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PostPosted: Mon Mar 10, 2014 1:52 am 
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Hi everyone. Please forgive me if this question has been asked before, I am brand new to this site. I've read a few posts regarding working as a nurse on Suboxone, but I didn't really find an answer that was similar to my situation. I've been working as a nurse for the past 7 years. About 10 years ago, I discovered the wonderous effects of Percocet and hydrocodone. It started as just taking it occasionally, maybe about 4-5x a month. I did this for years, never having any problems with stopping or withdrawl symptoms. Long story made short, (and I know, this is how most addicts start) over the past 1 and a half years I've found myself taking more and more. I tend to go on binges, 4 to 5 days straight taking, on average, around 60-80mg of oxycodone per day. In the beginning, I was legally prescribed these meds, but over the past year, I pretty much buy them off of a friend who gets them off the street. Here's my situation... No one know I'm addicted. Never once have I ever been accused of being under the influence of drugs while working. I've never diverted drugs. And to be honest with you, I've never diverted because I work on a unit where narcotics are rarely ordered.

I want to stop. Im tired of the anxiety- trying to get more pills and I just can't afford this horrible habit anymore. I want to start a suboxone program. I have had subs "here and there" to tide me over and prevent w/d until payday. Here's my question, can I be treated by a sub doc without disclosing to him/her that I'm a nurse?? I know I would have to self pay and not use my health insurance through my employer. I know legally doctors cannot disclose personal health information, but I heard that they can report me to the state board of nursing if they feel I am in any position to endanger a patient. So do I tell the truth and tell them I'm an RN, or do I say I'm just a homemaker?? Again, I never even been suspected of using pills- and I don't want anyone to know. I am a single mom with 4 beautiful children to support. I cannot risk losing everything I worked so hard for. I just want some help getting off of these dang pills. I tried to do it on my own, and I can't.

Any advise???
Thank you,
Caralynn


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PostPosted: Mon Mar 10, 2014 4:37 am 
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Hi Caralynn,
Welcome to the Forum, you will find lots of answers to your questions here. Here is my opinion, and it's an opinion, if you decide to get on a Suboxone program I would be totally honest. Taking Suboxone will in no way make you incapable of treating patients.
I had more promotions while taking Sub than I could of had if I wasn't on a program. There would be no reason for a Doctor to assume anything different. You sound like a pretty intelligent person. Suboxone will allow you to go about your work safer than the Percs would.

It's totally up to you but I would side being honest. I'm sure there are RN's here that can give you there opinion and may agree or disagree.

Best of luck to you.


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PostPosted: Tue Mar 11, 2014 9:44 am 
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Caralynn

I am a nurse-an LPN. I have 2 RN's in my family. As an RN you are more likely to have the keys to the cabinet then me. I bet that's why you are concerned. One of my family members works in a hospital & for OT works in a nursing home. Long story short the nursing home is closer to home & easier work. Recently there was some "diversion" of medication discovered in the nursing home & they wanted to do UA's on everyone (aid's etc) but the union stopped them.

Back to your question. I don't see why you need to tell the sub doctor you are an RN. As you know HIPPA is bull. Doctors & nurses talk about patients all the time, well at least that's my experience. IMHO if you have a legal script of suboxone you are in a better place then you are now. Most sub doctors take only cash in my area so you paying out of pocket would be normal. Suboxone is very expensive so maybe you can ask for the generic pills which cost less. It took me about a week to get used to the sub so it may be helpful if you have a few days off. Also, you have to be in w/d's when you start the sub so make sure you ask as many questions as you need before you go in for your appt. Some doctors want to meet you first & others tell you to come in after not taking anything for 24-48 hours & start you the same day. In case you are not familiar with the induction, in my case i went to the doctor in w/d & he gave me a script to fill & i went back to his office & he started me but it was a 3 hour process.

Each state has different laws about reporting substance abuse in the medical profession. I know a few nurses that got stuck with jumping through hoops for up to 5 years with the medical review board. There are special groups for medical professionals, sort of like AA but everyone is a doctor or nurse.

It is a personal choice & I hope i helped in some way. This is just my opinion. I would also like to mention that you may not need much sub to cover your w/d's. PM one of the moderators or someone here that you feel has good info to see how much sub they feel would cover you.

