Info for non-addicted nurses with chronic pain taking opioids

Heogog53 · Aug 15, 2009

Now that is very interesting to me. I suffered a back injury on the job three years ago. I have been treated also for fibromyalgia pain with narcotics, as I can't take NSAIDS. According to the written policy, as far as I can tell, I can take medications that are prescribed by my physician as per his orders. Yet I was told that I cannot take any narcotic pain medications while I am at work.

Currently, I am using a TENS on one side of my back most of the day. I am doing PT, as well, which HURTS. So- here you have it; I can't get through a working day without some pain medication. I take it when I get up in the morning, do my painful PT and lie on the heating pad for 30 minutes, maybe four hours later take more pain meds if it hasn't resolved, then gird my TENS unit, and head out to work. During the course of the shift, I will get such bad muscle spasms that I am locked in place, or half of the left side of my back will go superficially numb and spasm beneath that. It brings tears to my eyes. Sometimes, I get a shooting pain from one or two places, for no particular reason. As the pain spreads, it involves my right hip and front of the hip bone on the abdominal side. I have pain running down my right leg and have a small sensory deficeit there as well.

I'm not an addict. Far from it. I have been on pain medications for a long time, have only had to call the doc once when I dropped a brand new prescription in the driveway- and ran it over.

My doc says that in all his years of practice, he's never had anyone abuse, divert, become an addict. He's a careful man.

So-if our present treatment of pain says to treat it so that pain sufferers can function something like they used to, why is it wrong for me to take my pain meds at work? I've never been unable to function, to carry out my duties- except when I have no pain meds on board......It's crazy!

I thank you for the citation. I marked it for further reading.

You see, I've gone out on workman's comp twice in the last three years and just last week went to OH complaining that my back is getting more and more painful; no new injury, but my back just plain hurts and at the end of a very busy shift, all I want to do is go home, take one or two of my strongest painmed and wait for them to take effect.

I am afraid that I will end up in your friend's situation. If I am tested at most anytime, there will be traces of several forbidden but NOT ILLELGAL substances in my blood stream.

I am so very sorry for your friend. We can't win one way or the other. I'm hearing the pattering of little feet behind me, with a hand offering me a settlement in exchange for my resignation from the hospital. Since I work for the State, that could mean that all state, county and local nursing jobs are forever closed to me, no matter if I go back to school and learn how to do something that is more gentler and kinder to my beat up body.

Reallyconfused0160 · Aug 16, 2009

Hi,

I am new here and just a bit confused. First off, I am not a nurse, not in nursing school yet, but wait-listed till 2012 to start clincals. I don't understand why she is going through all of this because of her medications?

This kind of scares me. Should I even bother pursue a degree in nursing? Will I be denied by the Massachusetts Board of Nursing during the process when they look through my medical records?

Here is my situation. Without saying that I'm a nut, because I'm not, I suffer from a few things. The first being Bi-Polar #2. I was diagnosed with it in 2005, I've never had a manic episode. I think I might have been misdiagnosed because it is more depression that I suffer from.

I also suffer from chronic pain - due to a herniated disk, which is getting better without surgery and a condition called Post Traumatic Trigminal Neuralgia.

I have a goal to get off two meds. One is klonipin and the other is Oxy IR (Percocet, no Tylenol).

First of all, while I'm taking Percocet for the back pain, I developed a dependency on it or a slight addiction. I've been on it for a year and recently told my doctor that I needed help getting off of them because the pain has gone down. He's been very helpful with my goals and has not made me feel like a bad person and told me that it happens to some people and has set me up to get help. I also take Tegratol for the TN and the Tegratol is used as a mood stabalizer for Bipolar. Klonipin for anxiety, & Zoloft for depression (I think I need to get off the Zoloft, it's not helping for depression and maybe switch to something else.)

Does this mean that I don't have a chance in nursing with the dx of bipolar/anxiety. And that I'm having a problem getting off the narcotics, but I will soon be getting help, most likely Suboxone and therapy.

I guess it depends on each person. Being on Oxycodone Immediate Release for a year - the stuff still makes me feel high as a kite, and I've taken them for over a year at 120 per month. I don't think I could ever properly work with a patient while on Oxycodone because my mind isn 't there when I first take the med, every 5 or so hours. As soon as I take it, my mind goes into some high zone, I get tired yet feel like I'm floating on cloud 9. To call myself an addict, I don't know. I guess, because I can't just stop these meds cold turkey and think I'll have a prob getting off them without Suboxone.

