Drug Abuse Among Us?? - page 4

Am I that nieve?? A nurse on my unit was arrested for"drug diversion" Is this rampant among us?? I know we have all taken the occasional tylenol from work, but controlled substances ??... Read More

  1. by   Dr. Kate
    Chicoborja you scare the h*** out of me.

    In case you have some doubts, euphoria, whether drug induced or not, is a state of impaired judgement. A nurse with impaired judgement is a nurse without judgement and one who has no business taking care of anyone.

    There really are clear cut answers. A nurse who is unable to safely perform the duties of his or her job, has no business being at work. A reasonable prudent nurse and his or her supervisor will get him or her out of the clinical area. Reasonable and prudent coworkers will understand and cope.

    While legal and moral are not necessarily equivalent. We are bound by the law.
  2. by   sanakruz
    Yeah- Let's read between the lines here. One of the consequences of using is impaired judgemnt, right ?
    The user's feels fine , thinks they are working at optimal power, all four burners. Wrong.
    We are a dynamic system folks- Any change- allegra, caffeine withdrawal, ETOH, flexeril, ( I could go on and on) will influence the system. It's a fact. That there is no exact measurement for the change nor any way to predict how much of a change will occur is irrelevant.

    Two of the biggest drugs of abuse that will truly STRING YOU OUT are soma and ultram, neither of which is a controlled substance.
  3. by   RN2B2005
    I tend to agree, morally, with chicoborja...but I wouldn't do it. You'd have to lie and say you 'wasted' the meds, right? And the lying is what gets me hung up.

    As far as being impaired, I think it's an individual thing. I take Zyrtec, Zoloft and Wellbutrin every single day, no side effects. However, if I take a single dose of Flexeril, I end up flat on my back--literally. Same with most narcotics--30 mgs of codeine (the equivalent of one Tylenol 3 tablet) and I'm not only impaired, I'm totally useless. So, I don't take the Flexeril unless I have back pain so bad that I wouldn't go in to work anyway; and narcotics I just avoid unless I know I'm not working for at least 12 hours.

    I'm sure, however, that there are lots of people out there who could take four Flexeril, wash it down with some hydrocodone sirop, and still be relatively lucid and competent.
  4. by   P_RN
    ...but I must refer you back to my previous question regarding which of the two nurses would be more effective btw the one with the ha and stress or the relaxed euphoric one, like I said b4 I don't think there is a clear-cut answer.
    GASP...!!! I can't believe I just read this! The ONE CLEAR-CUT ANSWER is that nurse needs to go get some Tylenol or Advil and WASTE the med as the law mandates!!!

    Stealing drugs is not equivalent to dumpster diving in any way shape or form.

    And BTW dumpster-diving is dangerous and illegal!
  5. by   teeituptom
    Howdy ya'll
    from deep in the heart of Texas

