preemployment drug testing

Eris Discordia BSN, RN · Mar 6, 2018

I think Hppy was talking about what happens if the OP finds him/herself in monitoring. The suggestion is for OP to withdraw the job application and avoid the drug test until the benzo is cleared. That will avoid running afoul of the BON and the subsequent ramifications.

Ahhh. Yes. That is what I was desperately trying (and apparently failing) to get across; don't test yet unless you want to risk a gigantic pile of doo doo that will take years to wade through. No job screening is worth that risk. Clean up your act, then screen later. I tried to talk from a place of my experience with UA drug levels and consequences prior to monitoring...but I don't think OP was hearing me there.

Meriwhen, ASN, BSN, MSN, RN · Mar 7, 2018

I honestly dont see what I did wrong though. Legal prescriptions, taken as prescribed. How did I mess up?

Let's substitute "Ativan 1mg" with "Lisinopril 20mg"...or if you want to stay in a psychiatric vein, "Wellbutrin 300mg." Would you still have done what you've been doing? Be honest.

I say this gently: I think you knew what you were doing the entire time, and now you're hysterical that you're going to be found out...which is usually how these things work.

First of all, knowing how prescriptions and refills work is part of Nursing 101. Second, if you did have a bona fide concern about whether you were to take both prescriptions, you would have asked your PCP right then and there, instead of waiting until you were facing a drug screen.

Last, the content in the questions you are posting here, as well as in your responses to other posters, suggest to me that you're not quite as naive as you'd like us to think. Because if you were indeed truly naive, you wouldn't be throwing around terms such as "outside of therapeutic range."

So let's break this up into the two issues: your Ativan use and the drug screen.

Issue 1: if you are taking more Ativan than prescribed, you need to talk to your PCP. Either your anxiety is not being adequately managed with your current dose, and you need the dose or even the medication itself changed, or you're developing a benzo abuse problem. I leave it to you and your PCP to determine which one (or whether possibly both) is the case.

Issue 2: It's up to each hospital to determine what they want to drug screen for, how they want to screen for it, what their policies are regarding disclosure of medications you are taking, and what constitutes a "passing" drug screen for an applicant.

And yes, if they wanted, they could do a urine screen to determine the level of a drug present in the urine--my last job used to do that all the time for outpatient screens. It was a good way of seeing whether patients really had stopped using a medication, or whether they're abusing what they were prescribed. So while a lot of employment drug screens are of the "positive/negative" variety, a quantitative urine test could happen...and you may not necessarily be privy to that fact before taking the test.

Keep in mind that having a prescription is not bulletproof protection, especially when the sig on the script says Ativan 1mg Q6H but the benzo level in your urine is showing much higher than that.

So you have a few options:

You could take the test and hope that it goes no further than "you're positive for benzos but you have a script, so it's OK." It might work out that way. Or it might not.
You could ask for postponement of the test. However, a lot of employers expect you to take a test in a certain timeframe (e.g., within 48 hours), and if you fail to test in that time frame, they consider it an automatic positive/fail and act accordingly. Plus, what would you tell them is the reason for postponing?
You could not take the test and therefore lose the job offer, straighten out your Ativan use, and then find another job.

Regardless of what you decide to do about this drug screen, you do need to address your Ativan use, whether it's due to the medication inadequately managing your symptoms, medication abuse, whatever the reason that is causing you to take more than prescribed. Otherwise, you'll facing this dilemma at the next job you apply for, and the next, and the next...

Best of luck whatever you decide.

OrganizedChaos, LVN · Mar 7, 2018

I wonder if the OP took her drug test yet.

Oldmahubbard · Mar 7, 2018

Sad to say, in a tight job market, although the benzo is legal, you are probably poop out of luck in either case. They don't have to hire you.

I am curious how the OP got the early refill. There are zero early refills around here.

The pharmacies have all the information on this new fangled gadget, a computer.

I am a PMHNP and a believer in relieving people's misery when I can.

As such, I do prescribe benzo's at times.

They are best used in specific contexts, on a short term, or intermittent basis.

Long term, daily use is rarely the best answer.

allnurses Guide · Mar 7, 2018

I think Hppy was talking about what happens if the OP finds him/herself in monitoring. The suggestion is for OP to withdraw the job application and avoid the drug test until the benzo is cleared. That will avoid running afoul of the BON and the subsequent ramifications.

