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Thread: I'm NOT taking my medication?

  1. #1
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    Default I'm NOT taking my medication?

    Hi. I've been taking 6mg of Clonazepam per day for at least 16 years (possibly a year or two more). I live in Cape Breton, where the turnover of doctors is like the turnover of players in the CFL (the doctors put in their time before moving on to where the real money is). Anyway, my 'new' doctor (she's my 4th in the past nine years) is telling me that my Clonazepam isn't showing up in my urine sample. She seems to be implying that either I'm not taking it or that I'm somehow selling it (is there even a market for it??).

    When I saw her last week and 're-sampled,' she said that if it showed in the sample she would fax a new prescription to my drugstore (I'd be running out over the Christmas holidays and wouldn't be able to see her), otherwise no. Today her office phoned wanting to see me next week. I don't think this bodes well.

    The Question: Can anyone tell me if they've had a similar experience or any reason Clonazepam wouldn't show up in a urine sample 2 1/2 hours after taking it? I should mention that because I used to forget to take 2mg 3X/day, I decided to take half (3mg) when I got up in the morning and again before going to bed. Since last week's visit, I've changed back to 2mg 3X/day, but on the day of my last visit I had taken 3mg, as mentioned, 2 1/2 hours prior to the new urine sample.

    What gives? (I'm 6'1" and in the vicinity of 190 pounds)

    Any suggestions/recourse if she denies the prescription?

    Glenn
    Last edited by ennzennz; October 30, 2013 at 01:46 PM.

  2. #2
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    Default Re: I'm NOT taking my medication???

    Any suggestions/recourse if she denies the prescription?
    Hello Glenn,

    It seems like a peculiar response by your new doctor, especially if you have a documented history of having used the medication successfully to manage the symptoms for which it had been prescribed...presumably anxiety issues, correct?

    Clonazepam is in the minor tranquilizer class of medications called benzodiazepines, that are generally prescribed short term to help manege anxiety and/or sleep issues.

    Some doctors have reservations about the use of benzodiazepines even on a short term basis, and sometimes try to persuade their patients to consider other options in medications or non medication strategies to manage their symptoms.


    She seems to be implying that either I'm not taking it or that I'm somehow selling it
    I find that reaction to be a little unorthodox...any idea why your doctor would come to either of those conclusion?

    Your only real option would seem to find another doctor if you do not feel comfortable with the style and commitment of this doctor.

    Does this doctor work for a group clinic, or is she in an independent practice? Is she a graduate physician or a resident in training doing a rotation in your area? Can you speak to her supervisor to express your concerns? Another alternative could be to speak to your pharmacist who may be able to point you to another doctor.

    An option of last resort, if you feel this particular doctor is refusing to believe you and fails to care for your best interests could be to make a report to The College of Physicians, but before resorting to drastic measures, I would try to have a meaningful conversation with this doctor, and find out why she has difficulty accepting your compliance with your medication.

    Why has the clonazepam been prescribed for you in the first place?

  3. #3
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    Default Re: I'm NOT taking my medication???

    Hey Steve.

    Clonazepam was prescribed as more or less an attempt to temper my motor tics. It's worked for the most part, but when anxiety gets to a certain point things get away for a bit. My only concern was the veiled suspicion over the lack of evidence in the urine sample and the implied threat to halt my prescription.

    She's in private practice and has been practicing in Canada (from what I gathered from her wall framings) for 5 or 6 years.

    She's doing what I assume is due diligence, but I now question the lifespan of the drug in my body given the length of time I've been taking it.

    I'll know more next week, but I have questions beyond her response.

    Glenn

  4. #4
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    Default Re: I'm NOT taking my medication???

    Clonazepam was prescribed as more or less an attempt to temper my motor tics. It's worked for the most part, but when anxiety gets to a certain point things get away for a bit.
    As I said earlier, clonazepam is a minor tranquilizer usually prescribed to help manage anxiety and sometimes to help fall asleep. There is no way to know the rationale of the doctor who prescribed clonazepam for managing your Tourette tics, but I suspect the thought was that by moderating your anxiety caused by stress, your tic activity might be reduced. It seems that has worked for you to a certain extent, but might not be the best strategy long term.

