Dvla Medical Urine Tests

[Dvla]

Hi l am a wheelchair person who has a motabilty modified car and have been driving and working for 35 years. 

For a year now l have been trying to prove l no longer take Codeine (stopped 2018) l have a suprapubic catheter and undergone two Urine tests with the DVLA medical team, both showing diluted specimens. l have not drunk beforehand so at a loss as to why this has happened. Any help or suggestions would be appreciated. 

[BankFodder]

Are you eating anything which might contain poppy seeds?

[Dvla]

No nothing - l cannot understand how it can be diluted defo not drinking water to do this? l take multivitimans and blood pressure tablets pres by my doctor so l think it is the sample itself as is being taken from a urine bag outside my body so not sure how higher temp affects this? 

[BankFodder]

I have no specialist knowledge about this kind of thing.

Maybe someone will be along later who can help - but I'll be a bit surprised

[Dvla]

Okay thanks it is a difficult one.

[BankFodder]

Do you live on your own?

[Dvla]

No but will have to give up work soon and claim benefits so stop being a tax payer after 35 years and become unemployed as finding it hard to go to work without a car. 

[BankFodder]

I'm asking if you live alone simply because it occurs to me that you and the person you live with presumably share the same diet. It will be interesting – having made sure that your diets don't diverge for a couple of weeks – then for both of you to have urine tests and see if you come up with the same traces of codeine. If you do both supply positive urine samples then that might give you a starting point in tracing the source of it. Then by altering diets you might gradually be able to identify what is producing the effect on you.

I'm not at all the medico – but it seems a fairly logical approach to me

[BankFodder]

 

Quote

Forget Colorado, stoners. The real frontier of narcotic edibles is in Shaanxi province, China. A restaurant owner there just confessed to police that to keep customers coming back, he had infused his noodles with 2 kilograms (4.4 pounds) of pulverized poppy buds—which can contain narcotics like morphine and codeine—that he bought in August for 600 yuan ($98).

Apparently, it worked; the restaurant boss said customer numbers leapt (link in Chinese) after he started using his “special” seasoning. Chinese authorities say doses were enough to addict frequent diners, reports the South China Morning Post (paywall). Police launched an investigation only after one of the restaurant’s repeat customers tested positive for opiates in a routine urine screen.

 

https://qz.com/271411/to-keep-customers-coming-back-chinese-restaurants-are-lacing-noodles-with-opiates/

[BankFodder]

Quote

Codeine
Codeine is rapidly absorbed from the gastrointestinal tract. It is rapidly distributed
from the intravascular spaces to the various body tissues, with preferential uptake by
parenchymatous organs such as the liver, spleen, and kidney. Codeine crosses the
blood-brain barrier and is found in fetal tissue and breast milk. The plasma
concentration does not correlate with brain concentration or relief of pain. Codeine is
about 7-25% bound to plasma proteins and does not accumulate in body tissues.
About 70 to 80% of the administered dose of codeine is metabolized by conjugation
with glucuronic acid to codeine-6-glucuronide (C6G) and via O-demethylation to
morphine (about 5 to 10%) and N-demethylation to norcodeine (about 10%)
respectively. UDP-glucuronosyltransferase (UGT) 2B7 and 2B4 are the major
enzymes mediating glucuronidation of codeine to C6G. CYP2D6 is the major enzyme
responsible for conversion of codeine to morphine and CYP3A4 is the major enzyme
mediating conversion of codeine to norcodeine. Morphine and norcodeine are further
metabolized by conjugation with glucuronic acid. The glucuronide metabolites of
morphine are morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G).
Morphine and M6G are known to have analgesic activity in humans. The analgesic
activity of C6G in humans is unknown. Norcodeine and M3G are generally not
considered to possess analgesic properties.
The plasma half-life is about 2.9 hours. The elimination of codeine is primarily via
the kidneys, and about 90% of an oral dose is excreted by the kidneys within 24 hours
of dosing. The urinary secretion products consist of free and glucuronide conjugated
codeine (about 70%), free and conjugated norcodeine (about 10%), free and
conjugated morphine (about 10%), normorphine (4%), and hydrocodone (1%). The
remainder of the dose is excreted in the feces.
At therapeutic doses, the analgesic effect reaches a peak within 2 hours and persists
between 4 and 6 hours.

 

Presumably you are at your post-weaning stage?

 

http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/TYLENOL+WITH+CODEINE-pi.pdf

[BazzaS]

There are two separate but intersecting issues here.

a) why your urine appears dilute to DVLA

b) how to prove to DVLA you aren’t taking codeine.

 

a) You mention you are on blood pressure tablets. If these are ”water tablets” / ’diuretics’ : that might explain the dilute urine. Would you be happy to say which one(s) you are on?

If this is the issue, that then feeds into b).

 

b) if you are on diuretics, you could ask DVLA Driver’s Medical Group for which they would prefer of you:

i) providing a hair sample for drug testing, or

ii) Asking your GP to change you to a ‘non-diuretic’ blood pressure medicine if the GP can offer an option that you could accept for the benefit of allowing you to ‘pass’ the testing.

 

BF, my reading of the issue is NOT that the OP is testing positive for codeine, but that DVLA are saying the urine sample looks like it is too dilute, and looks to them like the OP has drunk lots of water or taken diuretics to dilute the sample, making it unsuitable to reliably test.

 

 

[BankFodder]

Thanks for this – frankly I have no idea what it's all about so I'm very interested to follow this conversation.

[BazzaS]

36 minutes ago, BankFodder said:

 

Presumably you are at your post-weaning stage?

 

OP said their last codeine ingestion was 2018, so, yes, presumably ... unless they have ingested eg (as you mentioned) Poppy seeds.

