about to start LPN course & questions about drug testing and suboxone

[debrastudent]

Hello, I am about to start classes to become a LPN in Massachusetts. I am clean from all drugs but I needed the help of suboxone for the last 2 years.

I am tapering and down to 1.5 mg and hope to be off totally by the time I graduate.

Suboxone is a long half time med and stays in your systems for a very long time even when sub users stops.

When should I expect the drug testing? Before I graduaute or during an interview?

Does anyone know if the drug test would look for it?

I have wanted to be a nurse since I was a child.

If my possible employer understand that suboxone is a medicine that makes sure any opiates would not be felt kinda of like antibuse for alcoholism.

If anyone has any input I would appreciate it. Thank you in advance.

[diva rn, BSN, RN]

Dear Jack,

I understand where you are coming from. As a recovering addict and alcoholic I truely get that this is a Disease....no doubt about it...not only that...it is a chronic disease to which there is NO cure...it is one that you and I will have for the rest of our lives (and will continue to recover from.)

However, what is wrong with the concept of detoxing from ALL controlled substances???? Including suboxone???

It was not easy, detox and early recovery was the HARDEST thing I have ever accomplished in my life...and the one of which I am the most proud.

I am not saying suboxone should never be used. I think it has it's place a a step off from the heavy guns in initial detox--for a very short time... I have a very hard time with it being used for months and years....when it then becomes it's own addictive substance.

It takes longer to detox from opiates, then the suboxone, granted, but once off, your are FREE.

Why not do it????

I don't understand the concept of substituting addiction of one controlled substance for another--for that's what it is...do you propose being on suboxone for LIFE???

(it is a partial opioid agonist-and it is used for pain contol-that's what it was developed for-I know you know this, Jack-it has to have some sort of impairment potiential)

THere is a difference between being on Insulin for IDDM--that is physically necessary-for life...and suboxone---that is NOT physically nesessary for life...trust me I KNOW.

So, Jack, I love ya Man, and I read everything you post and learn a lot...I think you are intelligent, well informed and one of the premiere experts on nurses and drug addiction, etc.

But--- having lived this--I have to respecfully agree to disgree....

diva

[jackstem]

Dear Jack,

It takes longer to detox from opiates, then the suboxone, granted, but once off, your are FREE.

Why not do it????

I don't understand the concept of substituting addiction of one controlled substance for another--for that's what it is...do you propose being on suboxone for LIFE???

(it is a partial opioid agonist-and it is used for pain contol-that's what it was developed for-I know you know this, Jack-it has to have some sort of impairment potiential)

THere is a difference between being on Insulin for IDDM--that is physically necessary-for life...and suboxone---that is NOT physically nesessary for life...trust me I KNOW.

So, Jack, I love ya Man, and I read everything you post and learn a lot...I think you are intelligent, well informed and one of the premiere experts on nurses and drug addiction, etc.

But--- having lived this--I have to respecfully agree to disgree....

diva

Diva,

I think you missed my point (or I didn't make it clear). Just as there are those who require extremely tight control of their disease, such as diabetes, hypertension, asthma, etc., yet still have frequent "relapses", (i.e. their symptoms become worse and their disease causes additional complications), so too there are those with an SUD who simply cannot remain clean and sober when completely abstinent. When they are not taking their ORT (suboxxone, methadone), then they return to using in an uncontrolled fashion with all of the consequences every addict suffers when they are in full blown, active disease. Only the individual and their addictionologist can make this decision. To expect every addict to achieve complete abstinence because you or I have been able to do so ignores the pathophysiology of the disease. To ignore those individuals, or to see them as somehow weak returns us to the "lack of willpower" argument so many continue to believe about addiction. I have seen several of my colleagues go through treatment several times (inpatient, outpatient, sober living, etc.) and attended meetings, saw psychologists, addictionologists, etc. only to relapse over and over and eventually die. I knew them personally. I worked with them diligently on their recovery. They simply could not remain clean and sober. Just as there are forms of cancer, diabetes, heart disease, and every other chronic disease we know of that simply do not respond to well to treatment. For those folks unlucky enough to have this lousy disease and who cannot remain active, productive members of society without ORT, they either need to be monitored closely to be sure they aren't impaired and are following their treatment regimen, or find a profession that doesn't present significant risks to others. The treatment of this disease is not black and white. There are way too many shades of grey involved.

We definitely can agree to disagree.

Jack

[diva rn, BSN, RN]

Dear Jack,

I do get what you are saying. I do. But were these individuals working a good program of recovery. Did they have plans for relapse in place. etc, etc. Or, were they just white knuckling it?..whatever the case, it's sad that they relapsed and/or used and/or died.

I still don't see the relationship between using a partial opioid agonist (that can be and is used for pain control) in place of a full blown opioid and IDDM/insulin. How do you feel about methadone? would you consider that the same as suboxone?

Maybe I am being idealistic, but I think maybe abstinence should be the goal...the "Holy Grail" if you will, and YES, it takes work....DAILY work...where as suboxone merely takes the opening of a pill bottle and placing a tablet under your tongue....hardly the same effort. I guess it sometimes depends on how badly you want it...not willpower, if you are in recovery and have "gotten it" you understand that willpower has nothing to do with it...but your program and how you deal with triggers and your relapse prevention has everything to do with it.

Seriously, how do you feel about methadone? One of the prominent substance abuse/chemical dependency psychiatrists here in south Florida believes that Suboxone is the "new Methadone" only uses it in very early recovery for very very short periods of time--if at all.

Love,

diva;)

[jackstem]

There are many folks with adult onset diabetes able to control their blood sugar with a diet and exercise. There others requiring oral medication or insulin in order to control their blood sugar...no matter how strict their diet and exercise regimen. Are those who require medication not working a good enough diet and exercise program? Nope. Their disease has progressed to the point where they must use medication to assist in controling their chronic, progressive, potentially fatal disease.

Similarly, there will be those with the chronic, progressive, potentially fatal disease of addiction who cannot remain clean and sober no matter how strict their program of recovery and how hard they work that program. Do we simply ignore them and then shake our heads when they die? Again, in an ideal world, all addicts would be able to live an abstient life style, all chemotherapy would cure every cancer, and all diabetics would be able to control their blood sugar with diet and exercise. Sadly, this isn't an ideal world.

Jack

[jackstem]

I work with a license defense attorney and one of our clients had a "borderline positive" for ETG. The question was, is this person drinking again or is it incidental exposure. My answer was, let's discuss it with the client, raise our concerns, re-educate them on being vigilant about incidental exposure and then watch what happens. If this is a true relapse, they will test positive again, and most likely with larger amounts of ETG showing up. It also gave me the opportunity to increase my contact with the person and discuss recovery issues they might be struggling with or not understanding. To date, they haven't tested positive again (over a year) which says to me they weren't in relapse mode, or if they were, it was short-circuited.

Recovery is a process and those in early recovery will still have "addictive thinking". It takes time and effort for addictive thinking to change into "recovery thinking."

Jack

[subee, MSN, CRNA]

If an employer or clinical site ever decided to test for suboxone, the OP would have a very serious problem. It's only a matter of time before suboxone is included in a panel because it has become a drug of abuse. The OP could lose the license or be forced to enter a lengthy monitoring program. It just makes no sense to pay a lot of money in tuition and then not be able to work because you flunked a drug test.