Suboxone

They won't let you work on Suboxone, at least not in my state. For Gabapentin.in my state they let you work but you had to stop it and the time you were on it didn't count toward your time in monitoring beyond the 1st year. I guess you're just supposed to be in pain. 

Healer555 said:

They won't let you work on Suboxone, at least not in my state. For Gabapentin.in my state they let you work but you had to stop it and the time you were on it didn't count toward your time in monitoring beyond the 1st year. I guess you're just supposed to be in pain. 

That's unfortunate because I was told I can be on it while in monitoring when I got access to controlled meds. At that time I chose not to take it because I had over a year in recovery. As far as gabapentin I'm allowed that too since it's not a controlled med and it's legally prescribed to me. So sorry your state is that way. 

Nursrcy00901 said:

That's unfortunate because I was told I can be on it while in monitoring when I got access to controlled meds. At that time I chose not to take it because I had over a year in recovery. As far as gabapentin I'm allowed that too since it's not a controlled med and it's legally prescribed to me. So sorry your state is that way. 

Can I ask why being on gabapentin would stop your time in monitoring? It does take away the nerve pain but it doesn't make me feel impaired. 

Gabapentin and why its important 

Gabapentin is on the rise for misuse because when taken in large enough doses, SOME people get a Euphoric effect. Its also being used to potentiate opiate use/abuse. The previous sentence is according to the USDTL and their research. Because of this, a few states have actually started to make Neurontin (Gabapentin) a controlled drug and over half of all states now require it at tp at least be entered into the Controlled Prescription Drug Database for that specific state. This is the database that every nurse in monitoring signs a form giving consent for their monitoring program in that state to check the database and if prescribed, the monitoring program will see it.

Because of all of the above, a few states (less than 5 right now but rising) have monitoring programs that treats Gabapentin like an opiate or nearly like an opiate or a partial opiate like Subutex, and most are starting to tighten up and get more strict. Here are the tiers and just examples

Tier 1. Only a handful of states Right Now.. Gabapentin is allowed only if prescribed by a pain management physician and if prescribed, the monitoring time stops or is not counted until you get off of it. Its treated nearly like an opiate. A monthly report must be sent by your pain management physician stating why you need it and the plan to get you off of it, and you can't work while taking it. Some states will continue to count your monitoring time, but you have to get off of it in 3 minths, etc.

Tier 2. Gabapentin is allowed, but it must be prescribed by a pain management physician and your monitoring time while on it is counted, but you can't take it at work, and a regular monthly or at least a  quarterly report must be sent by the physician stating why you need it and your progress, etc.

Tier 3. Gabapentin is allowed and your monitoring time continues (counts) while you are on it and it can be prescribed by a family practice physician.

Within a few years, nearly all states will look something like Tier 2 above. As for Gabapentin, yes, the USDTL can test for it in a hair test and its very, very accurate unlike marijuana or alcohol in a hair test which is variable, Gabapentin in the hair test is very accurate and their cutoff level is extremely low. It can also be detected in urine for about 5 days and a one time dosage can sometimes be detected in the hair, unlike weed or alcohol. A 2 time dosage in the hair will get you nailed if taking it without prescription and authorization.

Back Pain and Surgery and Monitoring Programs. Monitoring Programs view back pain as Not Needing any Opiates over the Long Term IF.......IF....the following apply and that is.....the nurse has tried injections, physical therapy, other non opiate remedies like Lyrica and NSAIDS and muscle relaxers and finally.....surgery. If ALL of these have failed, then the monitoring program takes a closer look at allowing you to take something they would normally not allow another nurse to take.

You will get many posts on this Forum over many years with nurses being upset that a monitoring program tells them they must get off of the opiates or partial opiates like Subutex. In these situations, even if the nurse doesnt admit it, and some times they do admit it, the Nurse has been offered back surgery and the nurse refuses the surgery. Opiates were Never designed to be taken long term except in cases of terminal cancer where it was clear a person wasnt going to be alive for over 1 year or 2. Monitoring Programs and addiction centers and pain management physicians know this. They know that a human being is not suppose to be on any opiate containing drug over a long term except in extremely rare cases when all things have failed such as infusion pumps and spinal simulators, steroid injections and nerve blocks, NSAIDS, epidural injections, combos of non opiate medications and physical therapy and surgery. If all of the above fail, then the rare possibility of a long term opiate comes into play and this is the absolutely RARE exception for most humans. 

You will find that most nurses who are upset with a monitoring program about being forced to get off of opiates (if they want to finish monitoring and stay a nurse) have nearly always...Skipped one of the steps above and that step is usually....refusing surgery. Monitoring Programs know this fact. They are aware of it. They can read. They can see from your provider notes that surgery has been recommended or a spinal stimulator has been recommended, but the nurse refuses. 

