEDICAL QUALITY ASSURANCE BOARD so that sanctions can be made against my former pain management physician, flonsase is no longer listed as a possible contributing factor to th false positive. Why the change over a 2 year time span. Have the quality of the tests changed?
Plus, what if I were employed in a job that required mandatory drug testing and a POINT OF CARE URINALYSIS resulted in a false positive for an illicit drug and was not CONFIRMED BY AN INFALLIBLE TEST SUCH AS TEH GC/MS? I would have lost my job and my livelihood. I have known this to happen to several people as a consequence of this pain management physicians' actoins or lack thereof--moral turpitude, lying, etc.
So, please help me in my ever continuing research wherein I am trying to find the substancre/medication that may have cntributed to the false testfor PHENOBARBITOL 2 YEARS AGO. I want to clear my name and my record and to never have toi endure such an episode ever again nor do I want anyone else to have to, either.









(the report being handwritten---not printed out had the speciment been sent out and done in a reputable laboratory). Even though the physician knew the results before he saw me for my 3 month medication check, he only briefly alluded to the results of the UA and wrote me out my usual prescriptions to last me another three months Upon leaving the officem, I pre-scheduled my next 3 month appoinment.
At my next appointment, after waitin in the waiting room for almost two hours and another 25 minutes for this physician to enter the exam room which was a typical waiting time for all of his patients, he walked in and told me I was being dismissed from the practice as a result of my last UA. Had I known at the time (day) that the test had been taken, I would have immediately requested that the test be repeate and/or that A CONFIRMATION TEST BE DONE VIA A GC/MS WHEREIN THE SPECIMEN WOULD HAVE BEEN SENT TO A REPUTABLE LABORATORY OUTSIDE OF THE OFFICE for verification. Of course, 3 months later was too late--the speciment no longer being in existence, thereby giving me no means by which to prove my "innocence". Plus I had been a patient in thispractice for over 7 years and on each and every treatment note, it was clearlly stated that I showed no signs of aberrant drug behavior and that I had been meticulous and responsible in management of my prescriptions. I guess my spotless history counted for nothing and since the specimen no longer existed, I had no recourse. Basically, he abandoned me as a patient, failing to assist me in finding another physician to take over my care. Nor did he give me any medication (some of which I had taken for an extended priod of time and had developed a "physical tolerance" to two of them, forcing me nto 4 weeks of agonizing physical withdrawal

As I understand it, a POINT OF CARE URINALYSIS can be done in office, is cost-effective, and the physician will have the results within minutes after the urine specimen is collected. The problems inherent in such a manner of testing is that it is merely a 'CURSORY, SCREENING TEST FOR SPECIFIC CATEGORIES OR CLASSIFICATIONS OF DRUGS" and not SPECIFIC FOR IDENTIFICATION OF THE EXACT MEDICATION(s) present in a person's system. A GC/MS, on the other hand, is infallible and is lilke a "drug finger-print" in identifying the spe3cific drug as well as ruling out any false positives which may have shown up in the POINT OF CARE scrrening test.
I also understand that the POint of Care UAs are prone to false positives, the results being subject to contamination, the proficiency of the person supervising and collecting the specimen (should be a nurse, not the office receptionist who not only collects the specimen but reads and records the results without verification--recording the results in a primitive manner--on a hand-written note and not on a n official print out form that would be generated and sent from an outside, hospital laboratory). It is also subject to tampering and issues of chain of custody as well as being easily mixed up with the specimen of another patient in a crownded, cluttered and unorganized front office.

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WOW! I am completely in sympathy with any and all pain management patients who are legitimately in pain, and have to take controlled drugs for their pain. The mandated drug testing is because of the DEA and the States trying to stop diversion and abuse of controlled drugs.
You are completely correct in the FALSE POSITIVES that are reported on just a urine dip, or even a saliva test. The card/ strip tests are NOT conclusive, EIA is even just a screening method. CONFIMATORY testing is expensive, because the technology is expensive. It takes longer time for results, and it is hastle for the staff to handle, and many DO NOT do the chain of custody, and mislabeling, and contamination, especially in the office setting, are very common. A Physician cannot withhold you medical records from you, and if in fact there are different versions this is fraud and a felony. You should report the doctor to the medical board of the state, and the attorney general's office. You could contact that state division of the DEA, although they may not be too interested. There is one caveat that you may be asked to pay for the copying of the medical record up to $1.00 per page....this is legal for them to charge. However, get an attorney or paralegal to get a sub poena from the court for your records, and force the uncooperative providers to comply with the law. If you are honest, and open, and do not hide or go with defensive talk to your provider, they should be more than willing to help you.
I too have chronic pain, and must go to a specialist, despite my own medical ability.
Best of health to all.

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