about to start LPN course & questions about drug testing and suboxone

Scooter5 · Jul 25, 2009

AS a probation officer for 15 years (who is now a nursing student:) ) I have seen more people kick opiates with the help of the suboxone than without it. I commend you on your progress! If you have the will you will taper and be done. Do not expect perfection- go back to it if you need to- it is a tool if used properly. Don't let this chapter of your life ruin your plans. IF you are drug tested, that would be the time to have your bottle of suboxone wtih you so they can see you have a legal perscription for it. Keep moving forward. Good Luck!

Magsulfate, BSN, RN · Jul 28, 2009

Suboxone does not show up in the standard 7 drug test, or the 20 drug test. However, it does show up in the comprehensive test that TPAPN has their nurses take.

There.... that's my answer and I'm sticking to it. I consider myself pretty much an expert on opiod abuse among ... myself.... and keep in mind I am writing this before I read jack's response,,, I think you're doing a good thing by using suboxone and tapering off. It is a good med to help while also going to na and counseling. It may not work if you just take the med and continue on with life like it's normal... because life is not normal, sepcially if you have to take suboxone to keep away from the pills.

So, good luck to you in your recovery :)

rninmi · Jul 29, 2009

It may not work if you just take the med and continue on with life like it's normal... because life is not normal, sepcially if you have to take suboxone to keep away from the pills.

I agree completely, good point. I think that is why my friends have not been able to get off of it. That is the only tx they are pursuing! You have to pursue your recovery in EVERY Aspect. Thanks for that good point.

jackstem · Jul 29, 2009

I agree completely, good point. I think that is why my friends have not been able to get off of it. That is the only tx they are pursuing! You have to pursue you! r recovery in EVERY Aspect. Thanks for that good point.

Well said by both of you.

What is recovery? Ask 1,000 people and you'll get 1,000 answers. It's pretty tough to achieve something if you don't know what it is you're trying to achieve! Since a nurse receives their authority to practice nursing from the nurse practice act in their state, you have to read that document in order to know if a nurse can practice while taking prescribed medications that are considered "mood altering". I'm not of any state that would allow a nurse to practice while taking soboxone or methadone, the 2 leading "replacement" medications approved for use in this country. If anyone is aware of a state that allows a nurse to practice while taking suboxone, please let me know. Thanks in advance.

Now, on to a definition for "recovery". Right now, the best definition available is from the Betty Ford Treatment Center:

To this end, a group of interested researchers, treatment providers, recovery advocates, and policymakers was convened by the Betty Ford Institute to develop an initial definition of recovery as a starting point for better communication, research, and public understanding. Recovery is defined in this article as a voluntarily maintained lifestyle composed and characterized by sobriety, personal health, and citizenship.

The full article can be read at this link:

http://www.facesandvoicesofrecovery.org/pdf/Betty_Ford_Institute_Consensus_Panel.pdf

Recovery is NOT simply abstinence. Terence Gorski, a leader in relapse prevention says it well...there are abnormal behaviors exhibited as a result of addictive disease when there is use of mood altering chemicals, and there are abnormal behaviors as a result of addictive disease when there is NO use of mood altering chemicals.

In my experience, the pursuitand maintenance of recovery requires 2 things (at a minimum):

abstinence from mood altering substances
the willingness to look inward and "fix" those things that make us a pain in the butt to be around and pursue mood altering substances as an answer to life.

Good luck with your pursuit of recovery!!!

Jack

rninmi · Jul 29, 2009

In my experience, the pursuitand maintenance of recovery requires 2 things (at a minimum):
abstinence from mood altering substances
the willingness to look inward and "fix" those things that make us a pain in the butt to be around and pursue mood altering substances as an answer to life.
Jack

Jack, I like this better than the Betty Ford definition. Good question though...what is recovery? For me it meant

1. Abstinence from all mood altering substances (including etoh and/or rx'd drugs)

2. A change in the way I think!

I don't have a drug problem, I have a thinking disease.....Every night I thank my higher power for keeping me clean today, then I take my 10th step inventory and see how I responded to people, places and things...how could I have done better, what will I do to change???? I can tell you this that after a short 5 years my response, the way I view people, myself and "things" have changed dramatically. Because of "recovery" I have completely "overhauled" my brain. I see things differently now. And because of the steps I learn something new every day. I make mistakes and I hurt today, I laugh, I cry and I experience raw, life emotions....I get to experience "life on life's terms" WITHOUT the use of a mind or mood altering substance to help me get "numb"...that is recovery for me! :wink2:

jackstem · Jul 29, 2009

Excellent! The "KISS" principle at it's finest.

