Suboxone and Nursing

Jules A, MSN · Aug 15, 2009

Hi,

I can't address the legal aspects although keep in mind it is not your past but your present that concerns me. While I applaud you for coming off the benzos I'm not a big fan of long term use of suboxone or methadone to treat addiction and wouldn't really consider myself "clean" while still on either of them. I do wish you luck and hope you can find a way to become a nurse if that is what you want.

geekgolightly, BSN, RN · Aug 15, 2009

In Texas the question they ask during pre screen for licensure is "Within the past five (5) years have you been addicted to and/or treated for the use of alcohol or any other drug?"

Suboxone is considered a treatment for drug addiction. When you have been off suboxone for five years and have been clean, you are eligible for licensure in Texas. I think this is pretty standard, but check with your local board of nursing.

geekgolightly, BSN, RN · Aug 15, 2009

I re-read your initial post and you seem to be interested in any part of healthcare, not specifically nursing, is that right? For whatever you are interested in, check with the licensing board. If you want to be a patient care tech (or aide), it is up to the individual hospital. After you have been hired and need to take a screen, if suboxone is a drug that will show up as an opioid, I would disclose the information then. Otherwise it is personal health information, on a need-to-know basis.

But, like I said, if it's for licensure, it then becomes a need-to-know situation.

Magsulfate, BSN, RN · Aug 21, 2009

Suboxone does not show up as an opiod in the standard pre employment drug test. They have to be looking for the drug to find it. I know several nurses in Texas that work while being treated with suboxone for chronic pain, etc. I believe you do NOT have to be off of it for five years before you apply for licensure. It is totally up to your doctor and you if you are practicing safe nursing then your medical information is private.

dph1965 · Sep 23, 2009

Why, if suboxone or methadone is being used by a nurse, under the supervision of their MD, and they have been on appropriately low "maintenance doses" for years, without any abuse of this or other meds, would any board disapprove. I mean, I know they will, but... One could argue that the med would impair the nurse, but tolerance is achieved rapidly and easily on these drugs and there is documentation proving that they do not have the euphoric, clouded sensorium effects on long term users that other opiates have. Is a diabetic nurse considered impaired? I mean, her insulin dose could cause her to bottom out or her unmonitored, super-high glucose could affect her judgement. Same goes for those of us on Ritalin or antidepressants. Monitored, medically supervised, symptom-appropriate prescription drug use is NOT drug abuse! When does it end? I do consider someone on suboxone, IF they have not used in any other context, clean. Just because they chose to treat the god-awful, relapse inducing withdrawal symptoms, is no reason to consider them as "using". :banghead:

Jules A, MSN · Sep 23, 2009

Just because they chose to treat the god-awful, relapse inducing withdrawal symptoms, is no reason to consider them as "using".

I don't think anyone is saying they are "using" but frankly treating "the god-awful, relapse inducing withdrawal (uhh ok) symptoms" long term does raise a red flag for me. We all know there are some doctors that will prescribe anything someone whines for. So far I haven't worked with any diabetics or nurses on Prozac that are imparied or divert those meds for kicks but I guess it could happen.

dph1965 · Sep 23, 2009

Actually, I've never worked with anyone who diverted Prozac either, but then who would know, it's not counted! And, easy to get anyway. But, I have worked with many impaired nurses who were not taking scheduled meds. I'm just saying there are many reasons for using narcotic medication that are reasonable, and if done under the care of a responsible physician, AND not taken while on duty, they are just as fit to nurse as any other nurse. Unfortunately, a person could take a vicodin on their Sunday afternoon off for, lets say, lumbar vertebral disc dessication with nerve impingement, and just because it would show in a random urine on Monday, this does not make the nurse impaired during her shift. My earlier text was an example. I think it's automatically assumed that a former narc addict (over 10 yrs ago, had 9 yrs without until accident) can't take controlled meds responsibly and minimally. The dogmas espoused by the hard core 12-steppers have propagated this notion. Why is the responsible user of occasional Vicodin impaired while the brittle, insulin dependant, obese nurse (with whom I work) who bottoms out at least once a week on shift less impaired?

Trauma Columnist · Sep 23, 2009

Let's get back to the topic of working as a nurse while on suboxone. Thanks.

Jules A, MSN · Sep 23, 2009

Actually, I've never worked with anyone who diverted Prozac either, but then who would know, it's not counted! And, easy to get anyway. But, I have worked with many impaired nurses who were not taking scheduled meds. I'm just saying there are many reasons for using narcotic medication that are reasonable, and if done under the care of a responsible physician, AND not taken while on duty, they are just as fit to nurse as any other nurse. Unfortunately, a person could take a vicodin on their Sunday afternoon off for, lets say, lumbar vertebral disc dessication with nerve impingement, and just because it would show in a random urine on Monday, this does not make the nurse impaired during her shift. My earlier text was an example. I think it's automatically assumed that a former narc addict (over 10 yrs ago, had 9 yrs without until accident) can't take controlled meds responsibly and minimally. The dogmas espoused by the hard core 12-steppers have propagated this notion. Why is the responsible user of occasional Vicodin impaired while the brittle, insulin dependant, obese nurse (with whom I work) who bottoms out at least once a week on shift less impaired?