    If you have been officially diagnosed as having Tourette Syndrome, I would suggest asking to be referred to a specialist in movement disorders, typically a neurologist or a sometimes a psychiatrist with expertise in Tourette Syndrome to re-evaluate your situation, your needs and possible treatment options.

    You can call the National Office to find out who specializes in Tourette in your area, and arrange a referral to that person.

    Clonazepam may or may not be effective for you for this purpose, but if you're saying there are situations where your tics are more difficult to manage, you may need other kinds of support to deal with these situations, either in the form of psychotherapy support, or alternative mediation support.

    What may help could be some strategies to diffuse known stressful situations with specific relaxation exercises to help manage your anxiety. Some light duty cognitive therapy might be something to look into.

    If this particular doctor seems to be focused on analyzing your urine samples to determine if you're taking your medication, she may be overlooking your real need which is to find an effective way to manage your symptoms, that, according to what you said, this medication alone is not doing.

    I'm still curious as to how the conversation between you and this doctor took place to lead her to the conclusion you were either not taking the medication or selling it. Have you had previous difficulty with medication non compliance or substance abuse?

  5. #5
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    Default Re: I'm NOT taking my medication???

    Steve:

    >I'm still curious as to how the conversation between you and this doctor took place to lead her to the conclusion you were either not taking the medication or selling it.

    As I mentioned in my initial post, the threat of not renewing my prescription if there was no trace in the urine sample merely implied what seemed to be obvious options. She said there was no trace of the meds in the previous urine sample and so wanted another sample. That was it.

    Glenn

  6. #6
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    Default Re: I'm NOT taking my medication???

    But why did the doctor request a urine sample to begin with? That's not standard practice generally...

  7. #7
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    Default Re: I'm NOT taking my medication???

    Hi Ennzennz!

    I, too, have taken clonazepam for quite a while, but haven't had a urine test, so can't say whether or not it would show up for me. I can say, however, from personal experience, that getting off clonazepam too quickly can have strange and uncomfortable consequences.

    In my case, I went down .5 mg per month till I was off. Then, the first few days were fine, the next few days I experienced withdrawal symptoms which weren't too bad. So I thought everything was okay. Nope! Have you ever heard of derealization? It's no fun, and didn't seem to be getting any better after a few weeks. So I planned to just wait it out and see if the symptoms would go away. Then, about one month after being off clonazepam, my original anxiety symptoms returned. My doctor didn't understand about the derealization, nor did I, so he sent me to a psychotherapist who put me back on clonazepam.

    The psychotherapist didn't know about derealization either; I learned about it from the Internet. Anyways, my pharmacist had heard of the symptoms I described, and said that going down by .5 mg per month was way too fast. So, the moral of this story is that I think it's a really bad idea to get off clonazepam cold-turkey! Your doctor should know that.

    One of my doctors told me that he has patients in prison, and that he gets them off 3 mg. clonazepam in two weeks. I hate to think of what it would be like for you to go from 6 mg. to nothing in one day! You should do some research and find out what the consequences can be for going off clonazepam too quickly, maybe ask around on psychlinks dot com or psyforums dot com, then tell your doctor.

    I'd guess there probably are people who are interested in buying clonazepam illegally. You wouldn't think so, considering that it's easy to get a prescription for it. But you do need to see a doctor and maybe some people can't afford it or don't have health coverage or just don't have time if they're in a hurry to find a drug. Addicts typically use alcohol or marijuana when they're coming down off drug, so probably clonazepam is something an addict might be happy to buy if you were interested in selling. Never heard of it personally, but wouldn't be surprised.

    One possibility is that the pharmacy you're using is not stocking good meds. This happens sometimes, especially at a pharmacy that doesn't get a lot of business or that doesn't sell a lot of whatever medication you're taking. If you think this is a possibility, switch pharmacies. Ask your pharmacist how much of the medication you're taking is sold there, and how long the batch of clonazepam from which you got your prescription has been on the shelf.

