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PostPosted: Thu Feb 02, 2017 2:05 pm 
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Hello all. I am an RN on suboxone, with an Rx receiving treatment from an addiction specialist. I have never been in trouble legally or with any nursing board. I sought help before things got to that point. Although I Am very fortunate the **** didn't hit the fan before i got treatment. All that aside, my question or concern is as follows, I am returning to a place (hospital) where I was previously employed. I left on great terms and in all honesty, my supervisor is excited to have me back. The trouble is, I started in suboxone while I was away and I am extremely concerned about the potential ramifications of full disclosure. I'm not even certain if the urine panel includes bupe. Either way, I want to fully honest. I am done with all of the lying. My state BON, Louisiana, is not very clear on whether RN's with a valid bupe prescription can practice in acute care settings....
I could ramble on about this for days but I believe I covered the basics. I cannot possibly explain how important obtaining this job is on so many levels. Any advice would be greatly appreciated.


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PostPosted: Thu Feb 02, 2017 6:59 pm 
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Steps 8 and 9
8.Made a list of persons we had harmed, and became willing to make amends to them all.
9.Made direct amends to such people wherever possible, except when to do so would injure them or others.
Honesty has its place, but you could be doing great harm to someone important to your family- you.
If you are in remission with your addiction, actively engaged in your recovery you have no reason to disclose to the board or an employer.
Highly unlikely any UA would test for Buprenorphine.
I don't have any insight to the LA BON, but in Minnesota you could practice.
Just an aside, there are a lot of triggers in healthcare, have a plan for dealing with them.
I wish you well,


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PostPosted: Fri Feb 03, 2017 12:37 pm 
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Hello Satchmo,

Are you a jazz fan?

Doc makes excellent points as always. I greatly admire your wish to be honest in recovery, but I can't see how you're disadvantaging your hospital, patients, or fellow workers by taking subs... a medication that does not impair you...in order to remain sober.

If there's some rule or regulation that says you can't be a nurse because you're on bupe, it's a dumb one likely written by some bureaucrat who doesn't really understand the medication. I would recommend the same thing as doc. Just keep mum. As long as you know you're sober and leading a life of honesty and self awareness, I wouldn't risk my career. That you asked for help before things got completely out of hand for you, shows a person of integrity and good intentions. I just wouldn't worry about it.


Hope that helps a little...

Best wishes,
Godfrey


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PostPosted: Fri Feb 03, 2017 12:49 pm 
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I am lover of all music, Godfrey. I appreciate the input from both you and Doc.
As the test draws closer, I am more inclined to leave it alone (undisclosed). It does worry me that it could be on the panel, however unlikely. Another monkey wrench in this whole thing is that I also take valium--only for sleep at this point. My concern lies in the fact that the Rx for it comes from the same physician--an addiction specialist. I am not sure how far the medical review officer's review process goes but it does concern me that he or she could question why I'm getting my sleeping meds from an addiction specialist.


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PostPosted: Fri Feb 03, 2017 1:29 pm 
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Hey Satch,

Good you're changing your mind. I'm screaming NOOOO, don't say a word. There is NO upside and only downside. you could end up being adversely affected by overt or subtle judgement. Any error or misstep during your shift could be wrongly ratcheted up to who wants an addict treating patients. They could lump you into those nurses w active addiction that need to be relieved of their duties. I've read enough posts here or on other blogs and forums where healthcare professionals that do tell are sooo sorry they did. Plus the LA BON doesn't seem to have any real guidelines so you'd be at the whim and opinion of that board who you don't know in any way to trust they'd understand buprenorphine treatment. Like docm2 who is well versed in his state's laws, ie an RN can be on bup but a Dr., PA, APN, NP cannot, can you ask your addiction specialist to find out the laws/regulations for an RN in LA?

Does your addiction specialist only see addition clients? Many of these Dr's also see other patient types and a xanax script could be unrelated to addiction. Best, P

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Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Fri Feb 03, 2017 3:03 pm 
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To answer the most recent question, unfortunately my physician is strictly an addiction specialist; however he is based out of state...so hopefully that helps keep things simple. If you google him, it says he is a urologist. I will probably be in communication with him about what information i need (or don't need) provided to the MRO.

I concur that the information provided by the LA BON is very non specific outside of a 2009 dated instruction that reads RN's cannot practice on bupe or any opiate replacement therapy. There are more recent guidelines that read more vaguely...that if a Rx'd drug causes "Cns impairment" a letter from the prescribing MD must be provided detailing how it won't impact RN's ability to do his or her job...

I am calling around LA today asking addiction specialists/psychiatrists if they can shed a little more light on the subject for me.

Thank you for all of the support. It had been really helpful.


