Urine testing VS Swab tests

[Claerwen]

Hi all,

I really want to go on holiday in October, but I've been told I need to do a clean test first.  I haven't been tested yet, I've had two opportunities but the first one I didn't take in the end due to a crisis issue that I needed to discuss with my key worker which took precedent (and the whole meeting, it was then too late to be tested, and I had been using anyway), and I cancelled the second one as I went with my Mum to hospital on that day.

It's hard to schedule a test with my work pattern, and my key worker really wants to get a clean test in the bag asap so that I can go on holiday, and take my meds with me.  Because of this, I am going to have a mouth swab test this week, as opposed to a urine sample.  For some unknown reason, you can only do urine tests at this one clinic in town, and it takes ages to make an appointment, so a swab test will be much quicker.

Out of interest, how do these swab tests work?  I assume they measure heroin levels in your saliva?  Will it detect codeine, as I have been taking 60mg a day, as directed by my GP.  How long does gear stay in your system? I have been going through a really tough patch, with LOTS of slip ups.  Obviously I'd love to be 'clean', but my dose of methadone is so low that I can't combat the cravings at the moment.  I hate it, everytime I see my worker I feel like I've let her down, and I know I'm at risk of losing my script as I had a letter sent through.

I hate the fact that if you have a set back and start using, you're immediately 'risking your script'.  I can understand the reasoning behind it, but when I slip up I need support, and getting letters and being told that I basically need to clean up my act puts the frighteners on me and then I know I'm more likely to use then.

There seems to be this belief that if you use on top of your script, you're abusing the system, but I don't think that you can apply that mentality to every case.  If it was easy to get off the gear, these D.I.Ps wouldn't exist, and all their key workers would be out of a job.  Yes I'm having a hard time shaking off the habit, I have an opiate dependency.  It's all well and good for key workers (who in many cases have never even SEEN gear, let alone developed a habit) to tell you what you should be doing, and what's right and what's wrong, but being on the receiving end of treatment is much harder than they seem to think.

Watch out, I've started ranting now! 

Just as a quick example of what I'm trying to convey above, when I bought my NHS pre-payment card, my key worker advised me to get the one that lasted 3 months.  Personally, I thought I should have the year long card, and I wish I'd gone with my gut instinct and set up the direct debit for a yearly pre-payment.  3 months to enter treatment, take your meth, reduce and end treatment is just silly talk! I'm not sure why I was advised to get the 3 month one, did they think I would have finished treatment then? 

Aaaaaanyway, slightly side-tracked there!  What I actually want to find out, asap, is : -

* How effective is a swab test when compared with a urine sample?
* Will the test results be somewhat compromised due to my codeine intake?
* How many 'clean' days prior to being swab tested do you have to have before your test registers as 'clean' (ie- how long does gear stay in your system)

For your information, I'm on 60mg of codeine a day, although most days I take 30 instead, and I smoke my gear rather than inject.  My 'slip ups' are one bag a day, spread out throughout the day - half in the morning, half when I get in from work.  The bag sizes are HUGE and the quality is pretty good too.  I tend to have a nice smoke as soon as I get up if I'm using, I hate early mornings with a passion and knowing I have a nice deck waiting for me is one way of getting me out of bed in a good mood! It's a sorry state of affairs, but it's true.

If anyone can help with the 3 questions above asap, that would be fantastic.

Thanks in advance,

xCx

[sapphire]

Claerwen = a swab test is supposedly much more accurate than a urine dip test.

The swab is placed between your cheek and gum for a couple of minutes, and whatever is in the saliva is tested.

Most swab tests will be able to differentiate between codeine and heroin. If you say you have a script for codeine tablets they will write that on the swab test form. Theoretically you can't "fool" the test by saying you've only taken codeine and that is why it's positive for opiates, the ets is more sophisticated than that (not saying that's what you're trying to do!).

Heroin usually stays in your system for about 3 days, maybe a little more depending on your metabolism.

If you're still using why the hell haven't your CDT upped your script? If you stay on the low dose you're on all that is going to happen is that you'll have an addiction to 2 things instead of 1.

You need to get the script up not just to a level that stops physical withdrawl, but that helps mentally with cravings etc.

The recommended dose range of methadone for treatment of addiction is from 60-120ml/day, so you're not even anywhere near the lower end of the scale.

Have they given you any increase at all? If not, I'd either be more firm with them, or ask for another keyworker as keeping you on (I think) 20ml/day is just crazy.

[Claerwen]

Hi Sapp,

I am going for a review very soon, and my key worker has put in a recommendation that I get put on a higher dosage, this is what I want too as I'm still using on 20ml because of the cravings, and also because my dosage doesn't last much over 24 hours.  If I don't pick up my script at the same time every single day, I feel it.  I know people on lower doses than me, and their usage patterns have not changed one bit.  I'm definitely using much less, but using is using!

