Pre-Employment Drug Screens and Perscription Meds

[EmmaLynnSmithRN]

Hi All! I am new to these forums so if this question would be better addressed in another forum please let me know and I can move it.

I had a question about pre-employment drug screens. I am currently on an ADHD stimulant medication and have been for over two years (prescribed-always have been). Within the last year I have developed some really bad middle back pain that just KILLS me after work. I work on a floor that requires moving a lot of patients and lifting and manual labor. About 600mg of Motrin and a heating pad will take the edge off the pain after work and I did that after work for a long time despite having had a gastric bypass surgery a few years ago and all NSAIDS are contraindicated for us. Being a nurse I was worried about the possible repercussions to my job if I used a narcotic-prescribed or not.

I took cautions with the large amount of Mortin I was having to use to control the pain including using it with Carafate, a PPI, and taking with food-but it wasn't enough. I developed a good-sized bleeding ulcer and can no longer use NSAIDS-but I still have this damn back pain! A chiro can help intermittently but not enough for all of the money and time that goes into it. So anyways I am now prescribed Lortab and Flexaril PRN. I take it 1-2x/day about 2-3x/wk. I NEVER use while at work, before work, or when I am on-call. Im frustrated because NSAIDS are sufficient to deal with the pain but they are contraindicated because of my bypass and concurrent bleeding ulcer. I was able to take small doses of IM toradol for a couple weeks and it eliminated the pain for HOURS while it was in my system but it is not a long-term solution because its so Nephrotoxic.

I have never had to take a drug test since starting this medication or my ADHD medication because I have been working at the same job since I became a nurse 7 yrs ago. I am going to become a travel nurse and the contracts last 8-13 weeks apiece. Each new facility will require a drug test along with each travel company I sign up with.

Im frustrated because these are prescribed medications I use on my time OFF the clock. I do not use within 12-24hrs of having to work so I have never been "under the influence" while working. No...Im sorry-let me clarify-when I say I don't use within 12-24hrs of work I am talking about the Lortab/Flexaril. I take my ADHD medication daily whether I work or not.

Anyways-I kind of feel like us nurses are set up to fail sometimes. I have read a lot of your stories where you have been turned into the board from a pre-employment drug screen. At the risk of sounding like a whiner-these people aren't even your employer yet! If people like this are reporting nurses to the BON-where in the world are you guys getting the nerve to go to an ER or an in or outpatient detox center to get better when you know this is "reportable"? How do you confide in a doctor or psychiatrist about any possible problems if you are just going to get reported? Its like there is no way to take a little time off, seek private treatment, get better, then go back to work.

That is a totally different soap box though and not the subject of my post. I don't have an addiction and these are legal medications. But I still do not want to subject myself to a drug test while knowing these WILL show up in my system. What do people who honestly don't use prescription narcotic meds in ANY way except PRN do for drug screens? My concern is I will be a new unknown candidate showing opiates, amphetamines, and TCA anti-depressants (Flexaril tests positive as a tricyclic anti-depressant for some odd reason for anyone who wasn't aware) in her urine. Not knowing the circumstances that doesn't look good on ANYONE. I have every bit of evidence to prove these are approved medications and I THINK they can test a "level" to make sure Im not taking MORE than indicated? Or I would be happy to submit to a pill count if they questioned "proper" use of the medication. But still-it just seems like quite a risk because from the reports I have read here and some other sites some labs will see you have a prescription, report it as a "negative" and that's that. But I have also read reports from people who had a prescription but the employer still stated they were required ethically to report them to the BON because there is a chance if its in your urine-there is a chance you were practicing impaired.

And that's just the Lortab...the ADHD medication I DO use while working. But it definitely IMPROVES my work performance rather than impairs it. For sure. My ADHD is moderate to severe undedicated. However-I have seen many people state they feel like their DOC improves their performance rather than impairing it so Im not sure that is a valid reason to "use" my ADHD medicine while at work?

Not to mention privacy rights and HIPPA. I do NOT think its fair that I would have to disclose my medical history including possibly disclosing my gastric bypass just to "justify" my use of Lortab while NOT ON THE CLOCK!!! I don't know. I can always take a couple weeks off between assignments, deal with the pain/ADHD, and hope two weeks is enough to not show up in my urine-but that doesn't cover me if a certain facility chooses to use hair testing. It also does not cure the underlying issue that once I start these meds WILL be in my system even though I would NOT be working impaired simply because the metabolite stay in your urine long after they quit "impairing" you. If I fell at work or got a needlestick or something random Id still be tested and still show positive and still have a prescription and still have to chance whether an employer would drop it at that or whether they would forward it on to the BON to deal with.

Sorry for the long post. A lot of it is just me venting my frustrations. I understand nurses are public health officials and employers have to take precautions to make sure they aren't practicing impaired. I just wish there was a better way to prove when this stuff shows up in your system that you are only using it because there is no alternative med for the pain and you are not using it while at or anywhere close to when you have to work!!!

[HunnieBadger]

If you have a legit Rx you have no worries...if its illegal then you're in a hot mess. The MRO who reviews the screens will be able to see that you have an Rx or will call and speak with you about this. It's when you abuse them it becomes an issue, drug screens test levels as well. And FYI Flexeril is a TCA that was found to have side effects which were then noted to be effect as a muscle relaxant. Best of luck in your travels!

[MichelleRN34, ADN, RN]

I agree with hunniebadger ...with a script you should have no issues.