There are nurses on this forum who have tried everything and it failed and their situation is terrible for them and I feel bad for them. There are also nurses who simply refuse some of things recommended by the physician such as surgery or spinal stimulator, etc, and I feel bad for them also, but their situation is considered and treated radically different by a monitoring program. The monitoring program is simply not going to allow you to continue taking an opiate (in most states) if they clearly read that the provider has recommended surgery or a spinal nerve stimulator and the nurse has simply chose not do it.

I had chronic back pain when entering monitoring years ago. Was given 3 months to get off of Subutex. The monitoring program read where the physician recommended a spinal nerve stim and if it didn't work, then they would recommend surgery. The monitoring program told me up front, that I was being non compliant with treatment and that I had to make a choice. I chose the surgery and after that, I still had some pain, but not much and Motrin did fine for it. They told me....."You cant simply keep taking opiates when the pain management physician is telling you that you need a spinal nerve stimulator or surgery, and you are simply refusing to try either one." They said that I could make the choice of picking one of the two above, or be out of the monitoring program and not being a nurse anymore. They said if I wanted to keep taking and opiate and not do the recommended spinal stim or surgery from the physician, then I could do that, but I wouldnt be a nurse any longer. They said that one you are now here in a monitoring program and have been diagnosed with a substance use disorders, then you WILL comply with the recommended treatment and taking opiates instead of refusing the treatment was something they would not allow. I actually respected them for this years later and kind of understood where they were coming from. They weren't just going by their own program guidelines or requirements, but they were going by what the medical literature supports for how to handle chronic pain.

Regalnurse said:

Back Pain and Surgery and Monitoring Programs. Monitoring Programs view back pain as Not Needing any Opiates over the Long Term IF.......IF....the following apply and that is.....the nurse has tried injections, physical therapy, other non opiate remedies like Lyrica and NSAIDS and muscle relaxers and finally.....surgery. If ALL of these have failed, then the monitoring program takes a closer look at allowing you to take something they would normally not allow another nurse to take.

You will get many posts on this Forum over many years with nurses being upset that a monitoring program tells them they must get off of the opiates or partial opiates like Subutex. In these situations, even if the nurse doesnt admit it, and some times they do admit it, the Nurse has been offered back surgery and the nurse refuses the surgery. Opiates were Never designed to be taken long term except in cases of terminal cancer where it was clear a person wasnt going to be alive for over 1 year or 2. Monitoring Programs and addiction centers and pain management physicians know this. They know that a human being is not suppose to be on any opiate containing drug over a long term except in extremely rare cases when all things have failed such as infusion pumps and spinal simulators, steroid injections and nerve blocks, NSAIDS, epidural injections, combos of non opiate medications and physical therapy and surgery. If all of the above fail, then the rare possibility of a long term opiate comes into play and this is the absolutely RARE exception for most humans. 

You will find that most nurses who are upset with a monitoring program about being forced to get off of opiates (if they want to finish monitoring and stay a nurse) have nearly always...Skipped one of the steps above and that step is usually....refusing surgery. Monitoring Programs know this fact. They are aware of it. They can read. They can see from your provider notes that surgery has been recommended or a spinal stimulator has been recommended, but the nurse refuses. 

There are nurses on this forum who have tried everything and it failed and their situation is terrible for them and I feel bad for them. There are also nurses who simply refuse some of things recommended by the physician such as surgery or spinal stimulator, etc, and I feel bad for them also, but their situation is considered and treated radically different by a monitoring program. The monitoring program is simply not going to allow you to continue taking an opiate (in most states) if they clearly read that the provider has recommended surgery or a spinal nerve stimulator and the nurse has simply chose not do it.

I had chronic back pain when entering monitoring years ago. Was given 3 months to get off of Subutex. The monitoring program read where the physician recommended a spinal nerve stim and if it didn't work, then they would recommend surgery. The monitoring program told me up front, that I was being non compliant with treatment and that I had to make a choice. I chose the surgery and after that, I still had some pain, but not much and Motrin did fine for it. They told me....."You cant simply keep taking opiates when the pain management physician is telling you that you need a spinal nerve stimulator or surgery, and you are simply refusing to try either one." They said that I could make the choice of picking one of the two above, or be out of the monitoring program and not being a nurse anymore. They said if I wanted to keep taking and opiate and not do the recommended spinal stim or surgery from the physician, then I could do that, but I wouldnt be a nurse any longer. They said that one you are now here in a monitoring program and have been diagnosed with a substance use disorders, then you WILL comply with the recommended treatment and taking opiates instead of refusing the treatment was something they would not allow. I actually respected them for this years later and kind of understood where they were coming from. They weren't just going by their own program guidelines or requirements, but they were going by what the medical literature supports for how to handle chronic pain.