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PostPosted: Fri Feb 03, 2017 5:43 pm 
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Quote:
Another monkey wrench in this whole thing is that I also take valium--only for sleep at this point. My concern lies in the fact that the Rx for it comes from the same physician--an addiction specialist. I am not sure how far the medical review officer's review process goes but it does concern me that he or she could question why I'm getting my sleeping meds from an addiction specialist.


Hey Satchmo....

Hmm. Well, I suppose you could tell them you realize that benzos can be an issue with some addicts, and you were just being proactive in seeking out an addiction specialist to keep you on the straight and narrow. Makes you sound very responsible. So thats a plus. You felt you needed something to help you sleep occasionally, but you wanted to be sure you had a physician who's aware of the dangers...


What do you think?

P,S, I just noticed your wrote he's a urologist. Plus out of state. So I doubt they'll bother to do any more research than that....


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PostPosted: Fri Feb 03, 2017 6:09 pm 
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http://suboxonetalkzone.com/the-problem ... iazepines/

I know you didn't ask, and please don't take offense. I would ask that you use your nursing critical evaluation skills and review the above blog post from Dr. J. To be honest, I would rather work with a nurse that is taking Suboxone over someone taking a benzodiazepine.
For the same reason I wouldn't want to work with someone that got drunk the night before. Legal, but the cognitive effects last into the next day, just like a nighttime dose of valium. If I were to rank the sleepers that I use or allow, Valium doesn't even make the top 10 because of its long half life and the accumulation in the body.
Having a script doesn't necessarily make it ok.
I admitted someone this week that was taking Klonapin, Xanax, Soma, oxycodone, all legal scripts. The three different providers never bothered to check a UA to detect the Morphine (heroin) and cocaine that was also present. Perhaps TMI.


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PostPosted: Fri Feb 03, 2017 8:36 pm 
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Really read and consider docm2's comments.

Any chance to switch from valium to another sleep aid? low dose trazadone or vistaril or seroquel or ?

Also, for concerns if bup is tested, maybe search drug tests of LA medical employers like LSUHSC NO.
IDK, if what they do sets precedent for other LA medical employers. maybe search around online for what drugs might be included in their preemploy and medical professional panels. Doesn't look like bup is in but an employer could ask for it as specialty item. Plus, maybe *67 and call local retail walkin labs and employer only labs. ask about medical employment drug tests for your employer, which drugs are tested. Sometimes its amazing what info is given... Best. P

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Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Fri Feb 03, 2017 11:21 pm 
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Of course doc and Pelican make good points. I felt slightly queasy myself when I saw the addition of valium into your situation. , but I'm ambivalent about giving advice about what a person takes or doesn't take.

I can tell you that I'm an all purpose alcoholic and drug addict and I've had my scheduled 3 rounds with benzos in my day. Xanax in my case, and I rode those lovely oblong pills...they reminded me of little canoes, down the rapids and ultimately over the falls. Very nearly killed me. Wiped out my short term memory and in the end left me unable to complete a simple arithmetic problem. At the detox/psychiatric hospital I ended up at they gave me an IQ test and decided I had brain damage. Turns out I didn't. Or if I did I eventually got most of my marbles back. But it took a while, and detox was hellish. And to round things out, I now live with the fear of increased risk of dementia. Lovely.

The last thing you were likely wanting was a drugalog, but it can happen. It certainly did to me.


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PostPosted: Sun Feb 05, 2017 6:44 pm 
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I would like to thank everyone again for their input. Full disclosure about my addiction. It was not limited to opiates but also included 3 to 4 different benzodiazepines and/or benzo analogues, A.k.a. research chemicals. They started as a means to sleep while working night shift but then boiled over to regular use. I worked very hard to get off of all of them and now only take Valium to sleep--nothing else. As far as how that may impact my ability to perform my job all I can say that I was an extremely effective charge nurse on a critical care unit when I was in a much worse place in terms of my addiction, i.e pre treatment.

I called over 20 local addiction specialist clinics to try to gain more insight on nurses using Suboxone in an inpatient setting. Suffice to say in spite of all of your advice, I will be disclosing all of the medication I am on including the Suboxone and hoping for the best. My personal addiction physician took the time to talk to me today, Sunday, and he reiterated the level of trouble I could find myself and if Suboxone does happen to be on the test. It is increasingly prevalent and although the odds may say it won't be on the test, I'm going to be honest route.


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PostPosted: Sun Feb 05, 2017 8:52 pm 
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Hey Satchmo,

The problem is medical authorities real belief that opiates and benzos taken together, IS a problem. Bup is lumped in w the full opiates.
Opiates and benzos now have a boxed warning to all health care professionals to avoid combined use.
Search the 8.31.2016 FDA special alert warning to all health care professionals to warn them NOT to combine the two.
http://www.fda.gov/NewsEvents/Newsroom/ ... 518697.htm

I think you're in a tough spot bc when you admit to both, just want to alert you that since your hospital employer is in the health care profession and likely aware of the recent FDA warning, it may not allow you to take both. IDK, I really don't know but want you to be aware of this possible complication. That's why I asked if you can switch to another non benzo sleep aid. You'd then choose to disclose bup only, I guess. When is your UA?

