Movantik And False Positive For Naloxone/suboxone

I am currently prescribed Belbuca 150 mcg/every 6 hrs. with Tramadol 50 mg. for break-through pain due to Ehlers-Danlos Syndrome/Chiari Malformation/Degenerative Disc Disease. My PCP does random urine screens (unannounced) periodically. Last February I had to stop the Butrans Patch due to severe skin blistering/chemical type burns caused by the patch medium, hence the change to Belbuca. I am also prescribed Movantik for OIC and take it as prescribed every morning. I am now showing "positive" for Naloxone/Suboxone on my urine screens and am being treated like I'm an addict -- even though the report from the lab states "patients taking Movantik (a pegylated derivative of naloxone) have been associated with positives on this test". I'm not taking any illicit drugs - only the drugs prescribed to me by my PCP. How can I convince him that I'm not "self medicating"?

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I am having the same issue with movantik. What lab has that message? I am trying to find something that shows this can happen.

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I recently had a colonoscopy, under anesthesia, and I take Subutex at a treatment facility. My drug screen says I have Naloxone in my system. What could cause this?

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Re: Ash (# 1)

Here is a recent update I posted on a similar issue. You need to get the lab to add Movantik to their GCMS library.
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I have a definite answer to the question of why I was getting a false positive test for hydromorphone.

A minimal understanding of GC/MS (or LC/MS) is needed.

GC/MS can be very precise. But that precision is not built into the hardware, but instead is dependent upon the library loaded into the instrument containing a spectra description that matches the compound being matched.

There are many millions of possible chemicals. Millions of comparisons would be exorbitantly expensive (and time-consuming), so, in GC/MS, the list of possible candidates is pared down, by using heuristics. One such heuristic might restrict the set of potential matches to only those containing the elements indicated by the sample's spectra. Often, 7 or fewer heuristics can narrow the match possibilities to perhaps one dozen.

After obtaining a small set of possibilities, one by one comparisons against sample spectra defined in a library are performed. There can be several very, very close matches and if the compound of interest is not present in the library, the closest match that IS present will be reported.

See "shimadzu.com/an/searching_libraries.html" for a flash animation of such comparisons.

In the animations, a set of vertical lines represents the spectra of a compound. The position of each vertical line represents one element from the periodic table, and its height represents the relative quantity of that element in relation to the others. The red lines represent the sample under test, and the blue lines represent potential matches, from the lab's library. When the blue lines are slid left over the red lines, more congruent the lines from a library member are with the lines of the sample being tested, the closer the match.

In the case of the false positive that was plaguing me: the lab in question was Millennium Labs. After digging into heavy papers in peer-reviewed journals, I came to suspect that the problem was that the library in use by Millennium did not contain a spectra match for Movantik (naloxegol).

I stopped taking the Movantik, and my next test after doing so was negative. My doctor spoke with Millennium. At first he was stonewalled, but eventually he spoke with someone there who understood the (potential) issue.

I started taking Movantik again after the doctor told me that Millennium had added a spectra specification for Movantik to their lab's library, and I have had no further false positives for hydromorphone.

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Re: Randy (# 2)

GC/MS tests are usually considered the gold standard for testing, but there can be issues.

One of the first steps is to ionize the sample, which breaks naloxegol into naloxone and PEG ions. If the GCMS library only has spectra info for naloxone and not for PEG, all that will be reported in that case is the naloxone ion.

I had a different issue. I was getting a false positive for hydromorphone until my doctor had the lab "add naloxegol" (they probably just added naloxone, actually) to their library of opioid spectra.

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Hi, I'm new to this site and just wanted to know if this medication and/or these new meds are actually better for us, and as EFFECTIVE as Fentanyl? I have degenerative disc disease and i've been disabled and unable to work for the past ten years and though Trans Fentanyl has worked relatively well, with periodic increases and decreases, the side effects are just unbearable. The constipation, the memory stuff, and just other weird things. Are these new drugs supposed to be better, safer, or are they just new drugs, with the same side effects, etc? Thanks for your input.

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