    I am haveing a little difficulty understanding some of the views posted here. The bottom line is you do not misappropiate drugs at work under any condition. Whether it is waste or not. Itis still stealing and abusing drugs. And you are in violation of the law. The board of nursing rules and guidlines in whatever state you work. Except maybe that newest state, EUPHORIA.
    I do not condone or excuse the theft of drugs, in any fashion.
    Also, I do not condone or excuse those that work while impaired from prescription drugs usage. If your are hurting bad enough to require using narcotics, muscle relaxers, or other mind or mood altering substances Then you do not need to be doing patient care. You do not need to be behind the wheel of a car. Read the law, read your PDR, Read the board of nursing guidelines. It is spelled out in black and white. You do not go to work impaired from the influence of medication.
    Now if the level of pain you are experiencing is enough to impair your judgement then you need to stay home. If the pain you are having can only be controlled with narcotics, then you need to saty home or find a job away from patient care. This is black and white legalities. This is very simple. I have 3 bad discs in my lower back and a left knee that is in terrible shape. I HURT all the time. I woulf never take narcotics and muscle relaxers in any shape or form and go to work. This simply isnt proper,legally and morally and responsibly. It just isnt to be done.
    Someone talked about umpairment level due to meds ia an individual based response. that may be. However you do not need to work in nursing patient care if you are under the influence of medications, Im not talking tylenol and motrin here.
    This again is the plain unadulterated truth to the matter.
    Someone discussed earlier which is better impairment from being in pain so bad you cant function, or walking around pain free and in a state of euphoria and feeling better. Niether is preferable, and niether should occur.
    For those nurses and I have seen more than a few in my life who can't work in nursing without taking numerous psychotropic medications, then you are a impaired nurse. And if nursing is what is making you so unhappy then pills are not the answer. You need to get out of nursing and patient care. And again you shouldnt even be behind the wheel of a car. Find yourself another job. I dont want you taking care of my family if they are ever unfortunate enough to be under your care. I can understand a little prozac or wellbutrin or something mild. But when you are taking benzodiazipines and sedatives then you need to look elsewhere for work and again dont get behind the wheel of a car.
    Someone was talking about the right to pain control and managemnet of pain. I have no issues with this. Except while you are at work and under their influence and taking care of patients. This is something that cant be resolved in any aspect that I can see.
    I have worked with a number of nurses who succumbed to drug
    use while at work. Then were caught and went through rehabilitation. They came back and apologized to us and cried and stuff. We witnessed their wasteages and all also. Out all that I have seen only one has remained straight. The rest all failed in their recovery. Yes we have a shortage in nursing but filling it with impaired nurses is not the answer. I can see being given one chance, so make the best of it. But 2 or 3 or 4 chances, I think is wrong. Go find another job.
    A little about my self I am 50 years old and holding. I am a recovering alcoholic who has not failed in his recovery. I am a ER nurse of many years and some of beliefs are fostered by not only what I belive but from what I have seen occur while at work. And the consequences that occur from those who work while impaired. And if I can see any one thing that is a constant. That is any rationalization that you use to justify your continued use of some of these meds and continue to work, is just that a rationalization. So if you are using these meds and taking care of patients then do what you have been trained to do since nursing school, be good to your patient and go do some other form of non patient care work.

  6. by   renerian
    Afraid so. I know several nurses with this problem.

  7. by   Kizomo
    An interesting topic, with many differing points of view. I first started nursing in Australia in the late 70s ... back in the good ol' days of in hospital training... all narcs had to be counted with 2 persons... one of whom had to be an RN... 2nd could be a student. Drugs such as Tyl 3s also had to be counted by 2, but both counters could be students. I'm not sure if it's still that way today... it's been 20 years since I worked there, and there have been sooooo many changes all around. I realize that using 2 people to count is quite impractical these days, but hey... it sure did make it difficult to divert any wasteage. I remember being dumbfounded when I first came to Canada, and discovering narcs only needed 1 person to count.... it really is a recipe for disaster. I wonder, that if in-hospital training were brought back, there would be a steady supply of students, making it easier to do a 2 person count... just a thought...
  8. by   jude11142
    Originally posted by Jen911
    Okay, now a view from the other side of the fence. I have a chronic pain problem for which I have prescribed narcotics. I'm always careful never to take them on work days, never go to work impaired, and refuse to take them within 24 hours of the beginning of a shift (would rather suffer than to go to work impaired or call in sick which is very rare). I've asked my physician to change me over to a longer acting *non*narcotic pain med, but he doesn't feel it would work, and I would still need just as many narcotics as I currently do now for breakthrough pain.

    Everyone I work with knows I have chronic pain. I'm always careful about my narcotic wastes because the LAST thing I want to do is be accused of diverting narcotics from the ER. I've had RN's sign off on wastes with me, then start to leave the med room before I actually waste the drug, I make them come back in and physically watch me waste that drug. Yeah, it's a pain for me (and for them) to do this, but I'm covering my butt. Once I remind nurses about my reasoning, they're very understanding. Perhaps in some places we make it just a little too easy for our co-workers to divert these drugs....