My goal is to be Percocet free within a month even if that means Suboxone. I don't like this feeling that the Perks give you, well I mean, it gives you a feeling of euphoria but also increases anxiety, but I want to find a non substance to do that and not be dependant on this medication anymore.

I guess some people are more prone to addiction than others and I don't consider myself a bad person because of it. Will that Bon thing prevent me from getting my RN license (I mean that is at least 5 years down the road), if I'm getting professional help to get off of the Oxy IR?

Yes, Percocet works wonders to help pain. I wouldn't have been able to move without it. If no one's experienced severe pain, then they don't know what it's like. Should I worry about having used Percocet for a year legally (RX) when I finally get to the stage of getting licensed? Should I worry about my DX of Bipolar, Depression and Anxiety?

I believe I can overcome these things. Life happens and I can only look forward but obviously don't want to waste my time in nursing school just to be denied by the board.

If you're in chronic pain and use narcotics and you're a nurse- why is that such a big dea, if it doesn't hinder your ability to work correctly? If it does make you high and spacy then obviously that would be a problem and maybe some other method of pain relief.

Nurses are human too!!! For me though, I wouldn't be able to function properly while on Percocet/Oxycodone IR. It just does something to me- makes me feel drunk. In some people, once they get over the initial stage of the euphoria- it is fine. They don't feel high, don't feel euphoric, can use it for pain for extended periods without becoming addicted- it's just like any other med, you get used to the side effects.

Unfortunatly, I developed a need for the drug after taking it over a year and my body is physically dependant on it.

Just wondering- will the same happen to me because of my DX's and I've used a narcotic for a year, developed a dependency and now working with my doctors to get off the stuff? Am I doomed from ever being a nurse?

Sorry for the repetevness and grammar / spelling, no pun intented but I just took a percocet - see what this stuff does to me! I am glad I'm getting off them.

Heogog53 · Aug 17, 2009

Physical withdrawal is unpleasant. Talk to your doc for help during your immediate withdrawal.

I just thought of something tonight- if I go tell management that I can't get through a shift without taking pain meds, then they won't let me work. Wen I come back to work(if I am not forced to resign or be fired), then they will likely start testing my blood and urine as spot checks to see if I am indeed taking narcotics.

Question; if I dont take any at work, but take them at other times, then the drug test will indicate that I am still using pain meds. Does that mean that I can be fired or that they can take my lisense?

My workman's comp doc knew what meds I was taking, it's charted, and despite my claims of pain and not being ready to go back to work- he sent me back with the knowledge that I was still taking prescribed pain medications.

Question; does that make him-and workman's comp- guilty of malpractice?

My pain management doc has written detail records on what meds he has prescribed me over time. He will offer me new scripts for pain meds and I'll tell him that I still have plenty,thanks. He certainly doesn't see my taking pain meds round the clock as an issue.

Question; is there a bouble standard in medical practice vis a vis "sufficient pain treatment" for other patients and then denying it for nurses? Why is there such a double standard? Is it becuase I have to function in such a way as to jump on in there and take care of patients- this making it a critical care issue? Because of my need to function sharply? Well, has anyone complained that I'm unable to do my job? Or at least, that I appear impaired?

No.

So this puts me between a rock and hard place tomorrow when I see my Occupational Health doc; if I tell him I can't work a shift witout supplemental pain meds, what happens next?

Think this may be time to talk to my lawyers.

Sigh.

saillady · Aug 17, 2009

I don't know this site very well. Is there a way for us to communicate privately? Don't do anything rash. First do your homework. What does your state Nurse Practice Act say about the matter? What is the policy of your employer? Are you a member of your state nurse's association? ANA? Are you unionized?

Lawyers are a completely separate matter. Does your attorney specialize in licensing issues? This is such a sensitive topic. Few people have much knowledge. We wished we could go to the media with this issue, but can you imagine how that would turn out? Think very carefully before you take action.

Heogog53 · Aug 17, 2009

Thanks for your concern.

Actually, I was able to clarify what the policy allowed with the Occupational Health Physician this morning.

