This is a follow-up to my "Drug Tested at my ADHD Appointment" article. It's going to be a recurring thing every three months when I go to get my meds refilled, which as I've already noted is going to SUCK donkey dick. I guess the purpose of this post is twofold: to chronicle my experience for future reference and to inform anyone who might face this situation themselves & landed here by frantically Googling "how to pass a drug test". There must be some codeine fiends in my audience, right? Even if you aren't, apply the knowledge here to whatever drug you do take.
Everything I've read online, which is a lot, says codeine is detectable in urine for 48 hours to 1 week in urine. If you're a heavy long-term user who has to endure withdrawals like me, that's a pretty big fucking difference. Quitting for 2 days is doable; quitting for a week is going to mean a week of cold sweats, diarrhea & insomnia among other symptoms. Normally I would substitute kratom for the codeine and not stress it, but I can't afford to have ANY non-prescribed substances in my urine including mitragynine which will likely show up in the lab test they do after the office test. I can't afford to fail another drug test or I lose my Adderall prescription which is the only thing standing between me and total ruin. Without it I'll never be able to live independently or function like an adult. So raw-dogging withdrawal it is, at least for the first appointment.
As stated, I failed my first piss test for benzodiazepines, opiates & THC at my prior appointment--pretty much the only thing NOT in my system was my Adderall which was supposed to be there. (I ran out early due to doubling the dose). I'm only allowed to consume substances I'm prescribed as well as OTC meds and supplements now, which leaves me quite a few options... none of them helpful for opiate withdrawal unfortunately. I currently take codeine in doses of 420 mg per day (roughly) which is a considerable dose. That means I'll be needing more than the standard 48 hours to detox just to be on the safe side. More on that below.
The Science of Urine Testing
|Average elimination times of codeine|
Drug tests come in many different types, including blood, urine, hair, sweat, saliva & less common methods like fingernail tests and breathalyzers (for alcohol). The urinalysis is by far the most common due to its simplicity and specificity. While hair tests can tell if a person has used drugs in the past 90 days (up to 3 years if you have long hair), urine gives a more accurate recent picture & is better at detecting sporadic usage than hair tests. Urine tests are not foolproof and are prone to false positives but can be sent off to the lab for confirmation if a result is contested.
Factors that can influence the rate of a drug's excretion for a urinalysis include: metabolism, age, weight, dose/duration of use, efficiency of your kidneys & liver, activity level & hydration. To get specific: older, fatter people with health conditions impairing the excretory organs as well as those who don't exercise or drink enough water are going to excrete drugs like codeine slower--and thus retain them in their urine, blood & other bodily fluids longer--than fit, young, active folks in good health who hydrate. Some diseases that might impair your excretory organs include cirrhosis, chronic kidney disease, chronic or acute hepatitis, NAFLD & alcoholic liver disease among other diseases affecting the liver & kidneys.
There are no quick fixes, supplements or silver bullets to rid your body of drugs the night before your drug test. You can buy fake urine or "borrow" a non-drug user's pee, but it's incredibly difficult to keep it the right temperature, pH & prevent it from spoiling in the interim. It's best to use your own and to do it the honest way. Sucks, but that's the way it is. It's also important not to go overboard with the water intake in an attempt to "cleanse" the drugs out of your system. This doesn't work and can be dangerous, causing electrolyte imbalances that can kill you. Just drink a normal amount of water and avoid caffeine or alcohol which are dehydrating. You can also sit in a sauna or do other things that gently promote sweating, but again, do not go overboard with this. You've been warned.
My Withdrawal Protocol
I quit the codeine 5 nights & 4 full days before the drug test is scheduled. Considering how much water I drink, I figure this should be sufficient to clear it from my system in time. I'm also not overweight, elderly & don't suffer any (known) kidney or liver diseases that would affect my metabolism or excretion of the drug. I bought a 12-panel urine test kit on eBay to be on the safe side. I guess if I pee dirty for codeine the night before the appointment I can call and reschedule, though this will surely look sus to my doctors.
