Should drug diverters be prosecuted?

elkpark · Mar 7, 2017

All three of you were wrong.

Documentation?

Angry LPN · Mar 7, 2017

People can get hooked on Ultram? I wondered why they started to keep them under lock and key and count them.

Horseshoe, BSN, RN · Mar 7, 2017

Healthcare workers are in a unique environment where they are constantly around opioids and yet can not be prescribed them, lest they be found out by the BON and be reprimanded.

Really doesn't matter what you think about prn opioid use, it is illegal, read your nurse practice act, that is in never, not when you are off, when you leave your shift, never.

Patently, completely, and most certainly FALSE.

Horseshoe, BSN, RN · Mar 7, 2017

I have taken opioid pain medications while working. I had an extraction done and was taking Vicodin and called off work that evening. The House Sup told me that I could take Vicodin and work as long as I had a legal prescription for it. I also informed my charge when I came on duty and she had no problem with it.

Personally, if I were taking vicodin for an acute pain problem such as a tooth extraction, I would most certainly be impaired after taking even one. I would never work while under the influence of a narcotic. However, those who are taking it as part of a chronic pain syndrome or have tolerance to its effects might be perfectly fine. I'm surprised that your supervisors were okay with this under the circumstances you described.

allnurses Guide · Mar 7, 2017

I don't think nurses should be criminally prosecuted nor should other types of drug addicts. I think the addiction should be treated. A prison is the least likely place to result in a therapeutic outcome that rebuilds a life.

Elibri · Mar 7, 2017

Unfortunately i feel like people responsible for staffing will say anything to get a warm body there

Horseshoe, BSN, RN · Mar 7, 2017

I have taken opioid pain medications while working. I had an extraction done and was taking Vicodin and called off work that evening. The House Sup told me that I could take Vicodin and work as long as I had a legal prescription for it. I also informed my charge when I came on duty and she had no problem with it.

All three of you were wrong.

Nope! Not in my state (as long as RN is not impaired). From my state's BON newsletter:

Should the nurse continue working if he or she is using a chronic pain medication?
It dependsâ€---this is up to the nurse and the nurse's treating physician. Short-term or long-term, the effect of any given pain medication (narcotic or not) on a person's ability to function and make correct judgments will vary from person-toperson. With long-term use of a pain medication, the nurse may develop toleranceâ€ as the body adapts to the presence of the medication and they may not experience common side effects such as lethargy, impaired judgment, and slower response times. Modern pain management has also resulted in better treatment options such as extended-release formulations of pain medications that release small amounts of medication into the body over several hours at a consistent dosage. This produces pain relief at doses that avoid many of the unwanted side effects noted above.

Are there certain types of medications that a nurse should not use while working?
The BNE does not prohibit any specific prescription medications obtained by valid prescription.

What happens if a complaint is registered about a nurse who is using a prescription pain medication? What would be the procedure for investigating this complaint?
Nothing in the NPA and agency rules and regulations precludes a nurse from taking prescription pain medications and practicing. However, if a complaint is received which alleges conduct in violation of the NPA or board rules, the complaint is investigated by the BNE. Specific procedures vary depending upon the case. General processes for disposition of complaints are explained in the NPA and Board Rules.

https://www.bon.texas.gov/pdfs/newsletter_pdfs/2007/july07.pdf

Healthcare workers are in a unique environment where they are constantly around opioids and yet can not be prescribed them, lest they be found out by the BON and be reprimanded. Those who may have pain issues are the only stories I have heard of in my long career. One nurse with renal CA and another with traumatic knee injury that was being misdiagnosed. Those Percocet was what made their shifts physically bearable. Really doesn't matter what you think about prn opioid use, it is illegal, read your nurse practice act, that is in never, not when you are off, when you leave your shift, never. Put that up against what happens to your profession when caught, it is arguably worse to go before the board. Repeat offenders should probably be prosecuted, but first time offenders should probably be given a pass.

Again, WRONG. See above.

ChryssyD · Mar 9, 2017

Documentation?

None needed--just common sense. Vicodin is an opiate, a mind- and mood-altering substance. It can impair judgement, recall, and reaction time. It's hard to say how impaired a person could be after one or two Vicodin--as nurses, I'm sure we've all known patients who got really looped on low doses of narcotics, just as in our personal lives we've probably all known that person who gets super-tipsy after a single beer. The difference is that with alcohol, there is a "legal limit" for blood alcohol-content to define legal intoxication; with opiates, no such legal limit exists. So, at the end of the day, if something were to happen at work to call your competence or judgement into question, the one thing you don't want is opiates in your system. The fact that they were legally prescribed doesn't mean a thing. Nurses should know better than to take mind-altering substances while at work; and if they don't, their superiors definitely should.

