work while on narcotics? - page 2

i injured my back at work two years ago, so have the usual (it seems) hassles with worker's compensation delaying my treatments and trying not to pay me. I've all ready been to court twice to fight... Read More

  1. by   leslie :-D
    if one is opiate-tolerant, i see no reason why they shouldn't be able to work.
    it doesn't cause a "high", but does make them productive and functional.
    it's ridiculous to compare one that is opiate-naive to one who is accustomed to taking narcotics.
    not even close to comparing apples to apples.

    leslie
  2. by   happybunny1970
    Quote from deehaverrn
    [font=franklin gothic book]
    i guess this means that they won't help me, but if i mess up ...they'll be right there to punish me.
    unfortunately, here i think you are right -- it almost becomes a "don't ask/don't tell" situation (though with it being a wc case, probably everyone around you already knows).

    yes, people who are opiate tolerant feel and act like sober people -- not 'high.' but heaven forbid something fishy goes on with your unit narc count and hey decide to drug test everyone... or you make an honest mistake in charting a narc. or even your unit hires a new employee or manager who is just completely against narcotic use for any reason.

    you might want to start looking into case management or some other sort of position, which would also help with your light duty requirements. there are plenty of nursing jobs out there where your physical limitations or medication requirements are probably not an issue (school nurse, insurance companies, telephone triage, blood bank, etc., etc.), but where your knowledge and expertise can be of great use.

    all it takes is for one person to make an accusation (founded or not) to land you in front of the board. and if that happens, you will not be permitted to work while taking pain medication. due to the drug laws in this country (and the abuses of some), the bon is never going to admit that it's ok for a person to maintain pain control with narcotics and work as a licensed medical practitioner.

    i wish there was an easy answer -- clearly you are conscientious and are concerned about this or you would not have posted the question. but you're going to have to determine, from your own experience in your job/coworkers/state bon whether or not you need to change your position.

    good luck in your pain control and your career!
  3. by   Transplant Nurse
    This is not legal advice, just my personal opinion (If I were in your shoes what I would think about). I wanted to reply to rehab nurse and happybunny1970. Agreed completely with rehab nurse; and as long as the BON does not forbid working while on opiates and you are chronic and tolerant a physician letter from pain mgnt should cover you as they are legally vouching for your ability to perform. Keep in mind any increases in dose or change in dosing would probably warrant a new letter detailing your meds etc. If you were found in error this would hopefully be solid enough to show your competence (could have a lawyer read it to be sure it's good enough).

    happybunny1970 I think the worst part of being on narcs while working is feeling like you cant tell anyone. But I felt like I might be suspect #1 if any problems arose. So, I was very forward about it (taking it) and had all wastes witnessed. Also if I was working in a patient room with another nurse (I was not primary nurse for them) for bathing etc, and they needed narcs, I asking the primary nurse to get it from pxyis. I did not want a red flag to be up that I was using more narcs for my pts. Also if you have a MD Rx for opiate and test positive at work, it is covered with the rx. They would probably interview pt about if they got the doses and that would be the biggest reason to suspect you.

