Drug testing a RN while a patient in the er

Esme12, ASN, BSN, RN · Mar 31, 2012

oh sure. one icu i worked in we had little 3cc glass screw-top vials of 100% pure medical-grade cocaine. we used to put q tips in it and the anesthesia guys would ram them up the nose for the semi-elective nasal intubation. since the q tips went from the nose to the trash, and there was always a little left in those little glass vials and it was nice and clean, some people took them home and evaporated them. (this was a looooong time ago.) not my drug of choice, but hey.

awe....the good ole days. heck we didn't even count the tac (topical cocaine). funny how things changed once the mid eighties hit. heck, remember those huge multidose bottles of narcs?

CompleteUnknown · Mar 31, 2012

I remember cocaine spray being used to anaesthetise the pharynx prior to ENT examination/procedures. I think the little atomiser bottles just sat on the bench in the minor procedure room.

diva rn, BSN, RN · Mar 31, 2012

How about those big canisters of Nitrous Oxide in the dental offices???? Just sayin.

morte, LPN, LVN · Mar 31, 2012

while this happened at work, it does not appear to be work related, therefore not WC. And the klonopin was PRN, so how long since the last dose. And then, of course, the fact that they were prob. using the wrong test. I would say, SOMEONE is looking for a way to get rid of you.

Editorial Team / Moderator · Mar 31, 2012

We use cocaine in the ED I work in, for epistaxis.

Yep, same here. Brown glass bottle, topical cocaine.

Wishinonastar, BSN · Mar 31, 2012

Ok so you go to the ER with a nasty nosebleed and they treat you with cocaine- next day you get pulled in for a drug screen....

I can just imagine this happening to me. "But I swear, they treated me with medical cocaine at St. Elsewhere ER yesterday!!" as they drag my name through the mud.

It is no wonder they are so aggressive about this stuff after reading these stories, but I know things changed a lot after the 80s. Much tighter controls seem to be in place now.

I worked as a hospice nurse for a while and I had a patient who was ordered q2 hour sq morphine. He had syringes and his prescription plan sent him a 90 day supply. Now imagine for a minute how many boxes of morphine that was. Tubexes prefilled with 2mg each x 12 a day x 90 days. So he just got a new supply and he died. I went to the house and attended the death and all and the family shoves this trash bag of morphine at me. They did not want it around, did not know how to get rid of it. We had no clear guidelines other than to toss narcs into the toilet back then. This was a Saturday- no supervisor. I was it.

I was terrified. I did not want it in my possession, did not have another nurse with me, did not know what to do. I took it straight to the outpatient oncology clinic at my hospital and gave it to them. No idea what happened to it but it was out of my hair then. I figured they had a procedure since they dealt with that stuff all the time.

Good thing I was not an addict, I could have had a field day. Or made a little extra money on the street. Creepy when you think of it. But this was the 80s.

BostonTerrierLover, BSN, RN · Mar 31, 2012

I mean, yeah, like one poster said, I was very familiar with the early mixture of coca cola. I knew the "snake-oil" traveling medicine sellers of the West had potent mixtures of Opiates, Amphetamines, and Cocaine mixed in their "Potions," but I didn't know it came into that recent of history, . . .and up until now, and on (y'all sparked my research button)!

I have since learned, after the cocaine post, that Heroin is still used throughout Europe in the Tx of "Hospice Care," and Addiction. They even have legal "Shooting Galleries," in Norway, and Switzerland I'm sure, maybe more EU countries as well, I know Norway and Switzerland are not part of EU, but during research, that's the two I found.

Sad, because I guess several illicit drugs did have Therapeutic worth. Boy have I been Naive. I didn't want too throw the thread off track, but what schedule is Topical Cocaine in the US? I thought Marijuana, Cocaine, and all those drugs were Control Class I.

You guys have really taught this ol' boy some stuff. Wow, the stories you guys probably have!

nurseprnRN, BSN, RN · Mar 31, 2012

about the nosebleeds-- recreational cocaine fries the nasal mucosa because the resulting vasoconstriction causes necrosis, and that's what causes the nosebleeds (that and the high bp).

on the other hand, topical cocaine, e.g. for treating nosebleed, works because of this vasoconstricting effect; there's no repeated use, no necrosis.

hope that clears that up, and now you can go back to believing things you learned in nursing school.

BostonTerrierLover, BSN, RN · Mar 31, 2012

do the patients jump up and say "You think you can kill me with just bullets! huh!? -Tony Montana "Scarface."

