I have a bizarre case...

[GladiatorBill]

I am going to try to keep this as short and sweet as possible. I tested positive for drug use at work and I’m sure the plan is for me to enter an IPN.

Okay but heres the thing.

I have a diagnosis of MDD. About two months ago i started taking 300 mg Wellbutrin daily. About one month ago..... my brain broke. I went from ‘normal’ to ‘not normal’. I was having massive constant panic and anxiety, suicidality, i would sit at home and cry all day every day when i didn’t work, and then at work i was like a frantic madman. I went and bought drugs from homeless people in the park, don’t even know what i bought. I would IV it.

I called and told my Psych NP something was really wrong. He told me to discontinue the Wellbutrin immediately. Prescribed Ativan. I THEN found out i was staying up hours later than i thought i was, running around the house speaking gibberish. (My sister and i live together). I got tested 3 days later.

I have now been off the Wellbutrin for 10 days and all of these symptoms have completely resolved. I disclosed to my Psych NP and stopped the Wellbutrin JUST prior to this going down and i can supply the medical records to prove it.

. I’m sure I’ll get fired I’m just waiting on the call.... but.... how the heck do i proceed from here? I don’t do drugs. I mean i did, for two weeks i was a fiend. I dunno. I’m pretty bummed about this.

[ThePsychWhisperer, BSN, MSN, APRN, NP]

I am a little confused. Do they want you to enter an IPN for drug use or bizarre behavior they believe is related to drug use? If you have a valid prescription for the Ativan, I'm not sure they can force you into an IPN, although your employer may opt to terminate employment because you may or may not have been under the influence on the job. Although it certainly may have induced manic symptoms, I'm not sure why all the focus on the Wellbutrin. It does not show in a drug screen.

In any event, wishing you the best!

[J.Adderton, BSN, MSN]

This is my thoughts, take what is helpful and leave what isn't. Regardless of underlying cause, if you tested positive for illicit drugs (or any scheduled med without RX) I feel you will face some level of monitoring. I agree with others, to avoid discipline, self referral may be best route since your employer will report you.

I think it would be beneficial to produce documentation from you psych NP, but still likely level of evaluations and monitoring.

Good luck!

[GladiatorBill]

Giving an update for continuity.

My result might be wildly unpopular ... but.., Peer Assistance in my state has been wonderful. They really heard me and heard my concerns and situation. They actually informed me that they didn’t feel i needed SUD monitoring but i told them i would be fine with it.

My focus on an antidepressant was that a known side effect is that they cause rapid cycling, which was the case for me.

I know some states treat IPN as a horrid draconian program, it does not appear that mine does. They have a responsibility to ensure that i am safe to practice, and i am on board with it completely. I was just horrified at the thought of having the book thrown at me.

[catsmeow1972, BSN, RN]

On 9/22/2019 at 8:08 PM, GladiatorBill said:

Giving an update for continuity.

My result might be wildly unpopular ... but.., Peer Assistance in my state has been wonderful. They really heard me and heard my concerns and situation. They actually informed me that they didn’t feel i needed SUD monitoring but i told them i would be fine with it.

My focus on an antidepressant was that a known side effect is that they cause rapid cycling, which was the case for me.

I know some states treat IPN as a horrid draconian program, it does not appear that mine does. They have a responsibility to ensure that i am safe to practice, and i am on board with it completely. I was just horrified at the thought of having the book thrown at me.

I don’t think your result is ‘wildly unpopular’ so much as it is an example of how such a program should work. I am glad you had a good outcome. These programs should not be about punishment but sadly many of them have become just that. Punishment. The ‘book’ is thrown at everyone across the board without consideration of the facts or differences.