Jack

jackstem · Jul 29, 2009

The article about how the Hazelden's definition was developed states, anyone who has achieved recovery knows what it is for them. The Betty Ford Definition is one of the first attempts to actually define recovery, and it's based on several premises.

Recovery is not simply sobriety (abstinence)
Recovery is a personal condition (meaning it's achieved by CHOICE), not a specific method (I personally love the 12-Steps, but there are other methods available)
This definition of recovery is specific to addiction, not general recovery from other conditions or diseases
This "definition" is a starting point, not a final definition
It's a voluntary process. While the initial "choice" to enter treatment and achieve sobriety (abstinence from mood altering substances) may be coerced, achieving and maintaining recovery is a personal choice which eventually is voluntary
It's a maintained lifestyle...in other words, you actually have to DO SOMETHING to maintain it!
Section 5.1.2 discusses sobriety sustained by medications (naltrexone, buprenorphine, acamprosate, etc.) specifically. The question for a nurse who is on a medication such as suboxone, which has agonistic as well as antagonistic properties is could there be a legal issue if they render care for an individual and there is a less than positive outcome. Naltrexone, which is a pure agonist does NOT lead to the same legal concerns.
Citizenship - means the recovering addict becomes a functioning, contributing, productive member of their community. In their words:

"...implies working towards the betterment of one's community through participation, volunteer work, and efforts to improve life for all citizens." We believe this captures important traditional recovery elements such as "giving back."

By developing a definition of recovery, we not only have specific milestones to achieve and maintain by the treatment community and the recovering individual, society also begins to learn what recovery is as well.

Think of it this way. If person A was running for office and they stated they were a cancer survivor, (those who are living symptom free for 5 years after a cancer diagnosis appear to have reached a period of significantly reduced risk for relapse and are thus termed survivors (Reis et al., 2003; Rowland, 2004), most people would understand what they mean and have some sort of understanding of the difficult and heroic journey they had to travel to be a survivor.

If person B was the candidate opposing person A, and they said they were in recovery, very few people would know what that meant. People would also have a significantly different view of the 2 candidates as a result of the lack of understanding what recovery is, and the difficult and heroic journey required to achieve it. This lack of understanding is also responsible for the stigma associated with this disease.

Defining recovery makes it real and achievable.

Jack

ercrazy · Nov 6, 2009

Im have to enroll in tpapn and have been on maitenance dose of suboxone. Im trying to taper off to get off of it completely. what do i tell tpapn. i need to work soon. been out of work for over 1 year because i relocated to houston. I'm afraid they won't let me work right away. i was working in my previous state while under a recovery program and under subooxone because they allowed it. is it really difficult to get off suboxone. and how long does it show up in a urine test for sub after you get off of it? also does anyone know what the hourly rate is here in houston now in 2009. they offered me a job for $28 an hour by a dialysis clinic. i have 9 years expr in er and was making much more than that in my previous state. is this a fair rate??? any help would greatly be appreciated.

mona1023 · Jun 11, 2011

That was an excellent definition of recovery, Jack. I appreciate your wisdom.

I did want to comment that I agree that working around opiates would be very difficult for a recovering opiate addict. This IS all the more reason to actively work at maintaining a recovery program. I have never taken suboxone-I am in recovery and am monitored by my state and it is absolutely NOT acceptable. My advice to the original poster of this thread is work, work, work at recovery and consult a physician about weaning from the suboxone because it will most likely be an issue at some point if you become a nurse. Best of luck to you.

diva rn, BSN, RN · Jun 11, 2011

I do have to chime in here. I have posted on this topic before and I have very strong feelings about it mainly because I lived through it so this is not supposition but what my experience was.

I am not going into my whole back story, it's too lengthy and it can be found on this forum.

But, I was on Suboxone. The withdrawal from the Suboxone was SO MUCH WORSE than withdrawal from opiates.

It took me 9 days to withdraw totally from the suboxone....now, it wasn't the vomiting and flu like w/d from say morphine or oxycodone, which is usually about 3 days, but it was horrible...I didn't sleep and I ached all over and it was like there were thousands of red ants crawling under my skin. For 9 days, I also had a stomachache and didn't eat much. Now, I don't know if that is typical...my Doctor said, well, sooner or later "you have to pay the piper" ( he wasn't being sarcastic" he actually was very supportive).

