unbelievable...

[june2009]

I've been out of PHMP for a few years now but I feel like it still follows me and here's why.

Two weeks ago My boss pulls me in to her office and asks why there were 2 oxycodone left in one of my patient's medication drawer. I stated that I pulled them in anticipation that the patient would want them as he frequently does. When I askd him if he wanted them, he refused them. I put them in my drawer to return to the med-dispense later. I forgot to return them and they were in the patient's drawer when the next nurse took over.

When that happens, apparently the policy is to do a drug investigation, complete with urine drug test. No problem, I took the drug test.

It turns out positive for hydromorphone. I had a script for hydrocodone for some screwed up teeth. I took one norco a few days prior to the drug test. One of the metabolites of hydrocodone is hydromorphone.

I did not take hydromorphone. I have been doing extensive research from scholarly journals and it appears that it is possible to test positive for hydromorphone.

The occupational health doc says I should have either hydrocodone or norhydrocodone in my system. I only have hydromorphone. Has this ever happened to any one else? I've been clean almost 5 years!

THere wasn't even missing meds, there were extra meds. If I was using, wouldn't I have taken the stupid oxycodone and not left it in my patient's drawer?

I can't believe this.

[Big Blondie, ASN, BSN, MSN, APRN]

Wow. Hope this ends well.

[JustBeachyNurse, LPN]

I'm so sorry. Five years of hard work to stay clean.

[iluvivt, BSN, RN]

Yes you are correct. Some of the effects of hydrocodone come from the fact that a fraction of it is changed to hydromorphone in the liver. How much apparently depends other medications you may be taking

and inherited metabolic quirks

.

Hydrocodone is metabolized by cytochrome P450 (CYP) 2D6 to form hydromorphone (active) and by CYP3A4 to form norhydrocodone (inactive).

I think you need to point this out to them and I would stop your practice of pulling narcotics and placing them in the patient's med drawer or never forget, ever, to return them. I do think it is silly to test under these circumstances because all they had to do was look at the code on the pill to determine what it was. If you can be trusted to pull the meds and place them back into the med dispense what is the difference. I actually thinks it riskier that you can return them because a nurse could replace them with a look a like pill and no one may notice.

What is the outcome for you?

[LPNSWEETHEART]

Hope this works out for you. Definitely learn from this, as crazy as this is, you will never have to deal with these accusations again ( hopefully)..Good luck hun !!