In my humble opinion you will be doing the best thing to change your life by going to sub if you can't taper off what you are taking now. You will have a legal script & that's important.

Good Luck & stick around....reading will educate you & that's always a good thing

Tiki


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PostPosted: Tue Mar 11, 2014 11:14 am 
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Thank you both for your responses! I am just amazed by the wealth of knowledge on this forum. I am so glad to have come across it. I'm still at odds about what to do.
As far as my usage goes, I tend to go on 4-5 day binges... Then I don't take anything g for a few days.. This has gone on for about a year and a half. I think I take that break after the binges just to try to prove to myself that I don't need them. I've had mild w/d symptoms, nothing too major. I think the majority of my wanting to use is psychological. I was diagnosed with an illness last year that left me exhausted, oxycodone gives me the pep and energy I needed to make it through my 12 hour night shifts- I don't use to "nod off" or anything like that. And, I'm not gonna lie, I can be Super Mom and Super nurse when I'm on it.

Just this past month, I've paid off some bills and loans, and didn't have the "extra money" I'd put aside to get my pills. The thought of them is consuming my mind, and that's how I've realized I've got a problem. I don't if my usage warrants entering a suboxone program given my lack of MAJOR withdrawl symptoms- but I've only gone, maybe 3 days without over the past year or so. I know if I have access to pills I will take them and won't stop until they're gone. I can see myself doing something g wrong, and I can see it only getting worse from here, so I want to stop.

Most nurse/suboxone questions I read on here are pertaining to using it after they've been caught or suspected of using drugs while on the clock- or they're in a state mandated rehab program. I've never been suspected of using any drugs ever. I work with babies, the meds I have access to are very minute, wouldn't even be worth trying to divert.
I am just afraid of losing my nursing license or being unable to work. I'm afraid of a doctor feeling the need to report me. Or, let's say I'm under the care of a sub doctor and I relapse- could he/she feel the need to report me then?? There are so many gray areas in the laws regarding nursing and drug abuse. I know it varies from state to state.
Thank you all for making me feel welcome. I've lurked quite often on this site and I'm glad I finally registered.
Caralynn


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PostPosted: Tue Mar 11, 2014 12:26 pm 
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Hey Caralynn..I think suboxone is the best medication to get you past your pill addiction. You probably don't need a real high dose of sub to keep you level and you won't crave the pills anymore. As for the doctor well they should be on your side and not out to lure you into a trap. Sub doctors should understand the dynamics of this medication in the work place. Unnecessary stress and worry is a common mental side effect of opiate use so try to chill. I found when I started suboxone I had more control over my life and greater perspective over work and personal affairs. Good luck and chill. Ben


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PostPosted: Tue Mar 11, 2014 1:25 pm 
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I don't blame you for being conflicted. In general, I feel that honesty is the best policy, but in your situation I probably wouldn't mention my profession to the suboxone doctor. At least not until you get a feel for how your doctor operates.

At this point, since you're addicted but not physically dependent, you have more options than a lot of addicts. It may not even be in your best interest to start sub at this point. Have you thought about seeing an addiction therapist who might be able to help you get control of your addictive behavior? However, if you think your addiction will lead you to use despite that kind of help, suboxone may be your best bet.

The major draw-back for you going on suboxone right now is that you barely have any tolerance to opiates right now. Going on sub is going to increase your tolerance enough that if you relapse on percs, you will need more than you do right now. And increasing your dose of full agonists is always dangerous and can lead to overdose.

If you do decide to go the suboxone route you need to make sure that the doctor puts you on a low dose. I wouldn't start on a dose any higher than 1mg and even that is probably too much. I hope that someone else comes along and replies after me about what dose would be smart to start on, because I know I'm not being very specific.

Whatever you choice, keep us updated and we will try to help as much as we can!