    Do you know someone who can vouch for your taking your clonazepam? Co-worker, friend or family member? Even if they can only say that they've seen you taking it, it might be a good thing to have as many people as you can get to write a short letter on your behalf, notorized if possible, make copies, and give them to your doctor. If not, then just anyone that can attest to your good character in general?

    It's pretty obvious that your doctor does not trust you. That's not cool. Also not good for your sense of self-worth. If it's true that clonazepam will not show up in a urine test in someone who's been taking it for a long time, then your doctor should know that and give you the benefit of doubt. At the very least, she should agree to have you go off the meds gradually, so you won't experience possibly severe effects from a withdrawal that's too fast. In any case, I'd get a new doctor and that's what I suggest you do.

    Just a guess, but it seems to me like you might just have an innocent, honest type of personality that most people aren't used to. Like maybe you're a bit more out-going or friendly than most people where you live? That behavior, in itself, can make some people suspicious, you know! Has anyone ever told you that you're "smarter than you look"?

    Let us know what happens, Ennzennz. Hope all goes well for you!

    Twidget

  8. #8
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    Default Re: I'm NOT taking my medication???

    djbaxter:

    Hi. My doctor for the past 5(?) years moved to Toronto late last year. She was always very thorough and always followed up on the most recent visits (from her notes, etc.) so she was up to speed and would also ask me questions to fill in gaps in her notes and so forth.

    I've only seen my 'new' doctor 4 times. On the first visit picked out something that was already worked out by my previous doctor's due diligence and persistence. So going over the same tests was pointless busywork and a waste of time. (She coughs with her mouth open and has no hand cleaner/sanitizer in her office. I know, right? How to instill confidence...).

    Visit number 2 ended with the urine test and she stated it was for a drug test. Now, since this was only my second visit and she still didn't know me from Adam AND the fact that I live in Cape Breton, I didn't think it was unreasonable (given all the recreational drugs floating around). In fact, I didn't think anything of it at all, until the next visit when the issue of the absence of clonazepam in the urine sample was raised. New urine sample.

    On visit 3 (about three weeks ago, maybe a month...), after being told the sample was clonazepam-free, she asked for another sample (#2) that would be tested specifically for clonazepam. Fair enough, I thought, nothing can be expected to be perfect and retesting made sense and since my most recent dose was taken roughly 3 hours earlier, I was fully expecting the previous finding to be overturned "upon further review..." But when she added that unless it showed positive she would not be able to renew prescription renewal and implied that the negative result lay entirely with me, I became concerned.

    So, finally, visit 4 this past Thursday (Nov. 7). I was surprised when she said [sample #2] was again negative. I was more surprised when she said "either you're not taking it properly or you're doing something else." I was still trying to parse that when she continued on, saying that I should give another urine sample (#3) and it would be tested specifically for Clonazepam. I reminded her that that was what she recommended last time whereupon she said no she didn't. I started to wonder who's urine needed testing.

    I have a cousin 5 minutes away (quicker if you walk) who runs biology labs at the local university but before that was a lab tech at a local hospital for several years before reprising the role at a private research center. So when I got home, I gave him a call and told him pretty much what I've posted in this thread and he was just as incredulous. He thought the whole thing was fishy and that he'd look into Clonazepam and get back to me on the weekend.

    Now, whenever I've done reading on Clonazepam, it's always been with a view to side effects and any updated information on it. But that evening I searched for anything I could find on it missing in urine tests. From people in a similar situation as mine, to people trying to avoid it being detected, I found that the definitive test for clonazepam in a urine sample is an immunoassay screen with a GC/MS follow-up, but that a serum blood test was more effective.

    So yesterday (Friday) I went to my hospital (Cape Breton Regional, in Sydney, NS; my doctor's practice is in New Waterford, 13 miles away, next to their local hospital) and spoke with the head nurse of blood work (and urine samples) and showed her what I had found online and asked if the hospital had this test in its arsenal. She told me that the test would have to be done in Ontario (she even suggested the Mayo Clinic), so clearly what appears to be the final say in the Clonazepam/Urine sample question isn't capable of being solved in Atlantic Canada. If what I found online is accurate.

