Texas BON licensing question / MAT

[tossit1919]

I am a new grad about to take the NCLEX. I have a job lined up pending licensing at the hospital where I presently work as a tech. (edit to add my job is on a med surg floor where I will have access to all medication). I do not have a history of substance abuse/use disorder but was in a traumatic accident that required months of surgeries and pain management. In the process of tapering off of those medications with subutex/bupe (not suboxone as my psych has no worries of me seeking/abusing) she has found (and there is actual literature on) bupe as an antidepressant. I have had genetic testing as SSRIs, etc., do not metabolize properly so finding an antidepressant for my moderate dysthymia has been challenging. Their practice selectively treats low risk patients like me with low dose (4-8mg) buprenorphine and it has worked wonders for my depression. I have been under her care for almost 4 years on the same medication regimen (Bupe 4mg Qam, lamictal 300 mg q am, ativan 1 mg PRN sleep and lunesta 3 mg PRN sleep). If anyone ran my info in the TPM site they would see the same medication every 30 days for the last 42 months or so from the same provider. 

I found articles online about under no circumstance does texas allow for bupe therapy as MAT for nursing (but OK for doctors with psychiatrist orders, come on now) but these are from 2012 and older. I am completely comfortable with undergoing evaluation and I know my psych, PCP, and counselor all would completely support my history. None of these medications affect my ability to provide care or impair me (sans the ativan lunesta for sleep) and I have been taking them for years as a tech and all through school without any issue. My employer drug screen was fine as they were RX'ED but obviously not a BON thing.

I have searched the Tx BON site for anything about specific medications such as bupe and cannot find anything specific to that medication. Does anyone here know for certain or have current published information about this specific medication/indication? 

On a side note - as I was attempting to taper from the pain meds (oxy hcl 40-60mg TID and was completely functional and alert on it at the end because of the tolerance built over months) the surgeon weaned me far too quickly and I went into acute withdrawal. In those few hours my level of empathy for those who have addiction diseases went through the roof. If I did not know I had an option to get help immediately the idea of doing anything to stop that feeling absolutely went through my mind. It was beyond any physical or mental pain I could ever describe to anyone and I have so much respect for those of you who battle this. Seriously so much respect.

Thanks.

[TIMFY]

I'm a little confused, who are you worried about finding out what meds you're on? The BON? They wouldn't know unless you had an incident at work and were reported to them. As long as you have a script, you should be good. I've been on multiple C2 meds throughout the years and its never been an issue as long as I just sent the MRO a picture of my script when I tested pos. 

[tossit1919]

My psych said (now that I graduated--wish she would have thought of this beforehand)..."does the TPAPN know you're on buprenorphine?" I said on my fitness I didn't disclose I ever had any issues that would prevent me from providing safe care but she said they probably run the prescription monitoring program (not a fact). It's fine that my hospital knows as it's never been a problem (I've been on them since I started working there) but if the BON does pull the PMP...should I be worried because there is historically a zero tolerance for it.

Bupe is literally the one thing that has saved me from going into a deep depression. I had mild depression that I would occasionally try meds for and they would never work since my teens (90s). IN 2018, I was sexually assaulted and then in a traumatic accident and that PTSD put me in a bad place. The bupe has me the best I've ever been (along with earlier ketamine infusions and consistent counseling). A great study is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121503/

I can't imagine having to come off of it (not because of withdrawal, but because of how it helps me) and try to find something similar because there aren't many, if any, drugs similar to bupe that would be "OK" due to their controlled status. Our bodies are just so different and brains have different chemical needs. 

[TIMFY]

I just don't know why they would pull the PMP? Or how because I believe only MDs and Pharmacists can access it. If you WERE in TPAPN then they might access it and care but if you're not, then I highly doubt the BON is reviewing prescription records for their 10s of thousands of licensed nurses. It's a great question and something important to think about but...I really don't see how or why they would get that information. Or how it would be an issue since you're prescribed. They care about things not prescribed, so it doesn't even make sense for them to look at the PMP since everything on there would be prescribed.