Failed my drug test and I'm pregnant

ruby_jane, BSN, RN · Feb 5, 2018

It's unusual to be tested outside the realm of the first prenatal visit (my provider ran a general drug screen, chlamydia, gonorrhea all covered under the general consent, HIV with a secondary consent). But you might check with the office manager if your general consent covers something like this or if you had to have a secondary consent.

You've gotten a lot of good advice here. Because it's your livelihood, I would make sure I got everything in writing.

Hang in there and best of luck.

klone, MSN, RN · Feb 5, 2018

But you might check with the office manager if your general consent covers something like this or if you had to have a secondary consent..

It wasn't in the clinic - this was in inpatient OB/antepartum.

KatieMI, BSN, MSN, RN · Feb 5, 2018

It's unusual to be tested outside the realm of the first prenatal visit (my provider ran a general drug screen, chlamydia, gonorrhea all covered under the general consent, HIV with a secondary consent). But you might check with the office manager if your general consent covers something like this or if you had to have a secondary consent.
You've gotten a lot of good advice here. Because it's your livelihood, I would make sure I got everything in writing.
Hang in there and best of luck.

Elevated BP in pregnant patient + light spotting + contractions >> abruptio?? >> automatic UDS for cocain and other stuff associated with this condition. It is standard of care covered by general "consent to treat".

ruby_jane, BSN, RN · Feb 5, 2018

Elevated BP in pregnant patient + light spotting + contractions >> abruptio?? >> automatic UDS for cocain and other stuff associated with this condition. It is standard of care covered by general "consent to treat".

Thank you!

jmg99 · Feb 5, 2018

This really isnt a joke. I tested positive for opioids when i applied for a job. it was because i ate two everything bagels, really does happen

JKL33 · Feb 5, 2018

Elevated BP in pregnant patient + light spotting + contractions >> abruptio?? >> automatic UDS for cocain and other stuff associated with this condition. It is standard of care covered by general "consent to treat".

Katie,

I am not sure that is universally true outside of true emergency situations and inability to consent. There is a chance that this patient's civil rights have been violated.

Regardless of any of that, the patient should be let in on the secret before she has one foot out the door. What about her actual health and well-being? Say she actually does have a fentanyl problem - this has implications for TWO patients' future health. No one thought that was worth investigating or addressing. What if a conversation with the patient had brought to light social difficulties or other situations that should have been addressed? What if she somehow also admitted to trying cocaine a week ago? Ooops....that is certainly relevant, but it wouldn't show up on the trusty UDS. What if she has risk factors for other problems that her team overlooked or glossed over because they think the fentanyl explains some things?

The more I think about it, the more I believe it was poor care. Now it may have implications for her as a nurse and a parent.

Guest374845 · Feb 6, 2018

I'm no expert, just a paranoid father whose been accused of munchausen's (sp?), but I'd get confirmatory testing that predates your false positive ASAP. The groundwork is potentially laid for medically kidnapping your child at delivery.

klone, MSN, RN · Feb 6, 2018

I'm no expert, just a paranoid father whose been accused of munchausen's (sp?), but I'd get confirmatory testing that predates your false positive ASAP. The groundwork is potentially laid for medically kidnapping your child at delivery.

How would you get a confirmatory test that predates the false positive?

And I'm not going to say it would never or has never happened, but CPS does NOT want to take custody of anyone's infant unless the parents are grossly unfit.

In the hypothetical case of the OP, what would typically happen is the patient would be questioned further, they might check with CPS in other counties that the patient might have lived in to determine if there were any previous CPS cases. If there are no red flags, it would be dropped. If there were red flags, they might do a home visit and come up with a plan wherein the parents do regular check-ins with CPS.

No, not ideal, particularly if the parents truly are innocent of illicit drug use. But hardly the "medical kidnapping" scenario that you paint.

99% of the time, DHS just wants to find that the infant is safe, and keep him/her with her parents. If nothing else, it's a LOT less effort and paperwork than to actually take custody of the child.

KatieMI, BSN, MSN, RN · Feb 6, 2018

Katie,
I am not sure that is universally true outside of true emergency situations and inability to consent. There is a chance that this patient's civil rights have been violated.
Regardless of any of that, the patient should be let in on the secret before she has one foot out the door. What about her actual health and well-being? Say she actually does have a fentanyl problem - this has implications for TWO patients' future health. No one thought that was worth investigating or addressing. What if a conversation with the patient had brought to light social difficulties or other situations that should have been addressed? What if she somehow also admitted to trying cocaine a week ago? Ooops....that is certainly relevant, but it wouldn't show up on the trusty UDS. What if she has risk factors for other problems that her team overlooked or glossed over because they think the fentanyl explains some things?
The more I think about it, the more I believe it was poor care. Now it may have implications for her as a nurse and a parent.

You may like it or not, but that's how it done in real life.