[EmmaLynnSmithRN]

I m hoping you guys are right and its as easy and as logical as "you have a script so its all good!". My fear is the subjective nature of using these meds. But one could also fight even if you are using these meds legally with a prescription you STILL would be breaking the law if you came to work under the influence of them. Much like alcohol is legal but coming to work drunk is totally illegal. My fear is if a pre-employment drug-screen will be able to use my positive drug screen against me because if I take the medication in my off time and return to work 2 days later-the metabolites are still in my urine and will test positive. Its all so confusing and subjective so I always try to compare it to alcohol in my head because I have legal and valid prescriptions and never practice under the influence-but if drug tested all I can prove is my prescriptions are valid-incase anyone knows a way I can prove WHEN I used the meds were no where near a time Id possibly have to be working??? I don't want to be paranoid for no reason while taking a legal Rx but the more I read these forums it seems so many nurses are putting the nuse around themselves for doing totally legal things and then admitting them to the wrong person or submitted to a UA and even if it was negative we are "guilty until proven innocent." My fear is there is no way to prove when I use an RX it is NOT while or near working!

[VivaLasViejas, ASN, RN]

Try not to over-think this. You're driving yourself crazy and it's really not as complicated as you might think. Just be prepared to tell the specimen collector what you're taking and produce the prescription bottles. Someone from the lab will more than likely call you to discuss your results, but that's nothing to be afraid of. I take Klonopin at HS for anxiety, and the half-life of this drug is long enough to show up on a UDS; when I was tested for my current job, the lab called me just to notify me of the (+) result and asked me what time of day I take it. I told them, and it's never been an issue. :)

[BamaRN2004]

There are a lot of health care professionals who take opiates for chronic pain or benzos for chronic aniety everyday. They are not considered under the influence. I know many in pain management. It would be discriminatory if one were to be fired bc of it. Plus the people that take meds everyday like they are suppose too and not in mass quantities cant even tell a euphonria from them anymore. Just like you with your ADHD. Just bc it is a narcotic not your adhd med doesn't mean it is wrong to take everyday. There are reasons why people take pain meds everyday just as you do for your brain.

[RNOTODAY, BSN, RN]

Dont worry not one more second about it. If you have a PRESCRIPTION FOR IT, i DONT CARE WHAT IT IS, YOU ARE FINE. end of story.

[MunoRN, RN]

Dont worry not one more second about it. If you have a PRESCRIPTION FOR IT, i DONT CARE WHAT IT IS, YOU ARE FINE. end of story.

Please don't believe this, I know Nurses who thought this was the case and lost jobs because of it. Employers are NOT required to limit their prohibited substances to illegal drugs, these can include prescription medications which are legally prescribed and used appropriately, it's the employer's discretion so long as they can claim the use of these medications may affect safety.

[SouthernPoint]

Dont worry not one more second about it. If you have a PRESCRIPTION FOR IT i DONT CARE WHAT IT IS, YOU ARE FINE. end of story.[/quote']

Not sure where you obtained your information from, but you are 100% WRONG!!

I was let go from a job I had for over 10 years because I was on Adderall. I have basically been denied employment because if it.

So I ended up seeing a therapist who has worked with me helping me keep my ADD under control without the medication. It's been worth ever dime. Medication free for 4 years, employeed for 3.

[ComeTogether, LPN]

Not sure where you obtained your information from, but you are 100% WRONG!!

I was let go from a job I had for over 10 years because I was on Adderall. I have basically been denied employment because if it.

So I ended up seeing a therapist who has worked with me helping me keep my ADD under control without the medication. It's been worth ever dime. Medication free for 4 years, employeed for 3.

Dear Lord that is awful and I am so screwed!!! Perhaps you could PM me.......

[ComeTogether, LPN]

How I've always know it to work is that you provide the MO the prescriptions and he/she sends the results back as negative because its legit..... maybe this isn't the way it is everywhere?

Obviously, if your company prohibits a certain drug while you are on the clock, yea that's a problem. BUT I don't know how they would prove when you'd taken it and I don't know how they can tell you that you aren't allowed to take pain medicine, for example, if you throw out your back on your weekend off.

I had no idea that hospitals could prohibit specific legal drugs while you are employed with them. How is that even legal?

[MunoRN, RN]

I had no idea that hospitals could prohibit specific legal drugs while you are employed with them. How is that even legal?

I think it's easier to start with why it would be illegal. The ADA prohibits employers from inquiring about or discriminating against those with disabilities as a hiring practice with a job-related reason. The EEOC (who enforces the ADA) specifically differentiates between "safety-sensitive" jobs, where there is a job related reason to discriminate, making it legal discrimination. From the EEOC:

" May an employer ask all employees what prescription medications they are taking?Generally, no. Asking all employees about their use of prescription medications is not job-related and consistent with business necessity.⁽⁵¹⁾ In limited circumstances, however, certain employers may be able to demonstrate that it is job-related and consistent with business necessity to require employees in positions affecting public safety to report when they are taking medication that may affect their ability to perform essential functions. Under these limited circumstances, an employer must be able to demonstrate that an employee's inability or impaired ability to perform essential functions will result in a direct threat. For example, a police department could require armed officers to report when they are taking medications that may affect their ability to use a firearm or to perform other essential functions of their job. Similarly, an airline could require its pilots to report when they are taking any medications that may impair their ability to fly. A fire department, however, could not require fire department employees who perform only administrative duties to report their use of medications because it is unlikely that it could show that these employees would pose a direct threat as a result of their inability or impaired ability to perform their essential job functions.

There is no well defined list of what these jobs are, but direct care Nursing is nowhere near the gray area where one could make an argument that impairment doesn't pose a safety threat to the public, which is why employers can test for even legally prescribed medications so long as there is some evidence that even appropriate use of these medications could result in some degree of impairment, and there's sufficient evidence to make this case for a wide range of prescription medications.