    Just my opinion.
  4. by   jwsav
    can you give more details of how you injured yourself and exactly what is still wrong with you or what the PM doctor and neuro surgeon have diagnosed you with post op?
  5. by   SuesquatchRN
    Dee, my concern is not the opioids - I think that we as a nation are far too puritanical as regards these useful drugs, and that one can be productive and medicated at the same time - but your back. You WILL worsen your injuries. Can you possibly find a case management or similar gig that doesn't put you back on the floor? For you, and your back, not out of being judgmental.
  6. by   deehaverrn
    Thanks for all the concern and well wishes. I haven't gone back to work, as my pain is not controlled even with medications. Last time I wrote I was taking Kadian (a kind of long-acting morphine), and experiencing many unpleasant side effects. These ranged from constant nausea and incapacitating constipation, to drowsiness which sometimes meant inability to stay awake. And I still could not do much of anything without being in pain. My Pain management doc finally switched me to the Fentanyl patch..which has been much better. I am still in pain when I do anything other than lie around, but can actually do some light reading and watch television (thank goodness for Tivo because I still fall asleep readily so have to rewind often). About the only other thing I do is family obligations such as occasional dinners at the parents, or one of my kid's activities. Even then I need to supplement with narcotics to get through it.. of course, there are the doctor appointments and worse..the legal proceedings. I think that most of us assume that Worker's Compensation will take care of us if we are injured...what a great fallacy that is. If this is how government regulation works..forget about the health care issues now in Congress! I get 2/3 of my 2004 salary (since that was the year before I was injured), but my lawyer receives 20 % of that ..which is standard in my state. And I needed that lawyer because the insurance company filed to stop my compensation, despite that even their initial doctor agreed with me! I have been to court about six times and so far have always won..but it only takes once for the worker to lose benefits. On the other hand, the insurance company can just keep refiling every six months with a new issue. They generally have paid what they owe as far as medical costs, although if the doctor's office or pharmacy doesn't fill out their forms just right they will not. Also, they have sometimes been behind thousands of dollars in compensation at a time. And keep in mind that the worker never gets any increase in payments regardless of inflation. The strategy for the insurance company is to keep harassing people until they feel it isn't worth continuing, and also offering a pittance as a settlement just to get them to leave you alone. And once they have decided that you have reached "maximum medical improvement", if you arent judged to be over 50% impaired they only have to pay you for a maximum of 500 weeks. (and with a back injury it is pretty much impossible to go over 25%) It doesn't matter that you can't work..they don't really consider that in their formula. In fact, they don't consider many things..like inability to sleep, or focus, or medication side effects... Anyway, more workers should be aware of this stuff. I know that I would have refused to do a lot of things.
    As far as my injury ..I just was pushed backwards when a stretcher bumped my leg...with immediate sharp severe pain in my back. My MRIs show many things wrong with my back...multiple bulging discs, degeneration, annular tears, pretty much a result of the daily stress which was put on my back in my nursing career. ..and make no mistake..I was told by a physical therapist years earlier..when I had strained my back..that I had great body mechanics! This is a complete fallacy that they tell you..that being strong and fit and using good body mechanics will prevent back injury..it won't! 120 lb women are just not meant to be lifting and turning 200 plus lbs! Since I worked in a delivery room, I often lifted and pulled women of all sizes, not to mention all the bending ..and since my hospital had antiquated beds and stretchers it was even worse. :angryfire
    Since I can't even tolerate sitting at the computer for an hour, it is impossible to even consider getting employment..although of course the insurance company doesn't agree. They are now claiming that I can return to work..although at a light or sedentary job. I guess that I should be happy that they are finally conceding something..but it is still too much. And guess what...to reduce my payments, they only have to convince the govt. that their doctor is correct in my being able to work a sedentary job, and that there are jobs that I can do. They don't even have to show a job being offered to me. Its hard to believe in this economy. Like any employer would chose to me rather than someone without issues! Anyway...I'm in way too much pain to come back to this again tonight!
    Thanks for caring!:heartbeat
  7. by   pooh54
    Quote from rehab nurse
    Deehaven, we have talked privately, but I have been in your position.

    I had many mental tests to prove I was not "impaired" and that reflex time, etc were actually BETTER with my pain controlled, than not. If all I can do is think of my 10/10 pain, how can I care for my patients??? If I am medicated, and not going through a dose change or dose increase, I think you are okay, as long as you have doctor's approval. But, I know in some states, BON's need to come up with the times.

    Chronic pain is increasing in this country, as the detrimental effects of pain on a person's body and mind is being discovered. As our country ages, we will see more and more people on long-term opiates for pain control. I know this scares the begeezus out of a lot of people, but those people probably have never felt our pain. My pain is not a simple "I did too much moving furniture this weekend". No, my pain at a 7 level makes me diaphoretic, shaky, unable to think about anything but my back feeling like a dagger is on fire, twisting along my spine and down my legs. It has gotten so bad in the past few months that I can't go to a store without a scooter. I am only 30. It is humiliating. I am scared to think about what will happen to me if I ever end up in a nursing home. I am on a lot of narcotics now, and in 30 years, it will be more. Will I get a nurse or doctor who thinks "Oh, she's on WAY TOO MUCH of this morphine!!! OMG!!! Take her off ALL OF IT and give her Vicodin!!!" or "She's an addict, take her off everything"!!! I would rather die than have that happen.

    BON's around this country need to understand CHRONIC pain is different than ACUTE pain. Yes, during an acute injury, when a opiate-naive patient is given morphine, most likely they will be "out of it". If a person has been on morphine for a while, at a stable dose, they are not "out of it". But, many many health care workers and laymen alike don't understand. I wish, more than anything, that all the nay-sayers I am confronted by could feel my pain just by my touching them. Maybe that would change some minds.

    I don't know what the answer is. My nurse practice act does not state that you can't work on narcotics. I have seen NPA's that DO state that, however. I know my opinion will be an unpopular one, but I think that nurses who are seen on a monthly basis by a pain management specialist, and who follow their contract with said physician, and are not just starting opiate therapy, or trying a dose change or increase, or a med change, should be able to work with physician clearance. Do the tests or whatever they need to do to see you are not impaired by having your pain controlled, you are impaired by having your pain OUT OF CONTROL. And that's all I have to say about that.
    Sorry for the long quote> Here in Virginia, it is not against the law or nurse practice act to work while on opiates for chronic pain, that this is an issue between the nurse and her employer. While I find this gratifying (in some weird sense), it doesn't address reality in that no one will employ you on the meds and/or disability, I am frightened that while working in an acute care area, I will make a mistake that will harm a patient. I decided to take myself out of the field when the pain became impossible to control. I wouldn't take any meds for at least 8 hrs before beginning a shift or during the shift. I spoke to my nurse manager about my concerns and got ZERO support Not very surprising since I have found that we are the least supportive of all the medical professions for disabilities, both mental and physical. Again sorry, I have no answers (still trying to find something I can do) other than make sure you are NOT disabled or malfunctioning in any sense while on the meds, you will be left to hang on your own!
  8. by   tewdles
    I clearly don't know all of the facts, however, based upon your descriptions I suspect that you pain is probably mixed, having some neuropathic element. Perhaps methadone would provide you will improved control. Also, do you have a breakthrough medication while using the duragesic? Anyone who has a long acting agent, like transdermal fentanyl, should have something fast acting to use for acute exacerbations.

