about to start LPN course & questions about drug testing and suboxone - page 2

Hello, I am about to start classes to become a LPN in Massachusetts. I am clean from all drugs but I needed the help of suboxone for the last 2 years. I am tapering and down to 1.5 mg and hope to be off totally by the time I... Read More

  1. 1
    I do have to chime in here. I have posted on this topic before and I have very strong feelings about it mainly because I lived through it so this is not supposition but what my experience was.

    I am not going into my whole back story, it's too lengthy and it can be found on this forum.

    But, I was on Suboxone. The withdrawal from the Suboxone was SO MUCH WORSE than withdrawal from opiates.

    It took me 9 days to withdraw totally from the suboxone....now, it wasn't the vomiting and flu like w/d from say morphine or oxycodone, which is usually about 3 days, but it was horrible...I didn't sleep and I ached all over and it was like there were thousands of red ants crawling under my skin. For 9 days, I also had a stomachache and didn't eat much. Now, I don't know if that is typical...my Doctor said, well, sooner or later "you have to pay the piper" ( he wasn't being sarcastic" he actually was very supportive).

    The only thing I could do, was sit on the beach at sunrise and stare at the ocean and Pray...

    Before all of the Suboxone fans start jumping up and down and countering with...well you didn't taper....etc..

    YES...I did taper...Like my Doctor said..sooner or later, the piper has to be paid.

    I really do not believe in the use of another addictive CONTROLLED SUBSTANCE being substituted for the one you are trying to detox from.
    Addiction is addiction...

    Especially those who have been on this stuff for Years...what is the difference in being addicted to Suboxone and in being addicted to Morphine??

    I mean Really???
    As Jack has said, Recovery is total ABSTINENCE...and the Florida BON sees it that way.. and so do I.

    But BON aside....Having been addiction to opiates for about 8 years, then on suboxone, and now Thank God drug free for 2 1/2 years it's so much better.

    It's so great not to have to WORRY all of the time...worry if something will show up in a urine test. or like in the old days, worry if my script will run out and I wont have enough of my meds...and will I start to go into w/d...oh my gosh...this is SO much better.
    I am So Greatful

    and that's why I am so passionate about suboxone...and by the way it can be detected in your body for up to 11 days
    Last edit by diva rn on Jun 11, '11
    catmom1 likes this.

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  2. 4
    diva, et al,

    In an ideal world, recovery is abstinence from all mood altering substances. Yes, I do believe that is the ultimate goal for someone with a Substance Use Disorder (or SUD, the new term for addiction/chemical dependence). HOWEVER, since recovery is a process (just as relapse is a process), there is a continuum for this whole SUD disease.

    Active Addiction ---------------------------------------------------------Abstinent Recovery
    (notice I didn't label it just abstinence or just recovery)

    Just as their are those with other chronic diseases who require a variety of modalities to keep their disease in remission/recovery, there will be those with SUD who will require more than abstinence and a couple of support groups a week (whether 12 Step or non-12 Step). I would much rather see someone who has demonstrated an inability to remain abstinent remain on suboxone (with appropriate medical care and continuing follow-up and regular evaluations...just like we do for hypertension and other chronic, progressive diseases) than returning to illegal activities (diverting from work, family, friends, etc.), buying from "pill mills", online "pharmacies", or obtaining their drug of (no) choice on the street.

    The folks who do require opioid replacement therapy (ORT) may not qualify to continue in a chosen profession as a result (at least until the medication is discontinued or testing has performed and lack of impairment is documented). Having a valid prescription for a medication should not (and does not) offer blanket "immunity" to continue working if their job performance requires a high level of mental acuity and/or manual dexterity. Those individuals are held to a higher standard than the "average". Examples include pilots, physicians, nurses (and other health care providers), heavy equipment operators (truck drivers, crane operators, tractors, etc)., police, fire, and other emergency personnel, etc. In order to continue working while taking their prescribed, potentially "mood altering" medications, safety precautions should be designed and utilized to give the best possible data that the person isn't "impaired". Mental acuity and manual dexterity testing along with toxicology screening to determine appropriate blood levels of prescribed medications and lack of non-prescribed "mood altering" medications should be developed and utilized. By doing so, a couple of things would be accomplished. First, treatment and monitoring would be individualized and followed closely to determine their safety to practice (and the effectiveness of therapy). Second, data would be gathered which would allow even more effective, evidence based guidelines for the use of mood altering substances to be developed. The reason this debate goes on and on is because we lack sufficient scientific evidence to provide effective treatment and continuing care (i.e. monitoring) guidelines.