    Just my own little 2 cents....
    Hi Jen,

    I am also a nurse who suffers from chronic pain that requires strong pain meds. I am also very careful not to take them while working/driving etc.....When I worked in the OR, it was in the height of my many surgeries and the beginning of my life of chronic pain, It didn't really affect my job nor did anyone really know about it, other than I have had some surgery. I left when I had children and was able to be a stay at home mom. After the kids were in school, I went to work in a short-term surgi-center and several co-workers knew about my "health issues"....I am sorry that I chose to tell them because in more than one instance, scripts were stolen/narcs etc....I never got confronted by administration but did overhear several coworkers trying to "figure out" who the culprit was and was shocked when I heard my name mentioned. Not only shocked but very hurt. To make a long story short, then investigated and it was found out that an anesthesiologist had a drug problem.

    Now, I don't let anyone at work know about my prior surgeries and the daily pain that I have. I am also very careful with the narcs, like you when I have to waste a narc, I will also call back the other nurse if she/he walks out before I discard it. I never want to be in a position where I would be questioned as a suspect if narcs were stolen/abused etc....I have found that when people(not just coworkers but family/friends)find out that you are on narcotic pain meds, many assume that you are addicted to or are unable to think clearly when taking them. Even once, when I was having a real bad day, the pain was unbearable, nothing worked etc....I had a family member say to me, "what's the matter, are you out of your pills?"....I was sooooo mad, same person joked with another another family member that I take pills strong enough to knock out a horse....what jerks.....It's no fun living with a chronic condition, let alone work with it. I have chosen not to let it control my life and I try and work very hard at trying to live a "normal life"....I refuse to have others judge me, doubt me, accuse me of things because I have chronic pain. lol, I'm sorry, guess that I am getting off subject and getting alittle sensitive.

  9. by   RN2B2005
    Not really on-topic, but...

    My mother calls me at work. She's on her cell, driving down the freeway. She has chronic LBP, and has just seen her (new) physician for an exacerbation of the pain. The doc has Rx'd some pain medication, which my mother has picked up and has already taken.

    So...I ask her, what did the doctor prescribe? She says, I don't know, but it's working already. I ask her to look at the med bottle and read me the label. She says, OK, well, it says "hydrocodone/APAP". I say, Hydrocodone? With acetominophen? Mom, that's Vicodin.

    My mother laughs and says, "Oh no, honey, I wouldn't take Vicodin, that stuff makes me all loopy."

    She ended up pulling over, and I went and picked her up. She thought she wasn't impaired...but she was, and in fact fell into a narc-induced sleep on the way home. So psychnurse is right, the PERCEPTION of impairment on the part of the narc or alcohol-impaired individual is usually wildly different from the ACTUAL impairment of the individual.
  10. by   SmilingBluEyes
    [QUOTE]Originally posted by FutureRN_Mandi
    Ive worked under the influnce of vikoden. Either I had o have vikodin or I was not going to be there. I was in TOO much pain. I had a horrible ear infection with throbbing pain, and blood and puss was just running out my ears, down both sides of my neck, it was so awful. I was in so mch pain that i wanted to curl up in a little ball, and then croak. [/QUOTE

    you do realize being under the influence of ANY drug, whether prescribed to you or not, is still a problem when working?? You are liable for what you do whether you use this drug or not. Vicodin, like any narcotic, can impair judgement and reflexes. I personally would NOT work if I had to be using a strong narcotic to get through my day.