Abruptio is a difficult diagnosis (ultrasound is pretty much the only one diagnostic modality and it comes false negative frequently enough) and it is life-threatening for mother and fetus. It is tightly linked with cocaine abuse. And, should there be emergency delivery with ongoing abruptio, doing so on patient with unknown cocaine, or any other substance abuse, is extremely dangerous. It is one of the most "catastrophic scenarios" in the whole medicine, worst of the worst. So, yes, every woman who is pregnant, has elevated BP, contractions and spotty bleeding - a classic "abruptio triade" - gets UDS, so we at least know what we're going to play with. Just like every woman who comes with fever, low abdominal pain and discharge, pregnant or not and claiming to be sexually active or not - gets pelvic and STD tests because, well, most PID cases are caused by STDs, and a PID can very easily lead to sepsis and death if not treated early and correctly. She won't be tested for HIV without secondary consent but STD kit will be there. This is not about her civil rights. It is about getting her proper medical care. If she wants to get treated but also wants to pick and do only tests she might like and not others, she is only endangers herself (and her baby, if she is pregnant), and she will be told so by any ER provider.

I do not completely buy the OP's story because 1) specific tests for different opioids are rarely available in hospitals due to cost and hassle of using them, and 2) while her civil rights were, IMH(umble)O, not violated by the fact of testing itself, what followed, as described, looks like as a bunch of folks who do not care a dime about their own skins, which is kind of highly unusual nowadays. As I wrote, any provider can contact CPS or police or Comission of Elderly with preliminary informing the patient or not, but he absolutely, by the law, cannot contact anybody and anything else unless it is involved in death-or-life business. That's HIPAA, and nobody wants to play with it. And, yeah, it is her undeniable right to request re-test.

BTW, I do not know where you are working, but in current medical practice nobody has time and opportunities to "address and investigate" every patient's multiple social, emotional and other issues which might lead him/her to abuse. People are free and encouraged to seek care (although options for such care are rather limited unless the patient belongs to upper-middle class and has high-quality private insurance), but everything we legally can do is to let them know that help is available and where it is. We cannot, and, again IMH(umble)O, should not solve their problem for them.

JKL33 · Feb 6, 2018

You may like it or not, but that's how it done in real life.
Abruptio is a difficult diagnosis (ultrasound is pretty much the only one diagnostic modality and it comes false negative frequently enough) and it is life-threatening for mother and fetus. It is tightly linked with cocaine abuse. And, should there be emergency delivery with ongoing abruptio, doing so on patient with unknown cocaine, or any other substance abuse, is extremely dangerous. It is one of the most "catastrophic scenarios" in the whole medicine, worst of the worst. So, yes, every woman who is pregnant, has elevated BP, contractions and spotty bleeding - a classic "abruptio triade" - gets UDS, so we at least know what we're going to play with. Just like every woman who comes with fever, low abdominal pain and discharge, pregnant or not and claiming to be sexually active or not - gets pelvic and STD tests because, well, most PID cases are caused by STDs, and a PID can very easily lead to sepsis and death if not treated early and correctly. She won't be tested for HIV without secondary consent but STD kit will be there. This is not about her civil rights. It is about getting her proper medical care. If she wants to get treated but also wants to pick and do only tests she might like and not others, she is only endangers herself (and her baby, if she is pregnant), and she will be told so by any ER provider.
I do not completely buy the OP's story because 1) specific tests for different opioids are rarely available in hospitals due to cost and hassle of using them, and 2) while her civil rights were, IMH(umble)O, not violated by the fact of testing itself, what followed, as described, looks like as a bunch of folks who do not care a dime about their own skins, which is kind of highly unusual nowadays. As I wrote, any provider can contact CPS or police or Comission of Elderly with preliminary informing the patient or not, but he absolutely, by the law, cannot contact anybody and anything else unless it is involved in death-or-life business. That's HIPAA, and nobody wants to play with it. And, yeah, it is her undeniable right to request re-test.
BTW, I do not know where you are working, but in current medical practice nobody has time and opportunities to "address and investigate" every patient's multiple social, emotional and other issues which might lead him/her to abuse. People are free and encouraged to seek care (although options for such care are rather limited unless the patient belongs to upper-middle class and has high-quality private insurance), but everything we legally can do is to let them know that help is available and where it is. We cannot, and, again IMH(umble)O, should not solve their problem for them.

Okay.

klone, MSN, RN · Feb 6, 2018

The thing is, Katie - while abruption (nobody I know who works in OB calls it "abruptio") can be a catastrophic emergency (not always, its common to have partial abruptions that aren't diagnosed until after delivery with gross examination of the placenta), abruption caused by cocaine use is no more a catastrophic emergency than an abruption caused by any other cause. Meaning, we would not change our course of treatment.

Knowledge of cocaine use has only academic value when it comes to the care and treatment of the pregnant woman. Our treatment of her would not change, knowing she has cocaine in her system.

Regarding your statement "It is tightly linked to cocaine use" - are you saying that cocaine use is a common cause of abruption? Please provide some stats for that. While cocaine use is *a possible cause* of abruption, I strongly disagree that it is "tightly linked". I've seen dozens of abruptions in my years working in OB, and I can't honestly recall one of them that was believed to be caused by cocaine use. (Frankly, I can't recall the last time I saw a pregnant woman who tested positive for cocaine - it's meth and opioids pretty much exclusively).

klone, MSN, RN · Feb 6, 2018

BTW, OP, how are you doing? I hope your symptoms have improved