    Oh I know, there will be those who will be angry with those "monitoring" suggestions. But don't we recommend the same thing with other chronic diseases? ESPECIALLY when the disease is particularly difficult to manage (the "brittle" diabetic, unstable angina, etc,)? Why is it "OK" to recommend a very strict regimen of disease management for a disease like diabetes, but not for a chronic progressive, potentially fatal disease like SUD? Again, it comes down to lack of understanding of the disease and lack of evidenced based information regarding treatment approaches. Couple that with the fact that many, many people don't "believe" SUD is a disease, and we have a really messy, haphazard approach to those with the disease.

    We see how emotional the threads in this forum and numerous other online "discussion" areas can become. It makes sense since one of the underlying components of this disease is the inability to deal in a healthy, effective manner with emotions. When we lack scientific, evidence based information, we are left to deal with this issue and this disease with what I call the "3 Ms" of addiction...Myth, Misbelief, and Misinformation. We do our best not to do that with other diseases. It's time we begin to do the same with this one.

    Jack
    catmom1, Meriwhen, TXRN2, and 1 other like this.
  3. 1
    Dear Jack,

    I understand where you are coming from. As a recovering addict and alcoholic I truely get that this is a Disease....no doubt about it...not only that...it is a chronic disease to which there is NO cure...it is one that you and I will have for the rest of our lives (and will continue to recover from.)

    However, what is wrong with the concept of detoxing from ALL controlled substances???? Including suboxone???
    It was not easy, detox and early recovery was the HARDEST thing I have ever accomplished in my life...and the one of which I am the most proud.

    I am not saying suboxone should never be used. I think it has it's place a a step off from the heavy guns in initial detox--for a very short time... I have a very hard time with it being used for months and years....when it then becomes it's own addictive substance.

    It takes longer to detox from opiates, then the suboxone, granted, but once off, your are FREE.
    Why not do it????

    I don't understand the concept of substituting addiction of one controlled substance for another--for that's what it is...do you propose being on suboxone for LIFE???
    (it is a partial opioid agonist-and it is used for pain contol-that's what it was developed for-I know you know this, Jack-it has to have some sort of impairment potiential)

    THere is a difference between being on Insulin for IDDM--that is physically necessary-for life...and suboxone---that is NOT physically nesessary for life...trust me I KNOW.

    So, Jack, I love ya Man, and I read everything you post and learn a lot...I think you are intelligent, well informed and one of the premiere experts on nurses and drug addiction, etc.
    But--- having lived this--I have to respecfully agree to disgree....

    diva
    TXRN2 likes this.
  4. 1
    Quote from diva rn
    Dear Jack,

    It takes longer to detox from opiates, then the suboxone, granted, but once off, your are FREE.
    Why not do it????

    I don't understand the concept of substituting addiction of one controlled substance for another--for that's what it is...do you propose being on suboxone for LIFE???
    (it is a partial opioid agonist-and it is used for pain contol-that's what it was developed for-I know you know this, Jack-it has to have some sort of impairment potiential)

    THere is a difference between being on Insulin for IDDM--that is physically necessary-for life...and suboxone---that is NOT physically nesessary for life...trust me I KNOW.

    So, Jack, I love ya Man, and I read everything you post and learn a lot...I think you are intelligent, well informed and one of the premiere experts on nurses and drug addiction, etc.
    But--- having lived this--I have to respecfully agree to disgree....