I said to him that my understanding of the Hospital's policy about taking legally prescribed medication was that I could indeed take narcotic medications as prescribed during work hours. He told me that I was "exactly right". I thien told him that both my bosses and his NP were making rather frightening and in the NP's case, threatening remarks about how I could not take my narcs at work or dire things could happen. He then told me that I was having these prescribed by a long time doctor for pain control, that these were legally prescribed medications and therefore, I was not doing anything wrong. He did ask me to get my pain doc to write a note stating that my doc had been following me for x amount of time, that my ability to function was unimpaired and that I took my medications according to his prescription orders. Since my doc is away on vacation, I told the OH doc that I'd get something from my doc ASAP upon his return.

All I can say is THANK GOD. Last week I was imagining all kinds of nightmares, like getting called for random drug testing and thelike and loosing my job and lisence based on the fact that there is almost always going to be a trace of narcotic medication in my blood stream. How could I then prove that I didn't take any at work? Well, now the question is moot.

I'm ok by company policy, backed up by at least two doctors. PHEW.

saillady · Aug 18, 2009

Glad to hear that you have a supportive healthcare provider. Just a cautionary note because you say that there are "threatening" noises being made. In this type of situation, there are two entities that are somewhat intertwined and also are not not. First is your employer. You should have some rights under the Americans With Disabilities Act. If you find yourself discriminately terminated, the time limit to do anything about that is 2 years. The Americans With Disabilities Act does not protect your license. The Board only cares about public safety -- not whether you have a license. They can initiate an action based on a complaint made by a private individual, such as a coworker. It does not have to come from the employer.

In my sister's case, two nurses told their supervisor that they could not work with a nurse knowing that she used pain medications. There was a pre-termination hearing where the Chief Nursing Officer tried to force my sister to voluntarily enter an inpatient drug detoxification - with no regard to pain control. The Chief Nursing Officer tried to coerce my sister into revealing the names of other hospital employees using pain medications. She said that they would do a retrospective chart audit and that they would find discrepancies - because every nurse makes them. (They found 3 discrepancies, 2 of which my sister was able to clarify with charting elsewhere in the medical record.). The CNO also insinuated an improper relationship between my sister and her pain doctor. My sister's pain doctor was the head of pain medicine in the hospital and he subsequently dropped her as a patient. During the trial, the prosecution tried to imply the same improper relationship; the the judge did stop that. (Interestingly, my sister's pain doctor encouraged her to educate herself by attending local pain society meetings - because she initially had concerns about using opioid medications and working. The Chief Nursing Officer also attended the pain society meetings. Because she attended the meetings one would think her somewhat educated, on the subject of chronic pain management, so her actions with respect to my sister seemed really strange. Did she attend the meetings simply for the free food?)

Early in the Board investigation, long before the trial, my sister spoke to an Assistant Attorney General (AAG) who's husband had chronic pain - and she seemed very understanding. Based on those conversations, my sister thought she had nothing to worry about. Later, abruptly, that investigator was replaced by another, and there seemed to be no transfer of information. Time went on and on. More people came and went. Things would start and stop and throughout the process, my sister was provided very little information. Then, suddenly, years later, everything seemed to take on a life of it's own.

Those of us who are not legal eagles assume the presumption is that one is innocent until proven guilty. Not so in Administrative Law Court where these cases are tried. My sister's attorney did not even understand that and he saw no need to produce an expert witness for pain management - the judge had very little good medical information, because the expert nurse witness provided by the Board was disqualified as a pain management expert. Additionally, many of the statements that the hospital provided to the Board in their initial written complaint turned out to be obvious untruths, based on the witness testimonies. The judge acknowledged this discrepencies, but did not believe my sister when she said her supervisor knew about the pain medications. During her testimony, the supervisor said she did not know about the pain meds, but, to her credit, she also said she was not concerned about patient safety, impairment, or drug diversion when the nurses made their complaint to her. (The prosecuting AAG was speechless for a few seconds after that statement was made.) At the end of the hearing, my sister's attorney was convinced they won the case.