Horseshoe, BSN, RN · Mar 9, 2017

None needed--just common sense. Vicodin is an opiate, a mind- and mood-altering substance. It can impair judgement, recall, and reaction time. It's hard to say how impaired a person could be after one or two Vicodin--as nurses, I'm sure we've all known patients who got really looped on low doses of narcotics, just as in our personal lives we've probably all known that person who gets super-tipsy after a single beer. The difference is that with alcohol, there is a "legal limit" for blood alcohol-content to define legal intoxication; with opiates, no such legal limit exists. So, at the end of the day, if something were to happen at work to call your competence or judgement into question, the one thing you don't want is opiates in your system. The fact that they were legally prescribed doesn't mean a thing. Nurses should know better than to take mind-altering substances while at work; and if they don't, their superiors definitely should.

People who use narcotics on a regular basis for chronic pain syndromes may well have NO impairment whatsoever. It's not a blanket assertion that narcotics render nurses incapable of providing safe care. I would NEVER use narcotics while nursing because at present, I have no tolerance for them at all (have only used them post op and once when I got the shingles). As my BON states, there are no specific legally prescribed medications that are forbidden for working nurses-it is an individual situation that the nurse and her physician must address carefully and objectively.

Obviously, all that said, if a nurse does have a bad outcome that can be traced to any kind of negligence, the presence of narcotics/benzos, etc., are going to be taken into consideration and could well have terrible results with regard to the nurse's license.

subee, MSN, CRNA · Mar 9, 2017

None needed--just common sense. Vicodin is an opiate, a mind- and mood-altering substance. It can impair judgement, recall, and reaction time. It's hard to say how impaired a person could be after one or two Vicodin--as nurses, I'm sure we've all known patients who got really looped on low doses of narcotics, just as in our personal lives we've probably all known that person who gets super-tipsy after a single beer. The difference is that with alcohol, there is a "legal limit" for blood alcohol-content to define legal intoxication; with opiates, no such legal limit exists. So, at the end of the day, if something were to happen at work to call your competence or judgement into question, the one thing you don't want is opiates in your system. The fact that they were legally prescribed doesn't mean a thing. Nurses should know better than to take mind-altering substances while at work; and if they don't, their superiors definitely should.[/QUOTe
And regardless of what the Texas BON says, no hospital would want it known that they permit nurses to work with patients while taking a narcotic. Psychomotor testing aside, thus would be bad PR. If one us so ill that living 10 hours without a narcotic isn't possible, their condition precludes them from working in acute care which is the mist physically taxing area if nursing.

subee, MSN, CRNA · Mar 9, 2017

None needed--just common sense. Vicodin is an opiate, a mind- and mood-altering substance. It can impair judgement, recall, and reaction time. It's hard to say how impaired a person could be after one or two Vicodin--as nurses, I'm sure we've all known patients who got really looped on low doses of narcotics, just as in our personal lives we've probably all known that person who gets super-tipsy after a single beer. The difference is that with alcohol, there is a "legal limit" for blood alcohol-content to define legal intoxication; with opiates, no such legal limit exists. So, at the end of the day, if something were to happen at work to call your competence or judgement into question, the one thing you don't want is opiates in your system. The fact that they were legally prescribed doesn't mean a thing. Nurses should know better than to take mind-altering substances while at work; and if they don't, their superiors definitely should.[/QUOTe
And regardless of what the Texas BON says, no hospital would want it known that they permit nurses to work with patients while taking a narcotic. Psychomotor testing aside, thus would be bad PR. If one us so ill that living 10 hours without a narcotic isn't possible, their condition precludes them from working in acute care which is the mist physically taxing area if nursing.

ComeTogether, LPN · Mar 10, 2017

If the reason for prosecution is about theft, it has to be because the meds taken aren't available without a script, which is a federal offence. If the drugs are being taken to sell I say prosecute to the fullest extent, those people are worse than drug dealers and deserve to rot in jail forever. If the drugs are to support a habit though, I say sincere expression of the desire to go to rehab and get better should allow for a free pass from prosecution but I don't think a future career in nursing should be an option. I think the penalty should be loss of nursing license forever.