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Mon Feb 06, 2017 12:47 am 
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Tomorrow 11 a.m


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PostPosted: Mon Feb 06, 2017 3:27 pm 
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Well, it was an absolute disaster. I narrowly escaped being reported to the board by being allowed to rescind my application and walk away. had I not disclosed, BUPE was on the test and I would have had no way to avoid being reported to the board. I am now trying to pick up the pieces and figure out how I can get a job.


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PostPosted: Mon Feb 06, 2017 5:40 pm 
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Satchmo!!
I was wrong! You were RIGHT to disclose. Thank goodness you did!
So you disclosed valium and bup?
Is bup a problem because your job would be w inpatients? would outpatient be a less inclusive test?
The 2009 LA nursing board rule banning bup remains in effect ?? No bupe - for any RN job? Would valium only be ok? Just trying to learn more here.
This needs to be said - you've shown amazing recovery efforts. You quit your prior job before problems, you sought help, you've come a LONG way and are now ready to work again.
MUCH respect to you! Seriously! you've shown real strength and courage. Again, much respect to you.
Please keep us posted as you go forward. sending positive energy you'll find a good spot to land. best, P

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Mon Feb 06, 2017 6:32 pm 
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Quote:
Well, it was an absolute disaster. I narrowly escaped being reported to the board by being allowed to rescind my application and walk away. had I not disclosed, BUPE was on the test and I would have had no way to avoid being reported to the board. I am now trying to pick up the pieces and figure out how I can get a job.


Satchmo,

I just happened to check back on this thread. So you disclosed the bupe and then it turned out to be on the test? I'm sincerely sorry I gave you the wrong advice. At least I've got company, though small consolation. I'm very glad you took your own counsel.

It was my understanding that bupe is generally not on these tests. Can I ask what went into your decision in the end?

I still say it's a ridiculous regulation. You disclosed your situation when you realized your habit was out of control, and they I'm assuming said, go get treatment then you can reapply. Well that's what you did. Buprenorphine will not interfere with your ability o be a good nurse based on everything I've learned.

What would have happened had you disclosed and it wasn't on the test?
Wouldn't that have been dicey as well?

I'm sorry things didn't work out for you. I'm sure this job brought you much personal satisfaction, not
to mention a decent wage.


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PostPosted: Mon Feb 06, 2017 6:53 pm 
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They wanted to report me to the board because of the reason I wrote for taking bupe--"opioid dependency treatment." I had thought about what my best option was for my "reason" for taking and bupe and settled on that...

As far as nurses on bupe in LA, I can tell you two things. One is that I anonymously emailed the state board specifically asking that question and the reply I received was simply a link to that 2009 PDF you are referring to. The second is that found a great resource in a nurse opening a Suboxone clinic through ocshner. She went to multiple search social workers and other nurses and the answer word for word was "it depends on who is in charge at any given moment at the state board." Pretty frustrating.
As for my case I would have to disclose the specifics of my treatment to the state board then they would tell me if the way I am getting Suboxone and associated treatment is one they approve of...
Regardless of what anyone thinks I know personally that I am far more well-equipped to provide patient care as a nurse right now, on Suboxone, then I was when I stepped away from nursing/pre treatment.

They didn't care about the Valium.


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PostPosted: Mon Feb 06, 2017 7:00 pm 
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No worries Godfrey. I surmise that I decided all of the lying was done and any workaround the system this time would catch up to me down the road. Like if I Used synthetic or clean urine then down the road had to be honest about it the timeline would not add up. I'm not really sure. My current physician was adamant that being caught in a lie now outweighed any alternative.

As an aside, the nurse who helped me out in this situation said that almost everyone in Louisiana is now testing for Suboxone because it's abuse has become such an epidemic around here.

I have read boards like this a lot in the past and took for granted people being thankful for all of the support. I now realize how meaningful it really is. Thank you to everyone again.


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PostPosted: Mon Feb 06, 2017 10:25 pm 
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You're likely right that had you kept quiet it would have haunted you down the road one way or another, even if just to weigh on your peace of mind. Which is not a small thing.

I hope you continue to hang around satchmo. You clearly have a lot to offer.


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PostPosted: Tue Feb 07, 2017 1:54 pm 
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So, I'm calling my state board anonymously today to see what my options are. I'm fairly certain that they will say my treatment so far isn't "valid," and tell me my only option is to enter their FIVE year Rn recovery program. I understand that in the grand scheme of things, they want to get nurses working again; however everyone has told me to do anything I can to avoid reporting to them.

I'm also trying to find states where RNs can practice On bupe. It's easier said than done. I mean a list where it's definitely legal, not a don't ask don't tell situation. Any advice is greatly appreciated.


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