    diva
    Diva,

    I think you missed my point (or I didn't make it clear). Just as there are those who require extremely tight control of their disease, such as diabetes, hypertension, asthma, etc., yet still have frequent "relapses", (i.e. their symptoms become worse and their disease causes additional complications), so too there are those with an SUD who simply cannot remain clean and sober when completely abstinent. When they are not taking their ORT (suboxxone, methadone), then they return to using in an uncontrolled fashion with all of the consequences every addict suffers when they are in full blown, active disease. Only the individual and their addictionologist can make this decision. To expect every addict to achieve complete abstinence because you or I have been able to do so ignores the pathophysiology of the disease. To ignore those individuals, or to see them as somehow weak returns us to the "lack of willpower" argument so many continue to believe about addiction. I have seen several of my colleagues go through treatment several times (inpatient, outpatient, sober living, etc.) and attended meetings, saw psychologists, addictionologists, etc. only to relapse over and over and eventually die. I knew them personally. I worked with them diligently on their recovery. They simply could not remain clean and sober. Just as there are forms of cancer, diabetes, heart disease, and every other chronic disease we know of that simply do not respond to well to treatment. For those folks unlucky enough to have this lousy disease and who cannot remain active, productive members of society without ORT, they either need to be monitored closely to be sure they aren't impaired and are following their treatment regimen, or find a profession that doesn't present significant risks to others. The treatment of this disease is not black and white. There are way too many shades of grey involved.

    We definitely can agree to disagree.

    Jack
    TXRN2 likes this.
  5. 0
    Dear Jack,

    I do get what you are saying. I do. But were these individuals working a good program of recovery. Did they have plans for relapse in place. etc, etc. Or, were they just white knuckling it?..whatever the case, it's sad that they relapsed and/or used and/or died.

    I still don't see the relationship between using a partial opioid agonist (that can be and is used for pain control) in place of a full blown opioid and IDDM/insulin. How do you feel about methadone? would you consider that the same as suboxone?

    Maybe I am being idealistic, but I think maybe abstinence should be the goal...the "Holy Grail" if you will, and YES, it takes work....DAILY work...where as suboxone merely takes the opening of a pill bottle and placing a tablet under your tongue....hardly the same effort. I guess it sometimes depends on how badly you want it...not willpower, if you are in recovery and have "gotten it" you understand that willpower has nothing to do with it...but your program and how you deal with triggers and your relapse prevention has everything to do with it.

    Seriously, how do you feel about methadone? One of the prominent substance abuse/chemical dependency psychiatrists here in south Florida believes that Suboxone is the "new Methadone" only uses it in very early recovery for very very short periods of time--if at all.
    Love,
    diva
  6. 0
    There are many folks with adult onset diabetes able to control their blood sugar with a diet and exercise. There others requiring oral medication or insulin in order to control their blood sugar...no matter how strict their diet and exercise regimen. Are those who require medication not working a good enough diet and exercise program? Nope. Their disease has progressed to the point where they must use medication to assist in controling their chronic, progressive, potentially fatal disease.

    Similarly, there will be those with the chronic, progressive, potentially fatal disease of addiction who cannot remain clean and sober no matter how strict their program of recovery and how hard they work that program. Do we simply ignore them and then shake our heads when they die? Again, in an ideal world, all addicts would be able to live an abstient life style, all chemotherapy would cure every cancer, and all diabetics would be able to control their blood sugar with diet and exercise. Sadly, this isn't an ideal world.

    Jack
  7. 2
    I work with a license defense attorney and one of our clients had a "borderline positive" for ETG. The question was, is this person drinking again or is it incidental exposure. My answer was, let's discuss it with the client, raise our concerns, re-educate them on being vigilant about incidental exposure and then watch what happens. If this is a true relapse, they will test positive again, and most likely with larger amounts of ETG showing up. It also gave me the opportunity to increase my contact with the person and discuss recovery issues they might be struggling with or not understanding. To date, they haven't tested positive again (over a year) which says to me they weren't in relapse mode, or if they were, it was short-circuited.

    Recovery is a process and those in early recovery will still have "addictive thinking". It takes time and effort for addictive thinking to change into "recovery thinking."

    Jack
    Last edit by sirI on Jul 3, '12
    TXRN2 and backtowork like this.
  8. 0
    If an employer or clinical site ever decided to test for suboxone, the OP would have a very serious problem. It's only a matter of time before suboxone is included in a panel because it has become a drug of abuse. The OP could lose the license or be forced to enter a lengthy monitoring program. It just makes no sense to pay a lot of money in tuition and then not be able to work because you flunked a drug test.


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