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!!!
