The Travel Nurse who uses a (Gasp!) Controlled Substance

[mustang_convt]

Hello Fellow Travel Nurses (and future travel nurses),

I learned a previously unknown tidbit today at the pharmacy and Im a little confused and annoyed at the hoops I am going to have to potentially jump through in the near future.

I have been a third shift nurse for five years. Three 12 hour shifts so not only is your circadian rhythm interrupted by work-it is interrupted when you try to switch to a "normal person" schedule on your days off only to return shortly to working nights. Any nurse who has had to work night shift more than 6 months knows the stress and toll that takes on most of our bodies. But for some of us-no matter how tired our bodies are we just cant sleep properly.

As a result I have been on Ambien the last 2 years. I only use as prescribed with one doc and one pharmacy. I live in northern Indiana but accepted my first travel position about 5 hours away from my home so obviously I had my prescription transferred to the local CVS here.

While using their online system to refill my medicine this morning I noticed the pharmacy didn't open until 10am and did not fill meds until 11am. When I work back-to-back shifts I prefer to be asleep by 10am at the LASTEST. There is a 24hr store approx. 25 miles from the CVS Ive used here on location so I decide it would be worth the drive since I get off at 6am to be able to be in bed by 9-10am to rest up for my next shift. I never got a confirmation my order had been filled so before making the drive I called the pharmacy to make sure my order had went through ok.

I was informed they were unable to fill my prescription because it was a controlled substance and in the state of Indiana you can only transfer controlled substances once!! I have never had a need to transfer my prescription so this was the first I had ever heard of this law. I explained my situation to the tired and annoyed pharmacist of how I change job locations every 13 weeks. How it is very possible for me to be in 4 cities several hundred miles from home or even my previous location. I cant imagine Im the first person who travels for a living and needs a controlled monthly medication for SOME thing like insomnia (me) or pain or anxiety or even ADHD. When I asked the pharmacist if there was any paperwork myself or my doctor could fill out to explain the circumstances and the need for transferring a prescription more than one time I was told "it would be better if I didn't attempt to try to get around the law"!!! I have never been treated so rude for what I believe were valid questions for a law I didn't realize existed. And its just a sleep medication. I cant imagine how someone with chronic pain meds would have been treated.

I looked up the law after hanging up to try to get more info and talked to other nurses and it appears the pharmacist was right. Even though the "transfer" is between the same corporation its still considered and transfer and can only be done one time. Im comtemplating going to California within a matter of weeks. Even if I don't-no matter where I end up its not going to be within a convenient driving distance to the CVS I currently use for a temp assignment! I feel torn because I feel my only options are to

1)Go without the medicine resulting in insomnia and not being as alert as I should be doing a very assessment heavy labor patients. Not to mention the meds labor nurses administer like mag sulfate that need very close assessment

2)Find the time and money to fly home once a month (SO inconvenient and expensive)

3)Find a doctor at every new assignment to write me a current script without refills and have my list of doctors the size of a small book which makes both pharmacists and providers very weary that you are doing something sneaky when in reality you just want to sleep and do it within the confines of THEIR rules!

I cant be the first nurse with this issue. I assume it affected many traveling professionals. What have other people done to obtain their necessary medications while away on assignment???

[dance4life]

I would call your doctor and have someone help you with this issue. Instead of having to fly to CA to do it.

[BluntForceTrauma]

Is there not anyone that you can send to the pharmacy to pick them up for you? Usually as long as they know your address they can't pick them up...or how about you explain the situation to your current doctor and he can write you for more than a 30 day supply?

[NedRN]

Usually your general practitioner's staff will call a pharmacy for you with a new prescription without bothering the MD if you take it now. While Ambien is a bit different, I've always managed to stash many months of prescriptions. One way of doing that is to ask your doc to write for more daily doses than you need if he trusts you. Ordering from an online pharmacy can get you 90 day supply. It is more about the price for me - I'll get it online or cross the border if I'm in California. Either I've had no insurance (the old days) or I'm on a high deductible plan (now) so it is all out of pocket for me.

[mustang_convt]

I def have some research to do on the ins and outs. It would be nice if pharmacists would actually answer questions to help people remain compliant with laws they as patients aren't intimately familiar with but the practitioners know everything about it because that is their job!! Unfortunately-while it could probably be done in a somewhat easy manner-having someone else pick up the script and mailing it to me inst an option because its illegal for anyone besides a practitioner to mail a controlled substance. And even though it could be done with very little risk I'm just way too honest/paranoid to put myself and another person at risk for breaking even the minorest of a law. Ambien is a little different from pain meds or benzos in that 10mg is a very standard dose. Some patients are prescribed LESS-like 5mg but it would be very odd dosing to see 20-30mg of Ambien-almost like its obvious you're doing it to get around a law rather than it simply being an unusual therapeutic dose. I think almost any practitioner would change a med or add a med if Ambien wasn't working rather than up the dose like you can do with pain meds/benzos. Using it this long its become a daily med rather than a PRN dose so not using it and stockpiling a little bit aren't really an option. Ill have to check into state laws concerning called in prescriptions from one state to another. I assume even if its allowed its probably like everything else and left up to the discretion of the pharmacist.