This post may delve into the philosophical realm but I've been thinking on it lately.
I work with this nurse who-I don't know if confided is the right word-but told me she has gotten used to winding down at the end of the day with a 'Lortab' or other painkiller before going to bed. Apparently, she (or one of her 9 children) have various medical procedures done from time to time and she is taking what is left over that they don't use. At one point she asked if I knew about ordering painkillers online (illegal, I believe). She claims the medication helps her relax and sleep better, and they work better than the antidepressants or anti-anxiety meds she has been prescribed. I got to talking to her and she says when she stays busy with a project or some other activity she doesn't even think about using them but she goes through bouts where she is bored (depressed?) and can't rest and the narcotics in the painkillers help a lot.
This is an excellent nurse. She's very impressive on the floor, actually. Her attitude is great. The facility where we work is very strict on narcotics and has no reason to believe she is stealing meds (there are several nurses who have raised suspicion and are being watched and she is not one of them.) There are absolutely no red flags, she rarely gives prn pain meds, gives the minimum dose ordered when she does, and none of the patients on scheduled pain meds complain of anything out of the ordinary after she has worked. Also, she has been there several years.
I understand that using narcotic medication for anything other than what they were prescribed for is prescription abuse. She claims that she doesn't always have these meds at home but it's nice when she does. Would you say she has a " problem?"
Another question, pain is not only physical but emotional. I know the Cymbalta commercial says " depression hurts." If she takes antidepressants and has been diagnosed with moderate to severe depression but claims Lortab (or Vicodin...etc.) helps the symptoms, could this not be a way to treat the pain as well?
Yes, I would say it could be a serious problem...as a CDU RN, I've seen too many people that start out this way, and down the slippery-slope they go. As others have mentioned, she would also be in serious problems if she had a random drug screen. Now...what to do? At this point, it sounds like it's not affecting her work-life, so I wouldn't worry (at this point) about that aspect of it. However, as a friend and co-worker, and someone that she obviously has some trust in, I would talk to her about your concerns (really emphasize the drug-screen dilemma, as this may be something that spurs her to action). If she minimizes it, though, you've done the best you can, and just keep a vigilant eye on the situation. You'll know if and when you need to step in, as that little nagging voice inside your head will be yelling at you. :)
OP - good thread. I couldn't say if this nurse in this situation has a problem or is doing something that would get her in trouble, but I can also vouch for the fact that addiction is indeed sneaky. It isn't difficult to go from taking something on occasion or nightly to taking something every day or multiple times daily. After the nurse runs out of her supply or her family member's supply he/she has to find another source. They may turn to diversion or making a purchase from a dealer.
I can say this because I started taking Lortab for PMS and cramps and then later added Ambien because I had trouble sleeping. Then I added to the mix Adipex in the am because I was still tired from the Ambien. I started getting them elsewhere when I ran out - and ended up in rehab and joining our state's recovering nurse program because of a positive drug screen.
It can be easier than a lot of people think to go from one to another. Just my .02.
leave her alone. she has not shown anything that reflects in her ability to work, i.e. no negatives as yet. i hope that you leave her alone. people get so pumped out and release their prejudices in times like this, very unfortunate at times.
I feel dissatisfied with the above responses to your question. After some thought, I realized that before giving any advise to your "friend," I would need to review her history and do an assessment. A useful answer probably can not be given in a thread. Except, seek the advise of a licensed professional.
I feel dissatisfied with the above responses to your question. After some thought, I realized that before giving any advise to your "friend," I would need to review her history and do an assessment. A useful answer probably can not be given in a thread. Except, seek the advise of a licensed professional.
You are right in that before someone qualified in the field makes a decision about a possilble addiction or issue the friend would need to be evaluated. I was only trying to share a personal experience with the OP and any other posters who may read it. It was only my personal experience where I started out using a certain drug and I added another to the first and how for me it snowballed into something that I never would have imagined.
I don't envy your situation at all. I would encourage this nurse to seek professional help because pain killers shouldn't be used like this and I would be telling her that it could possibly damage her career prospects.
It sounds as though she isn't impaired at work so in this case I would be not say anything about this to management. But I definately wouldn't mention anything about this to anyone else you work with in case this nurse is diverting narcotics. If the sh#t hits the fan then you don't want management to know that you were aware of her problem because you may get into trouble as well for not saying anything.
