Ultram cost me my new dream job

mskitty · Jan 27, 2004

Kellygirl,

This could have been me a month or two ago. I have fibromyalgia along with the usual arthritis that we acquire. My nurse manager (not just a coworker!) also has fm & noticed that I was having a day with more pain than usual. She takes Ultram for fm & gave me one of her pills. Yep it helped but after reading what has happened to you won't do this again at least not until I have my own script!

:nono:

vanburbian · Jan 28, 2004

Originally posted by athomas91
in urine drug tests the only opioids that show up (in a the tests generally used by hospitals) are ones that ultimately break down to codeine or morphine derivatives...therefore...percocet etc do not show up...they are hydromorphone and stay that way because they do not fully break down to a morphine derivative that triggers the test positive...drinking water to "flush" your system doesn't make them move out any quicker.

actually, urine drug screens are pretty thourogh, the basic screen is ran to detect "drugs of abuse", so generally, opiates, synthetic opiates, amphetamines, barbs, sedatives, anxiolytics, cannabinoids, etc. are hunted for.

as far as percocet not being detectable, thats one of the most commonly abused drugs, and they are definitely screening for it, it breaks down into "oxymorphone", not HYDROmorphone, nevertheless, syntrheics are easily detected.

this web site has some basic info, in case anyone is interested....

http://www.toxlab.co.uk/dasguide.htm#OPIATES

sheri

chris_at_lucas_RN, RN · Jan 28, 2004

On the first one I injected myself "Crono 12" (diclophenac + a strong corticoid) in my external-vastus that allowed me to finish my shift. The second time I asked my co to inject a mix of opium derivate + ibuprofen IV, during my next two shifts, with unfortunately, too little dilution. I burned my two best veins (although I could bear my shift till the end).

Am I the only one who read this and was horrified? Our credentials don't give us the privilege of self medicating when it comes to prescription meds, much less scheduled drugs.

Sheesh! Physician (or in this case, nurse), truly heal thyself: in other words, did you do what you would advise a patient to do? Next time, get care from a competent professional. Sorry, but remind me not to get sick in Argentina! Give me the US any time: clear rules and the means to follow them.

Opiates IV strong enough to damage veins and continuing to work? Not a good plan, IMHO.

Owney · Jan 28, 2004

Originally posted by chris_at_lucas
Am I the only one who read this and was horrified? Our credentials don't give us the privilege of self medicating when it comes to prescription meds, much less scheduled drugs.

Sheesh! Physician (or in this case, nurse), truly heal thyself: in other words, did you do what you would advise a patient to do? Next time, get care from a competent professional. Sorry, but remind me not to get sick in Argentina! Give me the US any time: clear rules and the means to follow them.

Opiates IV strong enough to damage veins and continuing to work? Not a good plan, IMHO.

NO NO NO Chris, I pray to GOD somebody else responds.

I have been an ER nurse for 20 years working in the combat zone of the citY. The last time I worked days I spent 10 min disposing of MN nurse's little "stashes." Some of them were pretty scary. Narcotics, paralyzers ect. I adopted this policy due to an incident that happened on one of our ICUs. A nurse left an unlabled syringe lying around and an ICU tech took it to party with during his lunch break. An hour later the guy did not return to work. The nurses figured out what had happened and waited until the end of the shift before they called a code on their dead co-worker. It turned out they guy died an agonizing death in the staff rest room after shooting up Pavulon. I always carry my stash in my Lab coat pocket, and ALWAYS waste them before they get to my locker.

Do you remember the first time you gave yourself and IM. I do. It was for a physicians order for a TD, on my chart. It took me over an hour before I could do it, and I had been an ER nurse for 10 years.

I had been a nurse for 20 years before I could give my wife compazine IM PRN vomiting, at home. Never mind that I had done this hundreds of times for patients who were still pending physician's evaluation (of course at least I got a verbal order by checking with the doc first).

I find any kind of self-medication extremely dangerous. What scares me even more is the sad fact that so many nurses have to take narcotics to do their jobs! Do you want someone taking care of you who is high either from pain or from narcotics? YEEESH!

:eek:

athomas91 · Jan 28, 2004

actually, urine drug screens are pretty thourogh, the basic screen is ran to detect "drugs of abuse", so generally, opiates, synthetic opiates, amphetamines, barbs, sedatives, anxiolytics, cannabinoids, etc. are hunted for.

i am also well aware as to what they screen for....as for the oxy/hydro...my mistake must have been not thinking strait...however you are wrong...generally neither percocet or oxycontin show up in a general drug screen - the drug must be broken down to a morphine or demerol base - and percocet and oxycontin do not...i have had many many many an oxycontin OD that tested negative and were by the pt's own admission using...therefore i researched the subject a bit...now if a hospital is using a hair follicle screening or blood screening that is different.but most urine drug tests are actually only a dipstick test that tests positive/negative.

