Suboxone use and the Boards of Nursing - page 3

Does anyone here know, with any degree of certainty, how the various State Boards of Nursing view the use of Buprenorphine (Suboxone/Subutex) for opiate dependence and/or addiction? Do they allow... Read More

  1. by   TXRN2
    epocrates: best of luck to you!!! i have absolutely no idea what your BON will say or do- but i hope it works out for you!!
  2. by   SarahFNP
    FYI-the Naloxone in Suboxone is not absorbed into the system. It is simply in the combination drug to keep people for shooting it up. Otherwise you actually absorb little to none. It's the Buprenorphine itself that has such an affinity for the mu receptor it can't be bumped off by 99.9% of opiates. So, the naloxone doesn't keep you from feeling the effects of opiates, or make you sick, it's the affinity of the buprenorphine to hold tight. If you were to take buprenorphine without naloxone whilst having opiates on board it would kick whatever opiate you've taken off the receptor and take it's place. that's why you cannot start someone on Subutex, or Suboxone until they are in full withdrawal.
  3. by   adriennebc34
    What if you have been reinstated just a week ago, already signed your agreed order from your BON? The only instructions is no mood or mind altering substances, if u are on meds your doctor must fill out a paper stating the reasons why you are on them. I have been an addict for 10 yrs. I thought suboxone would help me from a relapse. I'm in the state of KY, does anyone know??
  4. by   jackstem
    I don't think Kentucky allows a nurse to practice while on Suboxone. You might want to consider consulting with a nursing license defense attorney. I've put out some feelers from folks who might have the answer to this question. If I receive anything definitive I'll post it.

  5. by   gmkj
    Well said. I have been on it since 2006 .Some may say I am weak and still using but since I only answer to myself I say I am almost eight years in recovery. I can honestly say I have not used any iligal narcotics.i have no cravings and have gone from 32 mg a day to 4 mgs a day. I am now a practicing lpn for four years without a single incident.Although I have seen many other nurses using and diverting drugs with no proof I have to mind my business and worry about myself. I was out of nursing for almost three years and thought I would not be able to work in nursing a gain. I did start as a can until my compny felt they built enogh trust to let me work as a lpn which I am now doing. My life is normal and some day I may not need it but for no I will continue to slowly wean myself off and live in alife wear I can do what I love nursing. when I got my license back the nys nursing board new I was on suboxone and aloowed me to work while on the medication. So for any of you who think its as bad as using other narcotics yea I will call you ignorant because as they say addiction is a disease which can be controed with medication same as any other illnesses and also like other illnesses is no cure.Best wishes for any one going thru the struggle..
  6. by   adriennebc34
    I'm not sure either, thanks for the help. You are the only one who has answered me. :-)
  7. by   sallyrnrrt
    double edge sword, i am glad i was not afforded it
    most BON say no....

    i see it help in myclinical environment of practice, but only few have weaned off.....

    the 12 step way worked for me, and i personaly advocate the steps
  8. by   LilRedRN1973
    It was one of my options and I quickly turned it down because for me and me only, I would have been replacing my dependence on pain pills to dependence on suboxone. From what I have seen working in the psychiatric field for the past 5 years and many, many addicts, when they have been offered suboxone, it doesn't encourage them to find other ways to manage their sobriety. They aren't much interested in meetings, a sponsor, etc. This is just from my experience. I think it has its place, short term but long term use just wasn't for me and I didn't want to even start down that path. I was taking close to 40 Norco's a day and endured a nasty 7-10 days of withdrawal but then it was over and I was clear of any pills, medications or the need to take anything. And that was when I buckled down and started a 12 step program in order to ride myself of the obsession/craving.

    I know our BON does NOT allow it at all. They are very much opposed to the use of just about anything while on contract.
  9. by   Geslina
    Imodium??? Loperamide, the "opiate" in Imodium only acts on the intestines, it can't pass the blood/ brain barrier, so Cant actually effect the users brain or mood. Even not allowing Benadryl is ridiculous. Only in Texas.
  10. by   catmom1
    Quote from Geslina
    .. Even not allowing Benadryl is ridiculous. Only in Texas.
    No, not only in Texas. Several states are as bad or worse. My state has no alternative to discipline program of any kind for ANYONE with any addiction, so one's career is destroyed regardless of how many years, even decades of recovery are in place.