She's risking her job and license if there's a random drug test. That strikes me as using a med despite at least the possibility of adverse consequences. Please, I don't mean to say she's a raging addict, but it raises at least a very yellow flag, if not red.
What should you do about it? Seems to me that friendship requires you to have a very blunt and serious talk with her. Point out the consequences of getting "caught."
If her anti-depressants or sleep aids aren't doing the job, the appropriate step to take, especially for a professional in the health care field, is to talk to the prescriber about it.
Obviously, the possibility of harm to Pts raises the stakes, ethically, and I suppose legally, though I'm not qualified to address the latter.
OP - good thread. I couldn't say if this nurse in this situation has a problem or is doing something that would get her in trouble, but I can also vouch for the fact that addiction is indeed sneaky. It isn't difficult to go from taking something on occasion or nightly to taking something every day or multiple times daily. After the nurse runs out of her supply or her family member's supply he/she has to find another source. They may turn to diversion or making a purchase from a dealer.
I can say this because I started taking Lortab for PMS and cramps and then later added Ambien because I had trouble sleeping. Then I added to the mix Adipex in the am because I was still tired from the Ambien. I started getting them elsewhere when I ran out - and ended up in rehab and joining our state's recovering nurse program because of a positive drug screen.
It can be easier than a lot of people think to go from one to another. Just my .02.
Anne, RNC:sofahider
(emphasis added)
There is physical tolerance built up toward opioids, so one can expect that the user will need increasing doses as time progresses, even without psychological dependence. Where will that lead? Not hard to describe the possibilities.
She's risking her job and license if there's a random drug test. That strikes me as using a med despite at least the possibility of adverse consequences. Please, I don't mean to say she's a raging addict, but it raises at least a very yellow flag, if not red.
What should you do about it? Seems to me that friendship requires you to have a very blunt and serious talk with her. Point out the consequences of getting "caught."
If her anti-depressants or sleep aids aren't doing the job, the appropriate step to take, especially for a professional in the health care field, is to talk to the prescriber about it.
Obviously, the possibility of harm to Pts raises the stakes, ethically, and I suppose legally, though I'm not qualified to address the latter.
That's how our facility is, they get an idea there is someone to check up on, the yellow flag, and they are under the microscope. Our facility also crack down pretty tightly about narcs you have a script for, it has to be pretty recent, no s/sx of impairment, ect.
Right, rngolfer - In my case, the doc put me on Lortab 5, and I was taking 1 every 4 hours or so. Before long, I was taking 1 1/2 or 2 tabs, and not waiting 4 hours. I was in the middle of a divorce, so my doc put me on Xanax 2mg prn. Then I had saved the remaining pills from an old rx for Ambien, so I threw those in the mix. And, as you said, it doesn't take long.
OP - Hopefully you'll get some ideas here about your situation. My dependence on narcs is not something I am proud of, but I am definetly proud of the fact that I have been able to maintain my sobriety for 10 years. I'm glad for friend to have someone looking out for them, even if they don't think so at the time.
I agree-- leave her alone, maybe as nurses we feel the need to not only "eat our young", but our co-workers too. and I think the "Nurse" in us, always wants to assess .. If she is working fine, and no meds are missing ect.. I say leave it be.
You may want to take a look at the Nurses in Recovery forum here, or even show it to your friend. It's often difficult to find the line between supporting a friend and enabling a growing habit.
I agree to leaving it alone on the job, but, as others have pointed out, keep your eyes open. Once she starts being impaired on the job or show signs of diversion, you're pretty much obligated to do something. You might want to find a way of letting her know this.
Indeed, her disclosure to a co-worker may even be an unconscious asking for help ... she can't possibly be unaware of the possible consequences of a coworker knowing about non-prescribed use.
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SlightlyMental_RN
471 Posts
Yes, I would say it could be a serious problem...as a CDU RN, I've seen too many people that start out this way, and down the slippery-slope they go. As others have mentioned, she would also be in serious problems if she had a random drug screen. Now...what to do? At this point, it sounds like it's not affecting her work-life, so I wouldn't worry (at this point) about that aspect of it. However, as a friend and co-worker, and someone that she obviously has some trust in, I would talk to her about your concerns (really emphasize the drug-screen dilemma, as this may be something that spurs her to action). If she minimizes it, though, you've done the best you can, and just keep a vigilant eye on the situation. You'll know if and when you need to step in, as that little nagging voice inside your head will be yelling at you. :)