[

OK, but once again, what law is there that says you can be turned down for a position because you are using a non-narcotic analgesic medication

ultram is has a synthetic opioid as part of it's makeup - it therefore has the same side effects as any other opioid med - and it is because of their side effects that they shouldn't be used while working - ultram just like other opioids also has an addictive quality...

mattsmom81 · Jan 28, 2004

Originally posted by Owney
What scares me even more is the sad fact that so many nurses have to take narcotics to do their jobs! Do you want someone taking care of you who is high either from pain or from narcotics? YEEESH!

Someone who is taking prescribed painkillers therapeutically/correctly for intractable pain is not likely to be 'high.' Haven't you met morphine pump patients? Or people with Duragesic patches?

What scares me is how many nurses with painful conditions cannot risk treatment for it ... choosing not to get treated due to stigmas on the job. I suspect this is behind many a nurses' diversion....they hurt, they need relief, and make a very bad snap decision to self medicate. Wrong definitely...but I also look at the underlying problem.

A better understanding of and acceptance of chronic pain and use of analgesics would help society remedy the problem. But as nurses, we are supposed to be 'perfect' in every way. We can't have pain either I guess, and we sure come under scrutiny if we admit we do...particularly as we age or if we've had an on the job injury.

I totally believe in appropriate diagnoses and therapy, by the way. But some conditions are chronic and intractable, requiring meds. Including narcotic analgesics sometimes. And taking them doesn't automatically mean we are impaired or high, IMHO.

Off my soapbox now...sorry...pet topic of mine as you can no doubt see.

:chuckle

PS: I have never diverted narcotic nor have I given myself an injection...these are boundaries I cannot cross...the practitioner who treats himself has a fool for a patient....

CoffeeRTC, BSN, RN · Jan 28, 2004

Oxycontin not showing up on urine screens or blood screen... Had a A &Ox 3 LTC res with pancreatits who would go on occasional LOA from facility. Some staff and her doc questioned her pain and ordered a tox screen on her... nothing showed up on her labs except for ultram... she was getting 180mg Oxycontin a day, Dilaudid IV push 3 mg prn q 4 hrs..... Now I know I gave her the dilaudid and watched her take the oxycontin....so how come nothing showed up...except ultram (she wasn't ordered this) ????

KELLYGIRL · Jan 29, 2004

Okay... let me tell you what I read in the drug guide... Davis's Drug Guide for Nurses 7th Ed....

tramadol...

Classification: analgesics (centrally acting)

Indications: tx of mod to mod severe pain

Action: binds to mu-opiod receptors and inhibits reuptake of serotonin and norepi. in the CNS

Nothing about this being a opiod-derivative. Hell, I was in pain, with no relief from tylenol.

I shouldn't have taken it in the 1st place. ---> No Rx

I wish I could just go to the Dr and get my hip pain treated... problem??? No Insurance!

I wasn't looking for a 'high', a 'buzz', or whatever.... I just wanted to be able to walk.

Dragonnurse1, ASN, RN · Jan 29, 2004

Ultram is a synthetic opiate. Best check your meds better. Ultram can become habit forming. To all that think it is just a middle strength pain killer, think again.

A mistake made while working with ultram in your system will open you up to such a can or legal troubles - - - - :rolleyes:

As long as you have your own RX and you tell BEFORE you take test you will be ok.

redshiloh · Jan 29, 2004

Hate to argue, but ultram is a central acting analgesic. It BINDs to opiod receptors but is not itself an opioid.

sjoe · Jan 29, 2004

"Ultram did not cost you the job - taking an unauthorized painkiller did."

This thread has certainly wandered far and wide!

The crux of the matter has NOTHING to do with pain control, NOTHING to do with ultram, NOTHING to do with drug testing, and EVERYTHING to do with illegally taking someone else's prescribed medication.

I see no clear recognition of this fact by the author of this thread, but I do see a lot of regret about BEING CAUGHT and the institution's response to the illegal activity. (And yes, I have read all the posts to this point.) If the drug had not showed up on a drug test, it would STILL have been illegal, as well as grossly unwise.

Take some responsibility for yourself and your actions without making ANY excuses and perhaps your institution will believe that you are not likely to do the same thing again--though this next time with a less easily detectable drug. Otherwise, they will simply think, as I do, that you will simply try harder in the future not to get caught.

I don't know whether it is possible to change the title of a thread once it has begun, but if so I would suggest: "My poor judgment and illegal activity cost me my dream job."

Owney · Jan 29, 2004

sjoe,

Most of what you said was so well-put that I thought it should be said again.

Originally posted by sjoe
"Ultram did not cost you the job - taking an unauthorized painkiller did."

This thread has certainly wandered far and wide!

The crux of the matter has NOTHING to do with pain control, NOTHING to do with ultram, NOTHING to do with drug testing, and EVERYTHING to do with illegally taking someone else's prescribed medication.

I do see a lot of regret about BEING CAUGHT and the institution's response to the illegal activity. If the drug had not showed up on a drug test, it would STILL have been illegal, as well as grossly unwise.

Take some responsibility for yourself and your actions without making ANY excuses and perhaps your institution will believe that you are not likely to do the same thing again.

I think that unwise should definitely preceed illegal in consideration of this issue.

Thanks for the excellent post.:)