Amy

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PostPosted: Tue Mar 11, 2014 2:30 pm 
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My best advice is to do some serious research and see how situations of self-reporting chemical dependency has worked for other professionals in your state. My state has a monitoring program for all medical professionals called Health Professionals Services Program (HPSP), sounds helpful but after a naïve self-report a few years ago I got trapped in this cycle for three years and would have lost my ability to practice if I would not have followed their program to a T, I was discharged from the program twice for what I remember considering non-issues and almost did. Various people within my specific program were not friendly to various medications and made me see Addiction Psychiatrist after Addiction Medicine Specialist times three to justify my use of medication assisted therapy, they're a little more understanding of that these days about that in particular from what I understand. My life was definitely under a microscope for those three years, which was an interesting feeling to get used to. I also had to see a Therapist twice monthly foe those three years, attend additional support groups weekly, have a sponsor/mentor, have everyone involved in my care complete quarterly reports, have a workplace monitor/clinical supervisor. The most annoying of which, in the long-term, was a color-coded toxline system similar to probation for random drug screening (6 days weekly for three years), payed for individually. Again, very interesting for someone who had never been arrested, never gotten into any trouble 'officially.'

On a bright note, this set of consequences or similar consequences/long-term monitoring for medical professionals has very high rates of success, at least while followed. Those that don't comply are done with their professional practice.

Eventually, I got to a place of humility and decided to work with the monitoring program and it did hold me WAY more accountable than any other random person, even probably persons within the department of corrections probation system.

Just be careful and know how your individual licensing board handles either self-reports (as a Dr may encourage) or outside reports (If someone would so feel inclined/obligated to let them know for you.)
and who (if anyone) they refer to for monitoring and how that system operates.

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PostPosted: Tue Mar 11, 2014 2:37 pm 
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Caralynn2223 wrote:
I was diagnosed with an illness last year that left me exhausted, oxycodone gives me the pep and energy I needed to make it through my 12 hour night shifts- I don't use to "nod off" or anything like that. And, I'm not gonna lie, I can be Super Mom and Super nurse when I'm on it.


Hi Caralynn,

I just want to highlight this portion of your posts, despite having read all of it. This stood out to me because it seemed, in the smallest of ways, you were either justifying your use (for energy) or trying to set a distinction between using for energy vs. using to nod off. I just want to let you know that I used heroin for energy. Obviously, it was pills first, but then when I realized heroin was cheaper and easier to get than oxy, I started using heroin instead. Only for energy and "pep" not to nod off. I was a nanny for a prominent family and had to be "on" for long periods of time. The nodding off will eventually come later when/if your addiction progresses. Just pointing out that many, if not most addicts, start out in your exact shoes.



Caralynn2223 wrote:
Just this past month, I've paid off some bills and loans, and didn't have the "extra money" I'd put aside to get my pills. The thought of them is consuming my mind, and that's how I've realized I've got a problem. I don't if my usage warrants entering a suboxone program given my lack of MAJOR withdrawl symptoms- but I've only gone, maybe 3 days without over the past year or so. I know if I have access to pills I will take them and won't stop until they're gone. I can see myself doing something g wrong, and I can see it only getting worse from here, so I want to stop.


If you haven't gone more than 3 days without the pills, how do you know you're lacking in withdrawal symptoms? Maybe I've read that wrong..

I agree with Amy and any others who've said it, I'd hold back the RN info until I trusted my doctor and established a relationship with him/her.


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PostPosted: Tue Mar 11, 2014 3:28 pm 
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Hey Caralynn,

While I never had an illness like you describe, I can totally relate to what you said as far as getting energy while high on oxycodone. While not on it it was like I had no motivation to do anything but when i did take oxy i had the will to get done all of my tasks for that day. It's really hard to find a replacement for that. I don't know if suboxone will give you that same energy, it doesn't for me, but you can certainly use it to get clean and get everything in your life back in order.

As far as you being a nurse, I don't think it will really matter even if you did tell the doctor, which I don't see why you would have to. All of that stuff is usually in the contracts and paperwork you sign day 1.

My previous doctor took suboxone himself at a point in time and also told me that he had patients who are pharmacists and other high positions in the medical field. I don't think it's anything to avoid getting help over.


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PostPosted: Tue Mar 11, 2014 4:17 pm 
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Thank you all.... Tinydancer- while I haven't gone longer than 3 days without a pill, the only reason I said I've only had mild withdrawl symptoms, is because of what I've read here... Yes, I'm uncomfortable, anxious, yawning, and achy, but I've never felt as bad as what I've read some people have written on here- 3 days out. I realize most addicts start out in my exact shoes and that is exactly why I'm trying to get help. I am constantly chasing that energy buzz and it's taking more and more mg to do it. I'm not trying to justify why I was using.... I was sick, prescribed pain meds. On a day when I had something "big" to do or had to get a lot done, I'd pop a few pills- then it just became more and more frequent.