Even if my test comes back showing usage - I'll just scrape through the 3 or 4 days prior, I am going to use it as evidence that I'm not on a high enough daily dose.  I turn up to all my appointments (except when I went with my Mum to hospital) and have made some of the lifestyle changes suggested.  I am trying, so I hope they can see this and won't pull the rug from underneath me if my test isn't clean.  Everyone I know in supposed 'recovery' has had slip ups, and compared to a lot of people I know, I'm trying really hard.  I went for a few months without touching the gear, and wasn't offered a test back then.  I guess I should have pushed for it, at least then there would be a positive entry in my record.

xCx

[sapphire]

You are f'ing kidding me?? Doses lower than 20ml? that is a joke, all that will happen is people will have an addiction to 2 things instead of 1, no one is going to be able to stop using with doses like that.

Does your service dose anyone at proper doses? It seems like it's been a fight for you to even get your keyworker to ask the doctor about an increase, and since you're still giving screens that are positive for gear you'd think they'd know the dose isn't working as you're still using.

I'm sure you are trying hard, but being on a shitty little dose of methadone isn't helping, so don't beat yourself up over it.

I am quite agog that your service expects people to get "recovery" on such stupid dosing policies. Is it just your keywoker that has people on low doses, or is it endemic in the entire place?

I would really get firm with them about getting some increases, and don't let them fob you off with something like 1 measly 5ml increase.

I feel so bad for you, as you really seem to want to sort stuff out, but your service just don't seem to be playing ball.

[derek d j]

What a mess. Many a user in your position would lay out £20 a week on the black market and kiss off this seemingly hopeless bunch. Dosage aside, your key does not control your freedom of movement and you are not a convict on parole; tell him so and that, if he still threatens your holiday in this fashion, you'll take it to his manager or your dat. Stand up for your rights and stop trying to be nice - if circumstances are as you describe, you"re being treated appallingly. Re your original query, swab tests are more accurate and able to distinguish between street smack and pharmaceutical opiates like codeine. Take care, now,  and tell it like it is

[derek d j]

Jesus, I hate touch phones.  Wanted but couldn't edit in the possibility your key over estimates your keeness to come off now and is practising a form of toughlove - it seems the vogue in some circles. Whatever, it's rather incumbent on today's users to express themselves very clearly or face misunderstandings and communication breakdowns.

[Claerwen]

Low doses seem the norm in my area.

Last week when my chemist wasn't open to pick up in the morning I found myself with a tenner in my hand, walking the usual walk to score.  Instead of thinking 'why am I doing this, I have a script, I want to change my life etc' as I should be thinking at this stage, it was over 24 hours since my last 20ml dose and I was thinking 'ohmygodohmygod I'm sweating so much oh wait now i'm shivering - sneeze sneeze sneeze' and was sooo happy when I finally swapped my tenner for the goods - not progress at all! Whilst I was waiting in the usual place to pick up, 2 others turned up to score too, and we got talking about scripts.  Believe it or not, I was on the highest dose of meth there by far - and I'm on 20ml! The highest I know of around here is someone on 35ml. 

I do find it a bit bizarre that I've been told I can't go on holiday with medication unless I test clean, my worker says I need a break away and that it'll do my good, yet I'm not 'allowed' to go?!? Huh? Is this common practice?  I've blown it all now anyway by using 2 days before I'm tested, I could reel off a list of excuses for why as long as my arm, but the fact is I think about gear all the time and crave it like crazy, surely this craving can be managed by a higher dose?!

xCx

[sapphire]

Low doses seem the norm in my area.

Last week when my chemist wasn't open to pick up in the morning I found myself with a tenner in my hand, walking the usual walk to score.  Instead of thinking 'why am I doing this, I have a script, I want to change my life etc' as I should be thinking at this stage, it was over 24 hours since my last 20ml dose and I was thinking 'ohmygodohmygod I'm sweating so much oh wait now i'm shivering - sneeze sneeze sneeze' and was sooo happy when I finally swapped my tenner for the goods - not progress at all! Whilst I was waiting in the usual place to pick up, 2 others turned up to score too, and we got talking about scripts.  Believe it or not, I was on the highest dose of meth there by far - and I'm on 20ml! The highest I know of around here is someone on 35ml. 

I do find it a bit bizarre that I've been told I can't go on holiday with medication unless I test clean, my worker says I need a break away and that it'll do my good, yet I'm not 'allowed' to go?!? Huh? Is this common practice?  I've blown it all now anyway by using 2 days before I'm tested, I could reel off a list of excuses for why as long as my arm, but the fact is I think about gear all the time and crave it like crazy, surely this craving can be managed by a higher dose?!

xCx

Clarewen - as low dosing seems endemic at your DSP,perhaps you could either get the Alliance, or your local NTA rep to intervene for you? I had a "situation" at my DSP, and as I was in such a bad place I got the NTA involved, and they were brilliant.

I seriously doubt that even a dose of 35ml is going to help, sp perhaps some external intervention is needed? I cannot believe in this day and age that a DSP seriously thinks dosing people that continue to use on such low doses is helping anyone?

Can you print off the NTA guidelines about a therapeutic dose being 60-120 and take it to your doctor?

Seems pointless even having a script if the dose is so low you can't stop using. I would just flat out tell the doctor that, as your key doesn't seem to be much use so perhaps when you do see the doctor you need to be quite blunt.

Derek makes a very good point, that if you've told your keyworker that you want to be drug free, they might be trying to avoid maintaining you on methadone, or some such nonsense?

I think that as you sem to have tried mentioning it, and haven't relly got very far, that a more direct approach is needed.