    I have worked with many people who are cognitively intact while utilizing opioids for pain. If your BON will allow it, there are many environments where you could safely practice while on this type pain management POC.

    Good luck.
  9. by   deehaverrn
    I have lots wrong in my back..I suspect that my pain is a combination of all of them rather than just one. Until recently, my pain was relatively well controlled if I didn't do much other than resting. I do have Vicodin and Skelaxin to take for breakthrough pain. However, I have never reached a point where I could be active in any way without taking this extra medication. Also, I am constantly drowsy and falling asleep..maybe as a result of the Neurontin that I take. When I take my "breakthrough meds" I am even more sleepy as well as a bit dizzy. I always have issues now with concentration and focus, as well as memory. I really don't believe that I could do any work, much less as a nurse. In addition, recently i have had increased pain..even lying down doesn't help, and I have had to take my extra meds. To me this is a major step backwards.
    I have all ready lost my job, all those benefits and that seniority. I'm waiting to see if the court will grant the insurance company's request to reduce or suspend my compensation. (due to their vocational experts testimony about jobs that I could supposedly perform..based on their doctor's opinions). Yes, I had my own doctor and expert (for which I had to pay over $5,000 out of pocket), but it is up to the judge who he chooses to believe.
    If they lose, nothing changes right now...and I get my expenses back. But if I lose, the judge will stop or reduce my compensation, plus I am out the money i spent. ARrgh.
    Anyway, I'd like to write more..but I am in too much pain right now. At least the anger takes my mind off it slightly!:angryfire
  10. by   Transplant Nurse
    Just jumping in here. I think this is a very valid topic. Recently my grandfather who's 81 was hospitalized and commented how all of his nurses weighed less than 100 lbs; my immediate response was, "Yes, that's why they all have bad backs. They start here and leave the bedside after they hurt their backs."

    My only addition is that with chronic pain, when I take hydrocodone I am not delayed/impaired. The threshold is so much different than for someone who takes it on an occasional basis. No high for me, thank God.
  11. by   I love my cat!
    It really depends on what state you are in. Call your state BON and ask them about working and taking prescription scheduled drugs.
    The BON in my state has nothing on the books regarding prescription scheduled drugs...it is up to each facility to decide.
    Like others said, even if your state and facility allows it and you are injured on the job, they will draw blood and this may be used against you if their is a injured worker's claim. It may mean the difference of keeping your job and receiving Workman's Comp and losing your job and getting nothing.

    Ask your employers about their rules/restrictions. Get everything they tell you in writing, too.
  12. by   fridayannelpn1974
    Hi, I worked for many years while taking narcotics -Vicodin and then Morphine to be specific. When you have intense pain, morphine or any other drug does not make you "high' or impared if the dose is equavilent to the amount of pain you are having. I drive and worked until I was disabled by the social securiy disablility adm. Now I don't have to worry about the work issue. If I had to quit when I began having pain, I would not have been able to support myself or get SSD at that time. I would have been homeless. I always disclosed the drugs I was taking and when asked to "pee" for my job I just listed the drug I was taking and provided a MD RX and the positive test result was not given to my employeer. This was in Arizona. No one at work was aware that I was taking pain medication. I worked as a nurse for 36 yrs. and I never did anything at work based on whether I would get sued or not. I just gave my patients the best care I could. I have been deposed by lawyers several times (when I worked as a wound nurse), and never once did I not defend my position,( &that of my facitlity) sucessfully. If you work with good ethics and keep knowledable in the field, most nurses have nothing to fear. I must say that I am grateful to be out of the nursing field as it seems to have become a totally money oriented professsion, and the compassionate part of it seems not to be taught in our nursing schools any more. I have several friends who are older nurses who are finding it hard to stay in the nursing profession with the "new" nurse mentation. They can hire 2-3 nurses at starting wages as opposed to having to pay seasoned nurses with 25-30 yrs experience who '"command" a higher wage. This is so wrong. The years of experience are so valuable. Anyway don't work in extreme pain and end up with an MI or a CVA due to the pain. Your life is more valuable than that.

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