Amy, I agree with you, I'm addicted, but maybe not necessarily physically dependent. I think I'm leaning towards going to a counsler for now. Please correct me if im wrong, but from what I've read, it seems like alot of people have a hard time coming off of the subs. I don't want to go on the subs and create all of this conflict with my nursing license just to control a craving..... But I don't want to continue to abuse either- it's just not safe, period. I sure wouldn't want a nurse taking care of my baby on Perc's.
We'll see how this next week goes. I'm on my 3rd day without anything. I don't return to work until Friday night. I'm calling a Counsler today. Life just seems easier on pills - I guess that's were the counseling fits in.....
Thank you all again,

Caralynn


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PostPosted: Tue Mar 11, 2014 6:05 pm 
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Hi Caralynn,

I'm not going back on what I said, but I do want you to know that when people are really ready to get off sub, and especially if they can taper down to .0125 mg of sub (for example), getting off sub doesn't have to be that hard. The people who do well at tapering have mostly conquered the mental part of their addiction, work on their recovery, have cut off any source of supply, and are really motivated to be off all opiate medications.

If it ends up that counseling and meetings aren't enough to keep off the percs, suboxone is an excellent tool to utilize to maintain sobriety. I want you to know that once you have the mental obsession for opiates your addiction will always be with you. Addiction is a chronic brain disorder characterized by relapse. Those pathways have already been set up and there's no going back. There is only working on recovery. It is very common for addiction to wait until you have some problems in your life to rear its ugly head and catch you by surprise. Please don't underestimate this addiction!

I'm not telling you this to scare you. I am trying to help you guard against an insidious disorder. Any thoughts that come into your head that you can control it next time around are dangerous. You might start thinking, "Hey, I'm a pretty smart person and I've learned a lot about addiction, so I can just take percs once in a while." That's your addiction talking! You can know ALL of this intellectually and still falter.

It is awesome that you caught yourself and sought help before you got into major trouble. But that doesn't mean your addiction won't progress from here. The reason I know this is that I stopped and got help before I was in legal, financial, and personal trouble too. But being on this forum has shown me how fragile my recovery is. I am no better than a street junkie when it comes down to it. The only saving grace I have going is that I know I'm no better, that I'm on a low level of suboxone, and that I have a lot of support.

I feel for you and I'm pulling for you! I don't want you to end up another statistic. One enormous support for me is this forum. It keeps me humble and rooted in reality.

Stay with us even if you never take suboxone. Tell us how your therapy is going. Ask questions. There is so much collective wisdom here; please stick around.

Amy

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PostPosted: Wed Mar 12, 2014 9:52 pm 
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Well, first of all, congrats on wanting to take steps in the right direction....toward recovery! That sounds like a great idea considering that your use is escalating. At some point, you might be "caught" and then it would be a much different scenario than you are in now.

I don't really think its your doctor's business what you do for a living. I have a sensitive occupation as well, and, frankly, I think that's my business whether or not I want to disclose that to anyone, for whatever reason. As another poster mentioned, also, some medical communities are very small, so you don't want information to leak back to your employer.

I hate saying to "lie" or even "lie by omission" but you do have a right to privacy. My opinion.


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PostPosted: Sat Apr 05, 2014 12:10 pm 
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Caralynn