CompleteUnknown · Mar 31, 2012

I mean, yeah, like one poster said, I was very familiar with the early mixture of coca cola. I knew the "snake-oil" traveling medicine sellers of the West had potent mixtures of Opiates, Amphetamines, and Cocaine mixed in their "Potions," but I didn't know it came into that recent of history, . . .and up until now, and on (y'all sparked my research button)!
I have since learned, after the cocaine post, that Heroin is still used throughout Europe in the Tx of "Hospice Care," and Addiction. They even have legal "Shooting Galleries," in Norway, and Switzerland I'm sure, maybe more EU countries as well, I know Norway and Switzerland are not part of EU, but during research, that's the two I found.
Sad, because I guess several illicit drugs did have Therapeutic worth. Boy have I been Naive. I didn't want too throw the thread off track, but what schedule is Topical Cocaine in the US? I thought Marijuana, Cocaine, and all those drugs were Control Class I.
You guys have really taught this ol' boy some stuff. Wow, the stories you guys probably have!

Funny how things are different everywhere, and we get used to what we know and think anything else is strange or flat out wrong and dangerous. Cocaine is a Schedule 8 drug here, the same as morphine, fentanyl, oxycodone, etc.

Lorazepam, clonazepam, etc are Schedule 4, which basically means prescription only. So, there's no law that says they must be stored, distributed, etc, any differently to an antibiotic or blood pressure medication. Some facilities may require more rigorous controls on certain drugs, but it's not a legal requirement.

Preparations of paracetamol or ibuprofen and up to 15 mg of codeine are available without prescription, paracetamol or ibuprofen and 30 mg codeine are prescription only, but codeine 30 mg by itself is Schedule 8 (same as morphine). I can't imagine not being able to buy Panadeine (paracetamol and codeine) or Nurofen Plus (ibuprofen and condeine) without a prescription! What do you guys do when you have a really bad headache??

I think the majority of substances that are abused have therapeutic uses don't they? When I first heard that ketamine was being used as a recreational drug I thought 'what??? Ketamine?? But that's an anaesthetic!' I still remember working in recovery (PACU) years ago and the tags with a big "K" on them that were attached to the trolleys of patients, mostly kids, who had been given ketamine - it meant 'keep quiet and calm and don't disturb them too much or they'll wake up hallucinating and three-quarters crazy'. After watching some of those kids, I don't envy those of you who care for people who are brought in after taking too much ketamine!

Getting back to the OP's experience, I think one drug test is a little iffy and definitely unpleasant but can see where it would be policy, three seems like massive overkill. One negative test should have been the end of it surely?

Wishinonastar, BSN · Mar 31, 2012

I think the tight control of codeine is just terrible. You can't even get it prescribed anymore. Most everyone seems to order Vicodin which causes more nausea. No codeine cough medicine, no Tylenol with codeine for dental pain, everyone is so afraid that we will all become addicts that they just make it unavailable. So people suffer. Always overkill. That's the American way. Now they are talking about taking Percocet and Vicodin completely off the market because too many people kill their livers with them. Knee jerk reactions. Darvocet was a great medication for moderate pain and they took it off the market instead of being careful with it. Codeine just seems to have a bad rep among docs for addiction concerns.

tewdles, RN · Apr 1, 2012

In the OPs case, a urine drug screen was appropriate. Especially given the nature and timing of the incident. The treating MDs must know if your emotional instability is related to drug use or interactions. Your incident occurred on the job, thus putting the employer at risk.

However, I am not an advocate for routine drug testing of individuals. I believe in testing for cause. If a person conducts themselves in a way that makes them suspicious for impairment, take them off the job and test them - including for alcohol. Otherwise, I consider it an invasion of personal privacy.

I am aware that this is not a popular position for a health care worker, but, hey...I'm entitled to my own independent thinking. And, just for the sake of argument, I recently flew for nearly 20 hours straight on 3 different aircraft and I do not believe that those folks should have to submit to testing either. The pilots are not alone, they are supervised and monitored by the other staff, and they are professionals. Co-pilots are required to question the actions and behavior of the pilot if it is suspect. Frankly, I don't care if the pilot drinks scotch or smokes pot on his/her off hours, I just want him/her straight for the flight. Also, if he/she drinks rather than smokes an allowance should be made for the possibility of "hangover" which will impair performance as well.

On the other hand, I worked in a hospital system that, for years, tolerated the drunken poor practice of a urologist. No one confronted him, questioned him, or tested him...even though the medical and nursing staff were aware of his impaired condition. I mentioned it to the CMO who ended our meeting immediately advising me that this was "not my concern" as urology was not my area of practice or specialty. Those nurses were afraid to come forward with concern.