Six weeks later, the judge issued a written ruling and stated that he was holding my sister to a "higher standard" because she was a nurse. As such, he said, she practiced sub-standard nursing care because she did not tell her supervisor that she was taking mood and mind-altering drugs. He left it to the Board to evaluate my sister for fitness for duty. The Board deferred everything to Peer Assistance Services. Peer Assistance Services recommended the 3-year monitoring program. (I found this very interesting, because Peer Assistance Services is a private organization and they just landed the CO Board of Nursing contract at the end of 2008. Peer Assistance Services focuses on addiction and most of those people have no medical background. There was an Associate Degree RN supervisor who freely admitted she knew nothing about pain management.

Hope this is not information overload. I've left out many details, but you get the picture. Watch your back. Good luck.

Heogog53 · Aug 18, 2009

saillady,

if you want to speak privately to anyone, once you've logged in, you'll see MyAccount next to your name. Click on that and there is a place for sending and readng Private Messages.

I worked and am very tired....Goodnight.

Silverdragon102, BSN · Aug 18, 2009

saillady,
if you want to speak privately to anyone, once you've logged in, you'll see MyAccount next to your name. Click on that and there is a place for sending and readng Private Messages.
I worked and am very tired....Goodnight.

They need 15 or more posts to be able to send pm's

Heogog53 · Aug 19, 2009

Thanks for the information.....

I worked monday night and either pulled something or aggravated something. I slept 36 hours, tried getting up and moving so as to go to work and -BAM- the whole area just cramped and spasmed like crazy. I ended up calling in, yet again, even though I am tired of calling in.

I just want some time off to do an intesnsive and unpleasant but thorough PT program, so I can collapse and sleep when I need to, and not worry about doing both things and trying to keep up with work.

I appreciate all the warnigs, information and feedback, I truly do.

I think I might call my lawyer just to ask some questions about what to do next if the workman's comp idiot makes noises about jettisoning me completely.

These are very good lawyers, and I do feel quite confident in their ability to say, time to refer you to someone else for this component of your needs. I do hate bringing in the attorneys, but at the same time I am really wondering what to do next- if I can't work doing patient contact and moving, stooping, lifting, and the like- then what do I do?

saillady · Aug 19, 2009

I'm so sorry. I feel like I badgered you. I'll send you my contact info separately and if the need ever arises, I can connect you with my sister. Hopefully, not, however!

I've been a registered nurse for my entire adult life. One thing that astounds me is how we in our profession are so unmerciful with one another. There are about 3 million registered nurses in the U.S. and the only advocacy for nurses seems to come in the form of labor unions. We are an aging profession. In my estimation, few occupations are as productive. Is it realistic to expect a nurse in her late 40s, 50s, and even 60s to produce as she did in her 20s and 30s? With respect to this chronic pain issue - there is no voice or advocacy that I have been able to locate. Hence, the reason for my posts - some other unlucky soul may be able to use it.

At any rate. I hope you are also able to get some pain relief. Perhaps you are already considering another job that is less physically demanding? One really great thing about nursing is the diversity of opportunity. Take care.

RNinWI · Oct 21, 2009

This is rather disheartening to see. :crying2:

I am a nurse , albeit unemployed since I had back surgery in June, 2008 . I have been on chronic opioid therapy (Kadian) for low back pain due to degenerative disk disease for almost 2 years. I find that my cognitive functioning is not affected by this medication, unless we do a dose increase or I have to take something that is short acting for pain such as Percocet. I was still working when I began taking long acting pain medications and that was not a problem, even after we all had to do a random drug screen because the narc count was off. Of course the meds showed up but since they were prescribed (they also weren't the ones that were missing) nothing resulted from it...as far as I know anyway. I was eventually laid off from that position because I could not return to full capacity after my FMLA time was up.

However, I have been trying to find a new job for over a year now and have only had one offer, which was withdrawn after the pre-employment, post offer physical (and drug screen)...:angryfire So it is possible that they withdrew the offer because of the meds, but I also have restrictions and they claimed that they could not accommodate the restrictions.

Anyway, now I have applied for grad school to get my MSN. I hope this won't become and issue then if I am still on the meds. :crying2: People that know I am on the medications ask me if I am afraid of addiction. I usually respond that I don't have any fear of addiction because I only take the medication for pain. True I may develop some tolerance or physical dependence, but that is still a different issue than addiction. I don't like medications but don't know that I can face chronic out of control pain either...