    Plus, as sick as you were (pus draining from your ear?) you had no business at work anyhow....for YOUR sake and the SAKE of your coworkers and patients . You could be contagious! Sometimes, we need to let common sense rule over our sense of duty to be at work!
  11. by   SmilingBluEyes
    Originally posted by Kizomo
    all narcs had to be counted with 2 persons... one of whom had to be an RN... 2nd could be a student. Drugs such as Tyl 3s also had to be counted by 2, but both counters could be students. I'm not sure if it's still that way today... it's been 20 years since I worked there, and there have been sooooo many changes all around. I realize that using 2 people to count is quite impractical these days, but hey... it sure did make it difficult to divert any wasteage. I remember being dumbfounded when I first came to Canada, and discovering narcs only needed 1 person to count.... it really is a recipe for disaster. I wonder, that if in-hospital training were brought back, there would be a steady supply of students, making it easier to do a 2 person count... just a thought...
    when I went to school students were not allowed to TOUCH narc's period. We had to get an instructor or licensed nurse to sign them out and give them. This was in 1997. Also, having 2 people count and witness waste is the ONLY way you can cover yourself in the event suspicion is raised. I will NEVER waste ANYTHING w/o a direct eye witness, period. It keeps everything above-board and keeps me in the clear. No amount of convenience or time-saving is worth the aggravation and pain of an intense investigation because procedure was lapsed and people have not followed-though.

    I remember, once, several years ago, when I was working nights, I found a vial of Ketamine (appeared to be full but seal was broken) laying behind a couch in the breakroom. What fun it was, turning that in. The paperwork involved. I automatically self-submitted to a urine drug screen as did all of us on that shift. In the case of any suspicions, we wanted our names in the clear. My conscience and record are crystal-clear and I want it to stay that way.
    Last edit by SmilingBluEyes on Jan 8, '03
  12. by   duckie
    The attitude I have gotten from many posts here that if anyone routinely takes a narcotic pain relief med, they should not be working. I am speaking for myself and on my own views here. First drug abuse is much different than taking meds scripted by your MD to improve the quality of your life and the ability to maintain having a life. I have a spinal fusion involving 3 disc's in my lower back with radiating nerve damage down my right leg. I also have severe athritic knees from 22 years of walking hard cement floors caring for loved ones of people intrusted into my care. I fought very hard not to start taking pain medications. But when you reach a point, where you are on your knees doing a treatment and your patient has to call a staff member to help you up off the floor because the pain is so great you are frozen, something has to give and this happened to me more than once. My knees are beyond saving . Pain control is the only way to keep me working. I am 46, should I be kicked out of nursing? Should I be expected to work 10-12 hour shifts in so much agony that the tears rolls down my face without my ability to control them. Or should I be taken out and shot like a lame horse, because I am unable to meet the potentil I once did as a younger nurse, and I might add that even on the days of my greatest pain, I can still work circles around many of the whiny new breed intering our facility that calls off because they have a headache. I have finished med passes while passing kidneys stones on 2 occassions. I routinely take pain meds every four hours while working with another narcotic available if that does not make it tolerable. My work performance is not hampered. I think clearly, make vital decisions and have not had a med error in over the seven years at my current facility. So am I empaired. I have ran codes, worked an entire unit alone that was a 2 LN unit, due to call offs, and my average day is 9 - 12 hours. My supervisors know all meds I take. They back me 100% because the old me is back now that my pain is controlled and I can be me again. Please do not" critisize and accuse until you walk a mile in my shoes." My supervisors have even "noticed my pain and asked me to "take a break and give my meds a chance to kick in, to rest a while in the lounge. They do this because they know I never take breaks, I'm there for my patients from start to finish and will work as late as I have to to make sure they have received the very best of care. The discussion at hand is "drug abuse" not medications that are taken as ordered for a good quality of life. If that is the case, then any LN taking an antidepressant or antianxiety medication should also not be allowed to work, because they are also "mind altering". Now instead, let's all go out and get totally drunk the night before, come in hungover and what the dickens and " can I take care of your loved one?" I think not, I'll continue to do it my way and with a very clear peace of mind. Don't judge me till you've felt my pain and walked in my shoes. I would also like to specify that I do not feel "any buzz" from my meds, they have been titrated to minimum dose for maximum effect without those side effects and the principle is keeping the drug level consistant to control pain but not to produce a "High".
  13. by   Furball
    Hey Duckie, you're one tough cookie! Quick question...what does a kidney stone FEEL like? I'm asking because I had a weird, horrid crampy, knife like pain in my side last night at work...it took my breath away, kinda came and went, then came back again.

    Thanks from a hyperchondriac!