Re-eval in IPN outcomes?

[ERTwinMom]

I am wondering about other's experiences getting a reevaluation done by IPN.

Quick (sorry, not quick) backstory, I entered the program 9 months ago after a dependence with opiates. I am definitely grateful for all the treatment I have received and Sobriety it brought me. That being said, I feel like IPN is, at heart, a money-making machine. My current situation is that I am a stay-at-home mom with no plans to return to nursing until probably the last year of my contract, which is allowed. Even then, I have reservations about returning to nursing at all, as my family might be taking an "alternate route to life" a.k.a. moving onto a catamaran. I only say this because it goes towards my motivations about the financial obligations of this program.

About six weeks ago I had a traumatic injury for which I chose to take pain medicine for, for about four weeks. It was not a decision I entered into lightly; frankly I was terrified to open pandoras box after well over a year of sobriety but I'm off them now and I'm feeling fine about it. In other words, no cravings. During these four weeks I was still drug tested of course and unfortunately had one dilute specimen, my one and only that I've ever had. Amazing timing. Now that I'm off the painkillers, My caseworker states that I am required to be reevaluated because of my last use of painkillers in combo with the dilute, even though I went through all the necessary steps to notify IPN of my injury, medication prescriptions etc, and it was an approved use. I didn't even know that was a possibility when I chose to take them!

I feel like the evaluation is going to result in a recommendation of another round of IOP or worse, inpatient treatment. The fact that they send you to an evaluator who has a vested interest in his treatment facility seems like a clear conflict of interest. Out of the 8 people in my Rn support group, 6 have been required to be re evaluated at some point during their contracts and ALL of them had to go through another round of (higher care than their previous) treatment, some warranted, some that seemed absurd.

I guess my main question is, if I'm conflicted about staying in this program at all, even before these events of late, should I just throw in the towel now before I spend $$$ to be automatically told I need another round of treatment? I feel like I have a strong hold on my recovery, an awesome sponsor, go to meetings etc...believe me, I'm truly grateful for the peace in my life sobriety has brought me! But I feel like that is not going to matter one iota in IPN's eyes. There is no way I could leave my family for any type of inpatient stay and even if IOP was the recommendation, I just feel like it's completely unnecessary. Again, I'm not working as a nurse now, and don't plan to for another few years as my kids grow up.

Has anyone ever found success pleading their case, letters from sponsors making a difference...anything??? It seems like the rationale thing to do, but if I go in guns blazing, I think it will seem as if I'm trying to manipulate the situation, like "thou doth protest too much," lol. There just seems like no right answer to this and there probably isn't.

I would appreciate any and all feedback, if anyone even made it to the end of my post, that is! Sometimes it helps to just get all your thoughts down on paper, obviously in this case I've been mulling a lot around! My gut feeling is I want to keep my license bc I worked so hard for it, yet the financial (and demoralizing) effect of IPN on my family makes me feel like such a burden, especially if I never work as a nurse again by choice. I know if I surrender and change my mind somewhere down the road my license will suffer, but every nurse in my support group has public discipline on their licenses and all but one are working. So, not ideal, but possible?

I'm cleared to drive at the end of next week and therefore able to make the pilgrimage to Gainesville, should I chose to do so, as long as my wallet is full of cash that is...

[heynow1313]

just curious if IPN required further testing from you in addition to a re-eval. PETH? Hair? It seems absurd that they require an eval after ONE SINGLE dilute, with no previous ones. Usually, they get ansty if they see more than one back-to-back. But a single one? Wow. I agree, they are probably more suspicious due to the timing.

Couple things to put your mind at ease:

1) It will help your case that you are not currently employed as a nurse or looking to get back into the field in the near future. If you were, they'd have a greater vested interest in recommending additional treatment/monitoring so as to cover their a**

2) Myself, along with other people in my NSG have had to go for re-eval's. I did not get stuck with extra treatment and neither did the others.

3) Yes- the support and backing of your NSG facilitator can be weighed heavily. The IPN knows that person sees you weekly. They have an insight that your CM cannot.

Just a side note... I see an individual therapist as recommended by IPN. I have for several years now. That has served me well both in providing additional monitoring as well as having an outside professional (not affiliated, but approved by IPN) to have my back in situations like this. I'm wondering if you see one. Might be an option if god forbid, IOP or in-patient is even brought up. I just cannot see that happening based on the information you've provided.

I wish you all the best- whatever you choose to do regarding nursing and your license. Anyone in the IPN knows your struggle is real.

big hugs, love and light.

[margin261]

I don't suppose having the evaluation done by someone that doesn't have a financial interest in the facility would be an option?

That's something that has always bothered me. The ones doing the evals profit from sending people to the facility for treatment.

[ERTwinMom]

Rsw- thanks for your thoughtful and supportive reply. No further testing was required. When I called my caseworker to let them know I was done with the narcotics, she did ask a lot about how i was handling everything. Then my test that week came back dilute. (I did also have to reschedule an appointment with the doc who "manages" my one measly anti depressant I take, so his report was late for our last quarterly evaluations. I got an electronic warning from affinity for that, even though again, I had notified them prior to.) The next call was when my caseworker mentioned that they had then had a "conference" about me, and they were concerned bc my original use of opiates had snowballed from a similar incident...on the surface, I guess that's true but the first time I also had horrible post-pArtum depression for which I am now treated. I wouldn't disagree so much with their concern except for: one, I'm not working, and two, the evaluations are SO expensive! I do have a counselor and I'm sure she would vouch for my continued compliance and Sobriety. It's good to hear that there have been others that have gone through a re eval and not ended up with more treatment! So much of my success thus far had been with a fly below the radar approach, so I thought that if I went into this in defense mode, they'd penalize me just for that.

[ERTwinMom]

Margin-I couldn't agree more! And, not surprisingly, no...they only offered three names, all at this same treatment center.

Incidentally, Ipn has required me to get a psychiatrist to manage an anti depressant I take, even though it was originally rx'd by my OB. That wasn't good enough for them when I entered the program, so I complied and now check in with him every three months as required. He is coincidentally, also certified in addiction medicine and when I suggested his name for the evaluation (mainly bc I could be driven to his local office in a timely manner and not have to wait until I was cleared to drive the more than 2 hours away to theirs) they declined that suggestion. So frustrating! I mean, recovery teaches you to accept powerlessness, but I didn't think it would apply to ipn! í ½í¸

[heynow1313]

any chance one of the 3 recommended evaluators is one you've seen before? Most will offer a lower fee if so.

any idea why you tested dilute in the first place? I ask for 2 reasons: if you present your case convincingly as to how the dilute came to be- the IPN may reconsider and let you off with a warning. I remember a very specific incident where I tested dilute and knew I would. i explained everything to my CM and offered immediately to submit to additional testing if needed. Second reason is simply to try to identify how this happened so you never have it happen again and have to go thru this hell. Any deviation from your normal routine on this particular day that you can identify?

I feel like you're in this limbo where you're probably willing to muster up all your resources and money just this once to submit to this re-eval. If the outcome is favorable for you, you will stick with the IPN. If the outcome is unfavorable, you may be on your way to a new life and possible new career. Some people truly only see themselves as nurses and are willing to do whatever it takes to retain their license and good standing with the BON. Others realize they are more than a nurse and can envision a different life for themselves if the chips fall a certain way. I am certain whatever you decide will be the right thing. The universe provides when you are open and receptive and it certainly sounds like you are.

[jdub6]

Just so you know, if you fail to compete monitoring, leave nursing and try to come back later you will have to redo or compete monitoring.