 

It reads to me as “sample being rejected by DVLA” rather than “sample tests false positive”, though.

 

If the OP could confirm (+/- the details of their blood pressure med(s)),.....

Edited March 29, 2020 by BazzaS

[BazzaS]

OP,

again (separating out the issues),

If your current meds aren’t a reason your urine is more dilute than it should be, you might want to mention DVLA’s test finding to your GP, (or at least ask them if they are already aware of you having dilute urine).

 

so unless,

a) you are on diuretics, and

b) DVLA agree hair testing,

It seems likely you’ll be speaking to your GP’s. Even if DVLA agree hair testing you might want to discuss it with your GP anyway, for peace of mind.

Edited March 29, 2020 by BazzaS

[Dvla]

hi guys thanks for the great points made. l take 5mg of Amlodipa blood pressure a day. As urine sample taken from outside bag,?temp is higher when taken so not sure on this? Also have less muscle capacity due to disability and advised this could affect it. DVLA know my meds advised as coming back diluted cannot test, but they found my sleeping tablet 7.5mg zopiclone in the last test, so why too diluted. they will not do hair folic or blood test. feel guilty and having to prove innocent. My european human right article 4 and 20 anyone thing they should review my case on this basis? 

[BazzaS]

Amlodipine (on its own) shouldn't give ‘dilute urine’.

 

Amlodipine is also available as a tablet that contains 2 other meds, one of which is a diuretic (this would be under brand name ‘Sevikar’ though).

 

if it isn’t clear why DVLA think your urine is to dilute : muscle mass will affect the level of creatinine in your blood, and thus in your urine, so this MIGHT be the issue.

Suggest you seek advice from your GP. Your GP can consider why (& will be looking at it from a “your health, including driving” point of view, with a less narrow focus than DVLA’s “licensing only” point of view). Your GP might send a urine sample and might even send a paired urine and blood sample to look into this further.

 

Your Article 4 Human Right (if looking at the UK’s Human Rights Act) is an “absolute” right, and is the right not to be held in slavery or servitude, or made to do forced labour. I think it would be “a stretch” to claim your Article 4 rights were being infringed.

 

if you were thinking instead of your Article 6 right to a fair trial, you would have to exhaust your right to appeal first, which would be by complaint to the Chief Exec of DVLA, and then an appeal to a Magistrate’s Court. It’d be sensible to have the info from your GP to argue your point on medical grounds for the first , and sensible to use a solicitor used to the law regarding driving and DVLA appeals for the latter.

 

There is no Article 20 Human Right Under the UK’s Human Rights Act.

if you are instead trying to invoke Article 20 (personal mobility) of the United Nations Convention on the Rights of People with Disabilities: that’d be another complex battle!. I could ask a friend with experience in this field but I would expect the answer to be similar to above : would need to exhaust existing mechanisms for escalation / appeal, first.

 

 

[Dvla]

Many Thanks, My doctor is not clear o how my disability would affect my sample as due to my disability and how it differs it is impossible to know my muscle mass.  l know i do not drink anything before the test (last drink night before around 9pm) so cannot understand why it would show as diluted?  It is an impossible cycle as cannot get the DVLA to accept any other testing method, so feel will never move forward. 

[BazzaS]

Has your GP sent a paired blood and urine, (urine for ‘urine osmolarity’), test?

Checked your blood sugar?

https://labtestsonline.org.uk/tests/osmolality-osmolarity

 

That might give you a starting point.

 

Have DVLA given any indication of what tests they are using (urinary specific gravity? Urine  Osmolality?? Urinary Sodium and/or Creatinine???) to decide your urine is “too dilute”?

 

The approach I would take is:

a) Find out why DVLA think your urine is too dilute (starting this soon, as it may take a while to get a reply if they don’t want to say!), at the same time as

b) asking your GP for the blood and urine test, to ensure your results are normal for you / your muscle mass

c) If your blood and urine results are normal for you / your muscle mass, prepare to start the (appeal to DVLA / escalate to DVLA Chief Exec / Magistrates Court appeal) process.

 

The grounds for appeal would be that they are failing to make a reasonable adjustment for your disability (using alternative testing for those people with disabilities that lead them to have such reduced muscle mass) that lead you to be unable to meet their current testing regime.

 

I’d expect this to be a long, drawn out process (unless someone else has been through it, and you could refer them to that case, at which point they’ll likely back down when faced with precedent).

 

For that reason, once you have your medical evidence, I’d suggest enlisting the help of a disability rights / disability personal mobility rights organisation : to help you find a precedent, or increase your chance of winning and creating that precedent!

 

[Dvla]

Thank you so much, l really appreciate your points. I can not begin to tell you how this has affected my life, l have not taken the Codeine since 2018, but been treated like a criminal by DVLA if l showed all the facts in this case it would shook people. Once the country is up and running late will try again just the time it takes as been a year now and not sure how much longer l can keep my Motability adapter vehicle for due for renewal in October) and my job, total independence gone for someone in a wheelchair just trying to be “normal” and go to work!! 

Edited March 30, 2020 by Dvla
spelling

[ericsbrother]

It is down to how they do the testing. They dont measure a drug directly, they measure the metabolyte and compare that to a range of norms and use other normal metabolytes for common stuff like testosterone or thyroxine as a standard and that is why they are whinging about the samples being dilute. being from an outside bag will make no difference to the amount of these compounds as it is a ratio anyway but they just dotn believe they have the wrong calibration so blame someone else

The problem is the testing method but as this is farmed out to labs that do what they are paid to do you wont get them to use an altermative analytical method that would provide a measure of a compound rather than its byproduct.

Are you taking other painkillers like aspirin or ibuprofen?