The only thing I could do, was sit on the beach at sunrise and stare at the ocean and Pray...

Before all of the Suboxone fans start jumping up and down and countering with...well you didn't taper....etc..

YES...I did taper...Like my Doctor said..sooner or later, the piper has to be paid.

I really do not believe in the use of another addictive CONTROLLED SUBSTANCE being substituted for the one you are trying to detox from.

Addiction is addiction...

Especially those who have been on this stuff for Years...what is the difference in being addicted to Suboxone and in being addicted to Morphine??

I mean Really???

As Jack has said, Recovery is total ABSTINENCE...and the Florida BON sees it that way..:) and so do I.

But BON aside....Having been addiction to opiates for about 8 years, then on suboxone, and now Thank God drug free for 2 1/2 years it's so much better.

It's so great not to have to WORRY all of the time...worry if something will show up in a urine test. or like in the old days, worry if my script will run out and I wont have enough of my meds...and will I start to go into w/d...oh my gosh...this is SO much better.

I am So Greatful:redbeathe

and that's why I am so passionate about suboxone...and by the way it can be detected in your body for up to 11 days

jackstem · Jun 11, 2011

diva, et al,

In an ideal world, recovery is abstinence from all mood altering substances. Yes, I do believe that is the ultimate goal for someone with a Substance Use Disorder (or SUD, the new term for addiction/chemical dependence). HOWEVER, since recovery is a process (just as relapse is a process), there is a continuum for this whole SUD disease.

Active Addiction ---------------------------------------------------------Abstinent Recovery

(notice I didn't label it just abstinence or just recovery)

Just as their are those with other chronic diseases who require a variety of modalities to keep their disease in remission/recovery, there will be those with SUD who will require more than abstinence and a couple of support groups a week (whether 12 Step or non-12 Step). I would much rather see someone who has demonstrated an inability to remain abstinent remain on suboxone (with appropriate medical care and continuing follow-up and regular evaluations...just like we do for hypertension and other chronic, progressive diseases) than returning to illegal activities (diverting from work, family, friends, etc.), buying from "pill mills", online "pharmacies", or obtaining their drug of (no) choice on the street.

The folks who do require opioid replacement therapy (ORT) may not qualify to continue in a chosen profession as a result (at least until the medication is discontinued or testing has performed and lack of impairment is documented). Having a valid prescription for a medication should not (and does not) offer blanket "immunity" to continue working if their job performance requires a high level of mental acuity and/or manual dexterity. Those individuals are held to a higher standard than the "average". Examples include pilots, physicians, nurses (and other health care providers), heavy equipment operators (truck drivers, crane operators, tractors, etc)., police, fire, and other emergency personnel, etc. In order to continue working while taking their prescribed, potentially "mood altering" medications, safety precautions should be designed and utilized to give the best possible data that the person isn't "impaired". Mental acuity and manual dexterity testing along with toxicology screening to determine appropriate blood levels of prescribed medications and lack of non-prescribed "mood altering" medications should be developed and utilized. By doing so, a couple of things would be accomplished. First, treatment and monitoring would be individualized and followed closely to determine their safety to practice (and the effectiveness of therapy). Second, data would be gathered which would allow even more effective, evidence based guidelines for the use of mood altering substances to be developed. The reason this debate goes on and on is because we lack sufficient scientific evidence to provide effective treatment and continuing care (i.e. monitoring) guidelines.

Oh I know, there will be those who will be angry with those "monitoring" suggestions. But don't we recommend the same thing with other chronic diseases? ESPECIALLY when the disease is particularly difficult to manage (the "brittle" diabetic, unstable angina, etc,)? Why is it "OK" to recommend a very strict regimen of disease management for a disease like diabetes, but not for a chronic progressive, potentially fatal disease like SUD? Again, it comes down to lack of understanding of the disease and lack of evidenced based information regarding treatment approaches. Couple that with the fact that many, many people don't "believe" SUD is a disease, and we have a really messy, haphazard approach to those with the disease.

We see how emotional the threads in this forum and numerous other online "discussion" areas can become. It makes sense since one of the underlying components of this disease is the inability to deal in a healthy, effective manner with emotions. When we lack scientific, evidence based information, we are left to deal with this issue and this disease with what I call the "3 Ms" of addiction...Myth, Misbelief, and Misinformation. We do our best not to do that with other diseases. It's time we begin to do the same with this one.

Jack