I haven't quit opiates completely (with no kratom as a safety net) since 2011 so this will be gnarly. And when I did, I was using other drugs like stimulant research chemicals and benzos so I wasn't 100% clean of drugs by any means. For this recurring shitshow I plan to substitute Adderall or Benzedrex as my stimulant. (Definitely Adderall on the day of the appointment so they don't quiz me when it gets sent off to the lab). It's the downer part that will be difficult. I've got the following options to choose from:
- Vistaril (hydroxyzine)
- Fioricet (butalbital + caffeine)
- Unisom (doxylamine succinate)
For the gastrointestinal side effects like diarrhea & cramping I'll be taking Imodium. Just a regular dose, not enough to get high and cause cardiac arrhythmia. But I expect to get a total colon cleanse during this debacle anyway. Oh, and there's Bentyl (dicyclomine) for intestinal cramps too. It has a strange trippy effect that makes music sound good so maybe it'll do something for my mental state. I don't expect nausea but there's plenty of Zofran on hand if the worst happens.
I write myself a giant Post-It note reminding myself NOT to pop any untoward pills or gummies for the next few days & get on with it.
Withdrawal & Test Results
I gradually lower my dose of codeine by 2 tablets every weekend for about a month leading up to the appointment, which is -60mg per week. So by the week before the appointment I'll be down to 5 pills per day, from which I'll drop to 0. Going from 14 pills to 0 would be much worse than a gradual taper. Even cutting just 2 pills at a time, I can tell a difference with my sleep patterns & cognitive functioning, so I know it's gonna be bad when I quit entirely. To make things interesting, I come down with a viral infection mid-taper at the same time as my sister. We're both laid low by sore throat, lung pain, congestion, bone/muscle aches & other flu-like symptoms. This, on TOP of whatever opioid withdrawal symptoms are already present. Lucky me. Thankfully quitting opioids has never been that unpleasant for me, thank god.
I ordered a 12-panel drug test on eBay several months ahead of my appointment so I don't forget to take it the night before. As usual I have no cravings for pills and am not "sick" during withdrawal (minus the respiratory symptoms)--I just feel a bit "off". I was gonna take Milk Thistle to help with the detox but my acid reflux is too severe & it'll just irritate my stomach so fuck it. Just chugging water like usual.
|At-home drug test results, Pt. I|
After going from 5 codeine pills to 0, I feel basically fine. A little 'blah' and bored (and I'm pooping a LOT) but aside from that, I'm shocked how not-bad this is. I'm staying at my parents' house so mom can drive me to the appointment--I definitely shouldn't be driving in this condition. (I left my car running in idle for 2 hours the other day in early withdrawal and... yeah). I take 8 mg Imodium per day to keep the worst symptoms at bay along with the Adderall & caffeine. Nothing else mind-altering. The night before the appointment I use my home drug test kit to be sure nothing illicit shows up in my pee--the results are mixed (read on). The next morning I eat breakfast, take some Imodium and 1 Adderall & head out the door after chugging a couple bottles of water.
|At-home drug test results, Pt. II|
I pass my urinalysis with flying colors & get my ADHD meds refilled for another 3 months. Yay. Was a bit nervous going in because my drug test I got online showed "invalid" for oxycodone & positive for buprenorphine--a drug I've never taken. It also gave a false negative for barbiturates which I had taken 5 hours earlier that day! My faith in these tests is not high. At worst, if I fail & contest the results they will send it to the lab for confirmation but that means a delay in refilling my already hard-to-fill meds. The doctor's test is a 12-panel just like the one I took at home and they're even the same brand, so I was seriously worried I wouldn't pass despite not taking anything I shouldn't.
If you read this far, you're a mensch. I know there's a lot of rambling but the takeaway message is this: quitting codeine 5 days before my appointment & abstaining from other drugs like benzos & weed in the preceding week was sufficient to pass a 12-panel urine test. And tapering the codeine made withdrawal far more bearable than it would've been if I'd quit cold turkey. Do with that what you will.
If you're a doctor & have the option to give or not give these bunk-ass drug tests, please choose not to unless absolutely necessary. They're just another hurdle for already-struggling ADHD patients & chronic pain patients, and they're not always accurate. Try talking to your patient about your concerns instead to foster an open dialogue about substance abuse. All these tests do is create distrust between patient & provider, plus they often cost a lot and can affect the patient's insurance coverage/premiums if they fail a test.
Hi! ✌😀 Like this article? Drop a donation in one of the accounts below. Google AdSense does not support "drug-related" content so I rely on your contributions to keep this blog running. It's hard out here for an independent freelance writer in the digital age. Thank you!