  11. by   SEDK
    Quote from catmom1
    No, not only in Texas. Several states are as bad or worse. My state has no alternative to discipline program of any kind for ANYONE with any addiction, so one's career is destroyed regardless of how many years, even decades of recovery are in place.

    What state do you live in?! That's awful since addiction is accepted by the federal government, the AMA, WHO, NIH, etc as a disability and a disease. It would be tantamount to telling a diabetic, or hyperthyroid nurse they cannot work because of their diagnosis.
  12. by   edmia
    ^^ Right? You'd think these decisions and programs would be evidenced based since that's what nursing theory is all about ... SMH ...

    Sent from my iPhone -- blame all errors on spellcheck
  13. by   Lexi McDonough
    It depends on the state. I don't have a lot of knowledge on this, but I believe MOST states will allow RN's to take suboxone provided its being prescribed by a doctor. They may also impose additional requirements like regular drug testing and/or psych evals, but for the most part you can practice as anyone else (i.e. they wont revoke you narcotics access or anything). Thankfully, the medical community (including medical facilities) are a lot more educated about addiction and drugs and don't take as much of a negative attitude toward it (like the general public), but there is still a lot of bias and outdated views. Its also a legal thing, if the RN went to court you know the other sides lawyer would emphasize how the RN was "taking a potent narcotic painkiller and is a drug addict" and 90% of the people in the room will think that's the truth.

    I see a lot a negativity towards buprenorphine here and I think its misguided. First of all, it is different than methadone and different than street opiates and narcotic painkillers like oxycodone. It is a partial agonist, meaning its like a cross between nalxone (opiate overdose antidote) and a regular painkilling opiate. Methadone is a full agonist just like morphine and is actually used quite a lot for pain, its used for detox and maitence because its long lasting and also has a high receptor affinity, so it will block things like heroin and oxycodone at moderate and high doses. Since its a full agonist, it has the traditional opiate affects that buprenorphine lacks so nursing on methadone is probably not safe, but buprenorpine can be safely taken by nurses under the care of their psychiatrist.

    People taking buprenorphine do not experience any euphoria (after the first few doses), it simply stimulates those opiate receptors just enough to prevent withdrawal. An opiate addicts brain is rewired in a way to need opiates to function normally, and suboxone provides just enough stimulation to allow addicts to function normally without being impaired in any way. It also has a high affininty for the mu opiate receptor, which allows it to acts as a "blocker" so if the nurse was to, say, slip up one day and take a few painkillers from the narcotics drawer, she would not get any affect from taking them nor would she get any effect from buying a bag of heroin on the way back. The blocking effect can last for about 3 days (or more in some people) so that gives the patient plenty of time to rethink their desire to use again, whihc is great because most relapses are quite impulsive and almost always regretted.

    So there it is. I've done a TON of research on addiction treatments so I know a lot about this stuff.

    To summarize, suboxone/subutex/buprenorphone is a very beneficial drug (even if you are on it for your entire life) that does not cause any impairment that would make it unsafe for a nurse to be taking it on the job. Statistically, I would bet my life that a nurse who simply got clean and is trying to stay clear is a far greater risk than one on suboxone, the suboxone gives them that saftey net so they can fall victim to a momentary lapse of judgment that accompanies so many relapses.

    P.S. There is also long acting forms of the opiate blocker naltrexone which can be used to really restore the brain to its normal state, but its can take 1-3 years, requires detox, and has a number of side effects that most patients don't like. All the research we have thus far says patients can function very well on long term suboxone Tx so I don't see a need to have so much regulation and controversy over it (prescribing docs even need a special cert and they have a patient cap of 100, which only drives up the cost of treatment and makes finding a doctor that much harder). Again, this is all do to socio-political misunderstanding about drugs and addiction, but I'll save that for my ethics class