WOW thank you so much for all of this information! I didn't realize that gabapentin will be a controlled med soon in most states! As of now, mine allows it and I have 11 months left of monitoring so I'm not super worried about it at this time because by the time it's controlled I'll be done. That being said-the plan is to hopefully be off of it soon. I will also be going in for injections which I pray help. I have severe degenerative disc disease with protruding discs. I am willing to try anything at this point and I honestly don't want opiates at all which is why they offered the suboxone. I've been very forth coming with my addiction so that I can make sure I am staying clean and sober. I have 670 days clean and will make sure to protect that at all costs. I really appreciate all of this information because it does make my choice to stop gabapentin easier! As of now my state doesn't test for it-I've been on it a few months now and I've had normal UAs. I also sent my monitor all of the meds I've started but because they aren't controlled they don't do anything with that info. But I just want to be honest with them and doctors. Back pain is the worst thing I've ever had happen-I am really hoping injections are the answer to getting relief because I'd love to cut off the gaba completely and use Motrin when needed 

Nursrcy00901 said:

WOW thank you so much for all of this information! I didn't realize that gabapentin will be a controlled med soon in most states! As of now, mine allows it and I have 11 months left of monitoring so I'm not super worried about it at this time because by the time it's controlled I'll be done. That being said-the plan is to hopefully be off of it soon. I will also be going in for injections which I pray help. I have severe degenerative disc disease with protruding discs. I am willing to try anything at this point and I honestly don't want opiates at all which is why they offered the suboxone. I've been very forth coming with my addiction so that I can make sure I am staying clean and sober. I have 670 days clean and will make sure to protect that at all costs. I really appreciate all of this information because it does make my choice to stop gabapentin easier! As of now my state doesn't test for it-I've been on it a few months now and I've had normal UAs. I also sent my monitor all of the meds I've started but because they aren't controlled they don't do anything with that info. But I just want to be honest with them and doctors. Back pain is the worst thing I've ever had happen-I am really hoping injections are the answer to getting relief because I'd love to cut off the gaba completely and use Motrin when needed 

Gabapentin in my opinion should not be controlled. I think states are going too far as is the federal government. Gabapentin is NOT an opiate and carries nowhere close to the addiction risk or long term risk/life changing risk and dependency of opiates. 

Keep this in mind. It's not about what your state tests for. They could test you for nicotine or caffeine (coffee) or Ibuprofen and all of those are Legal and OK and you would show up positive and it doesnt matter. If you have a script for Neurontin then you have no worries, but All Monitoring Programs in the US SOMETIMES use the USDTL (US Drug Testing Lab) located in Iowa which is the gold standard for advanced drug testing for things like Healthcare Monitoring Programs and Forensic Cases, etc. Your state has CHOSEN not to test you for Gabapentin, but trust me on this, there is a test for it through USDTL. Most states use Recovery Trek or Affinity and their drug tests go through Quest and Labcorp for the majority of them, but they occasionally use the USDTL for more advanced testing.

I would recommend ANYTHING other than opiates as a choice for back pain. Neurontin I would take if Im a nurse who is NOT in a monitoring program (and Im not-finished 6 years ago) and I had back pain, I would do injections, physical therapy, heat, massage, cold, Neurontin or Lyrica with Motrin and Flexeril and surgery BEFORE I swallowed ANY drug that contains an opiate including Suboxone. No way for me knowing what I know npw and how I got hooked. You could cut my back wide open and fuse 3 vertebrae before I ever would swallow an opiate. I got hooked because of back pain. I should have had surgery years earlier but I delayed it and it nearly ruined my life for 5 years. Nurses, many of them, have no clue how dangerous and lethal opiates are (including Suboxone). Its poison. For 2 to 4 days post surgery taking opiates? Sure, that's what they were designed for. But, they were not designed to be taken for over a week to 10 days at most. 

Nursrcy00901 said:

That's unfortunate because I was told I can be on it while in monitoring when I got access to controlled meds. At that time I chose not to take it because I had over a year in recovery. As far as gabapentin I'm allowed that too since it's not a controlled med and it's legally prescribed to me. So sorry your state is that way. 

Can I ask why being on gabapentin would stop your time in monitoring? It does take away the nerve pain but it doesn't make me feel impaired. 

HI I am in florida and on suboxone for chronic pain my contract says that I have to stay on suboxone at least for a year and If I decide to come off on that first year I would have to get another evaluation. But some nurses are allowed to stay on suboxone. I have permission to work so you can definitely work while being on suboxone.