I read your story and felt compelled to respond. I am a Registered Nurse in Penna. I will relay my experience as best as possible and perhaps it will provide some guidance for you. I was seriously injured in a basketball game several years ago. It was an eversion-rotation injury that devastated my L leg. I had a fx/dislocation of my L ankle. I tore all 5 of ligaments (Deltoid Ligament) that attach your ankle to your foot on the interior aspect of ankle. I also sustained a complete fracture of my fibula approx 6" above my ankle. Two days after the injury I had reconstructive surgery which involved the placement of a plate and 9 screws among other things. I was in excruciating pain for the first 10 days after surgery. I had a cast for 4 months and was strict non-weight bearing L leg. In the final 2 months of the healing process, I had to have my leg recasted every 7 days to prevent shortening of my Achilles tendon. This process consisted of an assistant pressing down on my knee with my foot on a casting post. The surgeon would rapidly recast my leg in it's new position. The idea was to force my ankle into a 90 degree angle. It was some of the worst pain I ever experienced. Naturally, I was on Percocet for almost 6 months which covered the first 2 months of PT as well. As you now know, you cannot take 6-8 Percocet for 6 months then stop abruptly. This is exactly what happened to me. I can remember the sinking feeling and horror I felt when I realized that I was a full blown opiate addict. Long story short, I was unable to keep away from opiates when I returned to work. I was in home care and rarely if ever came in contact with opiates. A year after my first surgery, I had a second L ankle surgery to revise and remove some of the hardware. Again the Percocets flowed. At this point I knew I was hopelessly addicted to opiates. I confided in my immed supervisor and she told me the state of PA had a program for "impaired professionals" called the PHMP (Professional Health Monitoring Program). I called and "turned myself in". I was instructed to go to rehab and I would be contacted after I came home. Rehab went well and I came home in 17 days. Shortly after, I received a packet in the mail resembling a 75 page legal document. The packet clearly spelled out my options. I could enter the PHMP for 2 years with stipulations too numerous and ludicrous to list or....as an admitted "drug addict" I could surrender my license or have proceedings initiated by the state board to suspend my license. Running out of room...see below


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PostPosted: Sat Apr 05, 2014 12:36 pm 
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........I choose to enter the program as it was really my only option. I had bi-monthly random urines and had to abstain from all mood altering substances which is all Schedule 11-111 drugs. ETOH obviously and and a laundry list of other things like benadryl. I can honestly say that I no longer felt like a professional person. My co-workers were for the most part supportive. One group of people was exceptionally judgmental and viewed me as a dirtball who had "betrayed" the sacred ethical code. Interestingly enough it was my fellow RN's whom I am referring to. I graduated second in my class from a diploma program (do not exist anymore). The "alumni coordinator" removed my name from the alumni list and I no longer received invitations to alumni events. I was never arrested, never committed a crime and was not disciplined by my state board. However, given the chance to do it over again...I would never reveal my problem to anyone. Doctors may have some ethical obligation to report your problem as it is considered a "public safety" issue as I was told. Get a suboxone script from a MD without revealing your employment and get it filled... cash ...at a pharmacy that is not a chain pharmacy. Do not use your script insurance ever. Your only issue then would be switching jobs. A new employer will drug test for everything. I worked off my time in the PHMP as a prison nurse because I was really hurt by the reaction of my RN co-workers. These were people who had been at my home and celebrated holidays with. "Honesty" in this instance was a mistake for me.


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PostPosted: Sat Apr 05, 2014 3:33 pm 
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I don't advocate lying, but I do advocate self-preservation.

New Directions spelled out in a much better way than I did what State 'Medical Professional Monitoring' looks like.

I think the bottom line is that you should get some help before you are put in a position where this becomes part of your life due to a self-report or report by a supervisor or doctor.

New Directions got off a bit easy :), I got three years that turned into about five as I was discharged a couple times for reasons that I thought were insane/out of my control and I've heard of people becoming involved in that cycle for more years. There was an article at TheFix.com specifically about it, maybe a year ago.

The only point I disagree with, and maybe I'm not thinking it through clearly on this beautiful weekend day, is that you should at the very least be able to use your insurance for medication, visits if possible as your employer would not be privy to that.

Good luck, I can empathize 100%.

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PostPosted: Wed Apr 09, 2014 7:33 am 
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Even though New Directions has only posted twice here I ditto his post completly , get yourself a good Dr. ( mines a shrink ) and work to get yourself down to only needing 1 to 2 mg of Suboxone a day ... Don't panic , you probably could easily get by only taking 1/3 of the pills your taking now... You will have to put your Super mom uniform away for awhile ( you'll wear it again) ... Though I only use 2 mg of Suboxone a day , it has always given me energy I feel , this will be a lifestyle change though, learn to cherish this one ... And please keep private what needs to stay private , Mike Sullivan , Crown Point, IN


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