preemployment drug testing

[babynurse98]

Is anyone familiar with the preemployment drug testing policies of major hospital systems? I know mine is a UDS, but do they typically follow SAMSHA regulations even if they are a private employer?

[Eris Discordia BSN, RN]

A lot depends on the state and the program that you are in. In California at least when I was in the program I was required to come off of my pain meds (legally prescribed and responsibly used), My anxiety and sleep meds (Not so responsibly used) and of course no alcohol. I could only take Tylenol, Advil or Aleve. They didn't even let me take Benederl but they did let me take prescription buspar for anxiety. Bottom line they really don't care if you are in pain, can't sleep etc......What they care about is compliance with whatever contract they put you on.

Hppy

She's talking about a pre-employment drug screen, not monitoring. The original post is under "General Nursing Discussion" for further background info.

[J.Adderton, BSN, MSN]

I think this will be an issue with your board if it is determined you were taking more than the prescribed amount.

[hppygr8ful, ASN, RN, EMT-I]

pardon me for saying so but it appears you are splitting hairs here. If you doctor is reissuing a new prescription every 3 months then that prescription invalidates the previous one. Look at it like this you get a script for 1 mg benzo in December then in March you get another prescription. It's not a new prescription it's the same prescription so you can't just double up because you have two prescriptions written three months apart for the same drug. IMHO you would not be the first nurse to pop positive on a pre-employment screen and be remanded in monitoring for legally prescribed medication. Benzodiazepines have a notoriously high potential for addiction and abuse and the BON's know that. Also detoxing off benzo's can be quite dangerous and often the process requires medical supervision; I feel for you because I too have GAD, PTSD, SAD, MDD and fibromyalgia. Yep that pretty much covers the whole alphabet. When I was in monitoring I had to stop all medications except an antidepressant and a sleep med called rozerem which has a low abuse potential. Being off those meds forced me to get really serious in therapy about how I was going to live the rest of my life or at least the next 5 years. Guess what - the alphabet soup of diagnoses are mostly all in remission today because I couldn't fall back on pharmaceutical intervention. Please and I mean this as a kindness. stop trying to justify what is clearly doubling up on meds. Call your doctor and ask him if he has increased you dose or just written you a new script for the same thing. You should also be prepared to sign a release of information to the BON program in your state of your complete medical record including any psychiatric practitioners you might have seen. If you get referred to monitoring they will want to see clear justification and indications for benzo use .

State and federal laws are getting very strict on drugs that have high abuse potential. I can tell you the kind of gymnastics I have to go through twice a year for meds for my fibromyalgia. it is insane. I hope things work out for you but unless you absolutely must take them to function I would wean myself off by a bunch of home drug tests and test yourself every few days until it's out of your system. the half life for benzos is between 34 to 100 hours so it should be out of your system within 68hr (approx. 3 days) to 200 hours (8 days). Then when you test you will be clean - you can always say you have script for benzo that you almost never use.

Hppy

[Persephone Paige, ADN]

I think you know the answer already. If not, you wouldn't have begun this thread. You wouldn't dare take two of the same blood pressure medicine prescriptions concurrently, you know better. You would freak out if you gave a patient 1 benzo and then turned right around and gave them a second duplicate dose. That's a medication error. You know this...

That being said, I just don't want you to fool yourself.

Anyone who has ever had a problem with pills will tell you that it is a very insidious, ultimately devastating circumstance. And the breeding ground is denial. I will say that if you had some pills left over from a 3 months prescription that was filled in Dec'17, perhaps there's still time to drop your dosage back down to the 1 mg, as prescribed. I promise you that any short term payoff will not be worth the long-term consequences. You talk about anxiety? Wait until you have to detox... Benzos are particularly brutal and dangerous.

Only you know your truth, and I don't know how long it's been since you checked this thread, but be honest with yourself. You have a potentially long career ahead of you, good luck.

[Cat365]

I have had a PRN for a benzo for over a year, and the doctor wrote me the exact same script a few days ago, but the other script had not expired yet, and he did not tell me to d/c the other script. I'm confused as to what I have done wrong, as I have followed the legal and prescription instructions.

Sounds like you are justifying. You know the Doctor's intention was for the second Rx to refill the original one, not be in addition to it.

[sallyrnrrt, ADN, RN]

. She knows,

And chooses not to care

[traumaRUs, MSN, APRN]

Merged threads.

Please don't ask personal details in this forum. We are very mindful of our member's privacy

[Kel65, MSN, RN]

I had two docs tell me TPAPN doesn't test for Benadryl. I've been tested for over the counter banned drugs three times in the last 2 months. Doc's who are not MRO's do not know all that much about drug testing. There are cut off ranges on drug testing, tests show metabolite amounts. Yes, indeed they can show higher than expected ranges. And don't forget the half life of benzos. Sounds like you were prescribed 1 mg and are taking 2 mg. Risky.

[Nurse SMS, MSN, RN]

. She knows,

And chooses not to care

Oh she cares. A lot. She just wants validation that what she is doing is okay. It isn't and it is much more black and white than she is trying to make it sound. She isn't dumb, she knows this, but she wants so badly for it to be okay that she's willing to die on that hill and talk in circles, hoping to confuse the issue enough to get a different answer. Why, I am not honestly sure. It isn't as if the BON will come here and solicit our opinions before busting her.

OP, let's just be blunt. You are abusing your benzos because you are inadequately treated. You need to see your doctor, tell them the truth about how much you have been taking and start digging into the why of it. You need to go in a different direction if you are taking your meds inappropriately and still having this much trouble.

[lifelearningrn, BSN, RN]

From all of my research, UDSs are not an accurate indication of "therapeutic" levels. Everyone's body metabolizes drugs differently, and short of a blood draw they cannot accurately indicate what my therapeutic level should be. Am I mistaken?

If you're worried about it, then there IS a problem. You don't have 2 scripts, you have one script, with leftover pills from the last one. The directions are the same, 1mg PRN for anxiety. How often? Is it 1mg PRN q8 hours or daily? Are you taking 2 mg as often as you can (if it's for q6- are you taking it q6?)..

[Coffee Nurse, BSN, RN]

First off, OP if you are a nurse as you say and you can't figure out why you doubling up on the script your doctor wrote you for a highly addictive medication is "wrong" you need to find yourself another vocation. Secondly, you really need to look hard at yourself in the mirror and quit trying to rationalize your behavior.

THIS. OP, the denial/rationalization is strong with you. If you had a patient on an antibiotic and then a duplicate order popped up in your computer for the same antibiotic, are you seriously suggesting that you think the appropriate course of action is to just administer both, rather than questioning the prescriber? You're either a seriously dangerous nurse, or an intelligent person who deep-down knows better than the questions you're asking suggest.

[TriciaJ, RN]

She's talking about a pre-employment drug screen, not monitoring. The original post is under "General Nursing Discussion" for further background info.

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.