How does your monitoring program deal with dilute urine screens?

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    Hello, my fellow recovering addicts and alcoholics!

    I have been sober for 8 months now, after a relapse following my mother's death. I have been in my monitoring program for almost two years now. It is amazing how life improves when one doesn't turn to drugs for escape. I was paranoid, insecure, and never able to whole-heartedly pursue my goals when I was smoking. Although some days I still have cravings, I am convinced that life is better without it and I am pretty good at using my coping skills and support system to get through rough times. I have made an amazing network of true friends while in the program and I wouldn't give that up for the world. When I was using, I had no friends and I constantly isolated myself when I wasn't at work.


    Here is my really embarrassing situation: I recently got offered a job as a home health case manager for a very small home health agency. I honestly never thought I'd never be able to find a nursing job until I was done with my monitoring program.... so YAY for that! I had been applying non-stop, but when it comes to the interview and revealing my participation in my program, I either get "I'm sorry" or I get the run around never to hear from the employer again. I am so thankful that something came through for me and I do not want to mess this up!

    I have gotten approval from my program for this new job and I start sometime next week. However, I am now scared crapless that I have messed this up for myself. They popped me twice last week. When I turned in my sample the second time, it appeared pretty pale and dilute (pastel yellow). This is because (I am really embarrassed to tell this but here I go) I had taken 10mg of Lasix earlier in the day before I logged in and found out I had to test. I missed a couple birth control pills last week and I needed to take Plan B, which made my breasts really sore that day. I have kept my mom's old Lasix around to take a half tablet when I feel bloated. It really does and did help. Unfortunately, it made my urine dilute too.... I feel so dumb and I really hope I won't have to explain this to my program. I'm pretty sure I'd get in trouble for taking something that wasn't prescribed. Before you are too hard on me, you should know that I am well aware of the health risks of taking Lasix. I only take it once or twice a month, and then only 10 mg, and I haven't had any muscle cramps or ill effects.

    I had one other dilute early this year (from simply drinking too much water one day) and the letter says they would turn me over to the MRO and have me see a nephrologist if it happened again. I am so scared they will rescind their approval for my new job. I am prepared to offer my hair, blood, and soul to prove I wasn't using! I have already thrown away the Lasix so I am not tempted to take it again when I feel bloated and then get tested. I can't afford to be in this position again! I am a nervous wreck and I have called my sponsor twice already today. I can't change what I did, and I shouldn't worry so much about consequences before they even happen. But it is hard not to. I'm hoping hearing some of your stories will ease my mind a little.

    What does your monitoring program do when you have a dilute? Has anyone ever been denied a job for a dilute sample?
  2. 5 Comments so far...

  3. 1
    First dilute you get a notification of urine being dilute and coaching on how to avoid dilute urines.

    Second dilute they will test to the lowest limits of detection.

    Third dilute is a test to lowest limits of detection and you have to see an MD to determine if there is a medical reason for dilute specimens.

    Depending on your compliance etc they can continue to test to the lowest limits for all future urine specimens. I think it is after the third dilute if there is not a medical reason they refer you back to the board as substantially non-compliant.
    MichelleRN34 likes this.
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    Has anyone had success in offering blood or hair to prove sobriety after a dilute screen? Or perhaps a request to evaluate the sample with more sensitive lab techniques?

    After reviewing my program's policies, which are rather unclear I should say, it looks like they could do anything from *nothing* to preventing me from working and reporting me to the Board. If they take a disciplinary action that far, I want to have a way to defend myself. I did something stupid, yes, but I don't think it is reason to prevent me from working as I have not been using.

    I anxiously await the call sometime this week... I am sick over this, but I am trying to practice the things I have learned. Serenity prayer, here I come! Wish me luck!
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    I have had numerous dilute urines....I think about 6 or 7. I drink about 1 1/2 gallons of water a day (it's the only thing I drink) and if I'm not really vigilant about cutting back my water intake on a test day, I may test dilute. I was also told to eat something prior to testing; that it helps your creatinine levels. Makes sense...you don't eat that day, your creatinine levels might be low and women tend to run lower than men anyway. Also, when I went vegan for a short time, my creatinine dropped significantly.

    Anyway, the first time I had dilute urines, I had been in the monitoring contract for about a year. I was offered the job I'm at currently, went to drug test for them and was notified my urine was dilute. My supervisor called me and said they don't normally let an applicant retest but for some reason, they were going to allow me to. I was confused as to why I tested dilute because I said "but I did exactly what I've been doing for the Board of Nursing and their drug screens....I've never come up dilute. How weird". The very next day, I received a letter from my BON stating that I had dilute urines for Jan/Mar/June (this was in July that I was being offered this job). I was surprised it took them 7 months to notify me of a dilute urine!! They didn't do anything at that point and I didn't have to provide an explanation. This year, I had several more dilute urines and they did want an explanation. In fact, they pulled me in to talk with them face to face. Now, I limit myself to about 300ml of water prior to testing. I'm not sure what will happen the next time I have dilute urine and I hope I don't have to find out!
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    @ Life _is_good: you are very fortunate- in texas, they will consider one dilute a fluke- send you a letter about how to not have a dilute sample, & then they will consider any further dilutes an effort to cover up using, a relapse.
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    I know....I have been very fortunate, although I'm not sure it's really "fortunate". The compliance coordinator has cut me a lot of slack, which is not a good thing. I've since learned that even though I may not "get in trouble" for missed call-in's and dilute urines, etc. I need to stay in compliance with my contract for me, not necessarily for the BON. He was able to help me understand that it was alcoholic thinking and behavior; just because I wasn't "getting in trouble" didn't mean I could continue doing it. It has also affected my priviledges. I have not been able to request my "work more than 90 hours in a two week period" privilege yet because of being out of compliance. We have three privileges to request back throughout the 5 year contract: after a year, we can ask for our narcotic privilege back, then ask for the ability to work longer hours, and finally, supervisory privileges. It took me almost 2 years to ask for my narc privileges back because we don't handle narcs at my job and it wasn't a pressing issue; same thing with the hours - we aren't allowed to work overtime. But I would like to have my privileges back before coming to the end of my contract.
    TXRN2 likes this.


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