This - take a journey over to the nurses in recovery forum and you will find a number of nurses in monitoring programs whose only offense was a positive drug screen on a pre-employment drug screen. Some were new grads who never even had a chance to be accused of being impaired as they had never worked as a nurse.

Don't let this happen to you!

Hppy

allnurses Guide · Mar 7, 2018

Let's substitute "Ativan 1mg" with "Lisinopril 20mg"...or if you want to stay in a psychiatric vein, "Wellbutrin 300mg." Would you still have done what you've been doing? Be honest.
I say this gently: I think you knew what you were doing the entire time, and now you're hysterical that you're going to be found out...which is usually how these things work.
First of all, knowing how prescriptions and refills work is part of Nursing 101. Second, if you did have a bona fide concern about whether you were to take both prescriptions, you would have asked your PCP right then and there, instead of waiting until you were facing a drug screen.
Last, the content in the questions you are posting here, as well as in your responses to other posters, suggest to me that you're not quite as naive as you'd like us to think. Because if you were indeed truly naive, you wouldn't be throwing around terms such as "outside of therapeutic range."
So let's break this up into the two issues: your Ativan use and the drug screen.
Issue 1: if you are taking more Ativan than prescribed, you need to talk to your PCP. Either your anxiety is not being adequately managed with your current dose, and you need the dose or even the medication itself changed, or you're developing a benzo abuse problem. I leave it to you and your PCP to determine which one (or whether possibly both) is the case.
Issue 2: It's up to each hospital to determine what they want to drug screen for, how they want to screen for it, what their policies are regarding disclosure of medications you are taking, and what constitutes a "passing" drug screen for an applicant.
And yes, if they wanted, they could do a urine screen to determine the level of a drug present in the urine--my last job used to do that all the time for outpatient screens. It was a good way of seeing whether patients really had stopped using a medication, or whether they're abusing what they were prescribed. So while a lot of employment drug screens are of the "positive/negative" variety, a quantitative urine test could happen...and you may not necessarily be privy to that fact before taking the test.
Keep in mind that having a prescription is not bulletproof protection, especially when the sig on the script says Ativan 1mg Q6H but the benzo level in your urine is showing much higher than that.
So you have a few options:
You could take the test and hope that it goes no further than "you're positive for benzos but you have a script, so it's OK." It might work out that way. Or it might not.
You could ask for postponement of the test. However, a lot of employers expect you to take a test in a certain timeframe (e.g., within 48 hours), and if you fail to test in that time frame, they consider it an automatic positive/fail and act accordingly. Plus, what would you tell them is the reason for postponing?
You could not take the test and therefore lose the job offer, straighten out your Ativan use, and then find another job.
Regardless of what you decide to do about this drug screen, you do need to address your Ativan use, whether it's due to the medication inadequately managing your symptoms, medication abuse, whatever the reason that is causing you to take more than prescribed. Otherwise, you'll facing this dilemma at the next job you apply for, and the next, and the next...
Best of luck whatever you decide.

This. All of this. Perfect response.

Kel65, MSN, RN · Mar 7, 2018

And no further posts from the OP ???

wondern, ASN · Mar 7, 2018

Essential Mathematics for Nursing

morte, LPN, LVN · Mar 7, 2018

Sad to say, in a tight job market, although the benzo is legal, you are probably poop out of luck in either case. They don't have to hire you.
I am curious how the OP got the early refill. There are zero early refills around here.
The pharmacies have all the information on this new fangled gadget, a computer.
I am a PMHNP and a believer in relieving people's misery when I can.
As such, I do prescribe benzo's at times.
They are best used in specific contexts, on a short term, or intermittent basis.
Long term, daily use is rarely the best answer.

If the original was on 12/3/17, it was not an early refill. the fact that she has left overs would appear to say she is not abusing. however, doubling up was stupid, and NOT the doc's intent.

K9lover, ASN, RN · Mar 11, 2018

As others have mentioned doubling the dose is not using it as prescribed. I do not think UDS is looking at therapeutic levels but it would jump out @ MRO if you were taking twice what sig called for.

npdallas · Mar 18, 2018

there are minmum ranges (say 50 nanograms is the cut-off) if test positive for over 50, you're busted. They measure with urine. asking multiple doctors about drug testing testing sounds like something an addict would do. I should know. All of us know.

rn1965, ADN · Mar 19, 2018

there are minmum ranges (say 50 nanograms is the cut-off) asking multiple doctors about drug testing testing sounds like something an addict would do. I should know. All of us know.

BOOM!