    The nurse at my hospital suggested getting my doctor to fax in a blood work request for clonazepam before they closed collections for the day (and holiday weekend), which was in a half hour. I was told that my doctor "was seeing patients right now" (seriously, how long does it take to tear the top sheet off a blood work pad and write what, five words, and hand it off to either of two receptionists??). Anyway, the fax didn't beat closing time and with collections closed on Monday, I'll know Tuesday if she sent it. So the wait continues and I look for another doctor.

    A part of the answer to your question could be that a urine sample at the office couldn't be 'prepared' for the way a blood sample could be 'fixed' in advance by popping some pills ahead of time. But surely repeats of urine tests could be similarly manipulated beforehand so I guess I don't get it either.

    Sorry for the wordy reply, but thanks for yours,
    Glenn (ennzennz)

    ---------- Post Merged at 05:21 AM ---------- Previous Post was at 03:37 AM ----------

    Twidget:

    Thanks for the great post (it's my kind of post!).

    You make a couple of great points that wouldn't have occurred to me:

    a/ derealization: never heard of it before. Only just scanned some material on it. Yikes and a half. That couldn't have been any fun unless you were channeling Salvador Dali. 2 1/2 years ago I received a major concussion and it was a month before things started to ease themselves back toward normality (whatever that is/was) I only have a partial sense of who I was before so I'll take the more mellow version that exists now. Silver lining? It felt like I was in a full size cocoon watching everything around me as if it was all a play. It was interesting to say the least, but I can't imagine what it must have been like having a much more intensely distorted version rearing up...you must be a survivor.

    b/ shelf life at the pharmacy: sounds like a sitcom. Definitely something to look into. Although I don't think it is a factor in my situation, knowing is better than not knowing. Plus I can ask them if THEY know about derealization. Two birds/one stone.

    Yes, I am able to put a list of "character" witnesses. Fortunately, a lot of my high school/university friends and a number of my relatives are lawyers (have you seen "Jaws?"), specialists and high end military types, so that's not an issue, but it's a point to consider collating some statements.

    Gotta laugh at the personality comment. I like to think I'm honest (like most people) but I know I'm earnest and I've noticed over the years that it really seems to bug people and feels like a no-win proposition at times. It's as though people only feel comfortable dealing with weasels. You're right on the money with the "suspicious" observation. I'm-not-hitting-on-you-I-just-want-to-know-if-there's-ANOTHER-concrete-paint-option!! Live, I'm actually not the least bit out-going (socially) and I'm only friendly when cornered until I can find an exit. On my tombstone it will read "He was so stand-offish, he's buried EIGHT feet under." I get more "who do you think you are?" type comments/looks. So I tell them. Nobody ever expects a response!!

    Thanks again for taking the time for the great post, the new things to consider and other suggestions,
    G (Ee)
    Last edited by ennzennz; November 9, 2013 at 03:42 AM. Reason: didn't proofread

  9. #9
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    Exclamation Re: I'm NOT taking my medication???

    Well today was D-day and it didn't go as well as the allied invasion. My doctor refuses to authorize a blood test/blood work to test for Clonazepam. In addition, and I'm not making this up, her receptionist came back on the phone and told me that my doctor had said the urine test was the BEST (!) method to test for Clonazepam and I explained that my hospital suggested a blood test would be more effective and the receptionist hung up on me in mid-sentence.

    Yes, that did happen. I'm not being melodramatic, and I wasn't being argumentative; it just happened as if it was a regular conversation that got cut off.

    Any reaction?

    G.
    Last edited by ennzennz; November 12, 2013 at 04:12 PM. Reason: didn't proof read - spelled ME as BE..

  10. #10
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    Default Re: I'm NOT taking my medication???

    Sounds like you need a new doctor. Go in, ask for your file (I'm fairly certain it's your property anyway), and take it to another doctor.

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