Thanks for responding. I think this is a relevant line of discussion. Sorry the plug got pulled.

Miss Mab · Sep 23, 2009

Thanks for the topic--for those of us in CA, at least, the discussion couldn't be more timely..

First, to the OP: I'm sorry I don't know anything about Texas licensing issues but I suspect, like most boards, issues regarding past medical/criminal/etc. issues tend to be handled on individualized bases i.e., no 'hard and fast rules'. Best of luck to you!!

HOWEVER, is anyone else following the attempts to revise prorocols for all licensed boards that fall under the Dept. of Consumer of Affairs? Some of it is as a result of the recent 'headlines' regarding BRN discipline and diversion program enforcement shortcomings and some is just a timely overhaul of all the various boards in order to form a more coherent system of guidelines for any such future substance abuse program to be run, regardless of whether each separate board decides to initiate and maintain a program of their own.

That said, and while nothing is set into law as of yet, there are a number of proposed changes to CA's current system and, while perhaps some are needed, I personally feel they are displaying enormous difficulty in managing the protection of patients/consumers of the state on balance with the individual rights of RN(and to now include LVN) licensees.

I don't want to muddy the topic with many concerns(this is actually a relatively lighter one) but, as of now, the legislative staff has endorsed not utilizing a MRO in conjunction with any drug testing process to be put in place. This is relevant as the specific need NOT to install such a professional in place was because an MRO can deem whether or not a positive test is as a result of legal and prescribed means and that, following these new proposed protocols, NO licensee in any diversion program will be allowed to ingest any scheduled medication, legally prescribed or not--for any reason. A specific example of an injured nurse testing positive for a prescribed opoid was given as a reason for a program 'failure'.

I guess I'm just wondering if this is the norm for other states? Is it reasonable to suggest a nurse would not follow medical advice regarding presribed medications for the duration(3 years as proposed standard)?

How do you balance acute injury, for example, with the desire for program compliance?

How does, if you know, your state handle licensee's w/ADHD, chronic pain issues, etc.? I know we all have our own opinions on whether nurses should or should not work on various meds outside of these programs and that generally seems to boil down to a big, fat, 'it depends'. It also tends to be a divisive point of contention...

But, how does your board deal with scheduled meds AFTER you've become involved in the diversion process?

exnursie · Sep 25, 2009

Why, if suboxone or methadone is being used by a nurse, under the supervision of their MD, and they have been on appropriately low "maintenance doses" for years, without any abuse of this or other meds, would any board disapprove. I mean, I know they will, but... One could argue that the med would impair the nurse, but tolerance is achieved rapidly and easily on these drugs and there is documentation proving that they do not have the euphoric, clouded sensorium effects on long term users that other opiates have. Is a diabetic nurse considered impaired? I mean, her insulin dose could cause her to bottom out or her unmonitored, super-high glucose could affect her judgement. Same goes for those of us on Ritalin or antidepressants. Monitored, medically supervised, symptom-appropriate prescription drug use is NOT drug abuse! When does it end? I do consider someone on suboxone, IF they have not used in any other context, clean. Just because they chose to treat the god-awful, relapse inducing withdrawal symptoms, is no reason to consider them as "using".

To the OP, my personal advice to you is that you can enter the HC field and be successful, as a recovering addict, I know people who have done so. I also know people that have relapsed after yrs of recovery, when they became nurses. I would not encourage nursing to any recovering addict, just based on the reality that nursing is stressful and is emotionally and physically hard, the hours are irregular, and the availability of meds is always there.

As far as disclosing this info to the BON, I personally would not do so. This is not their busienss and if a person is able to recover without incurring any criminal records and on their own initiative, this is private medical info that is protected by HIPPA laws. It would only be used in a negative way by any BON and is discriminatory.

As far as suboxone use... too many "recovering" people object to it, and think that people using it are not in recovery....I personally disagree with this, and base recovery on how a person lives and acts, and the people I know using maintainace drugs are NOT the same as addicts trapped in the hells of active addiction. They don't lie, steal, or behave in ways that addicts do, instead they are working, responsible, and looking for ways to grow and change for the better.

I cannot see how people can make a determination about someone elses recovery based on what they read online, and the idea that people automatically label a suboxone user as a red flag, and are concerned about them soley due to the use of a medication is unjustified to me.

There are some states that do allow sub use, IN is one for sure... and there are some states like FL that is definitely against it. All states differ, most don't address this in their NPA.