Suboxone and the Addicted Healthcare Worker

When I went through treatment in 2001 I had a number of rough days–  I liked the treatment center very much (eventually), but the detox facility was horrible. I wouldn’t treat my dog the way I was treated during that horrible week that I spent there.  I was very sick;  I have talked about it before, so feel free to skip ahead if you have already heard me wallow in self-pity…  but I was using intravenous opiates, including fentanyl, sufentanil, demerol, morphine, dilaudid…  you name it.  I had gone through a couple horrible experiences, once by accidentally injecting naloxone in a desperate effort to treat withdrawal (I was at that dangerous stage of addiction where I was so sick that even an unlabeled syringe seemed worth the risk…. for some reason it didn’t help!), and once by intentionally swallowing 100 mg of naltrexone in a desperate but misguided effort to ‘get clean’.  I lost about 30 pounds over a six month period of time, going from a skinny 175 to a sickly 145 pounds.  I try to avoid self-pity by seeing the world through my wife’s eyes as much as I can– not because she is immune from self-pity, but because during the time I was at my worst, she was probably suffering more than I was!  But during the time of that last detox my thoughts, memories, and perspectives were entirely self-centered.  I talk a lot about insight, and as I think about it now I realize that insight is completely absent during withdrawal;  instead the addict becomes as driven as any other nonhuman animal that is searching for an escape from pain, with no ability to empathize, or to even pretend to empathize.

I assumed that the nurses and other staff of the locked, inpatient psychiatric facility where I ‘detoxed’  were disgusted by me;  I didn’t do anything out of the ordinary for a withdrawing addict– just lay in a corner and shiver– but I figured they were all whispering about ‘another one of those doctors’…  which I now realize was a bit narcissistic, my thinking that my status in detox would be any more ‘special’ in a good or bad way than the appearance of anyone else.  In other words, I now realize that they may treat every detoxing addict like dog sh#@, not just me!
I don’t know if this is universal, but I have met a few other docs that felt the same as myself– that as a detoxing doctor I felt that I was the ‘scum of the earth’ incarnate.  It is no wonder, when you consider that for years I dealt with deep feelings of insecurity by getting perfect grades, to prove that I was good enough…  I could look back on the two losers that beat me up in High School and think that yes, they truly ARE the losers, because ‘look where I am NOW, sucka’s!” But (ahem….) …. look where I actually am now… Not a whole lot to be proud of right now.
I was so sick… SO sick.  The worst part of withdrawal is how time just slows down…  I am so busy now, and I will sometimes be amazed at how when I sit at the computer the day is just gone before it starts.  But during withdrawal, hours take weeks to pass, and days take years.  I was supposed to get clonidine every four hours or so, but my darn doc had written ‘hold for blood pressure less than 90 systolic’.  I would hear the nurses shoes coming down the hall and I would strain all my muscles as hard as I could, hoping to push my BP up to the pressure that allowed a dose… and I never got it there the entire time I was in detox.  Nothing like dehydration, starvation, and diarrhea to keep one’s blood pressure down.  But hey– didn’t anyone ever think of a liter of intravenous saline, for Pete’s sake?
I remember day three or day four, somewhere around there, my goal for the day was to get in the shower.  And I actually make it, thanks to the handrails down the length of the hall.  The rest of the time was just waiting… and waiting.  I remember sobbing spells that would suddenly rise up without warning;  my legs kicking involuntarily all night long;  the psychiatrist grunting at me… literally… when he saw me on morning rounds.
Yuck.
I don’t know if they have a ‘mean spot’ in their hearts for addicted doctors… but I can tell you they didn’t have any spots that I would characterize as overly empathic or understanding.
Detox was the most miserable part of treatment by far, but there was one day in the ‘residential’ part of the program that stands out in my mind as well.  One day about a month into treatment I received several letters in ‘official’ envelopes.  Anyone who has been in trouble with their job or with a licensing authority will likely know the types of envelopes I am referring to– they say ‘certified’ on them, and you don’t get to open them until you signed that you received them.  I considered their arrival at the same time to be quite a coincidence, especially since they came from different people… but in retrospect the people probably had all held a discussion about me and all reacted at the same time.  One letter said I was being kicked off the staff of the hospital where I had worked for ten years, the next said I was fired from my anesthesia group (I was ‘Chief of Anesthesia’ at the time– no power in THAT position!), and the third said that I was being investigated by the Wisconsin Licensing Board.  I was already in the downside of a significant depression and so the news hit me hard;  I went up to my counselor and explained what I had received, expecting some measure of support, a hug, a ‘poor you’… SOMETHING…. but all she said was ‘yup– consequences suck!’
I felt sorry for myself for a long time… but eventually I was set straight by the treatment team.  I learned that there is little benefit in feeling sorry for one’s self.   I learned that there IS a stigma– a big stigma– against health professionals with addictions… but that there was little benefit in complaining about it.  I learned that mandatory drug testing is a GOOD thing– and the more frequent, the better– because it allows one to regain the trust of others.  I learned that addiction is a ‘protected’ disability, but that from a practical perspective the ‘protections’ are meaningless. I learned that if you eat a Starbucks poppyseed muffin on an empty stomach and then giving a urine sample, the sample will contain about 700 nanograms of morphine- enough to result in a phone call from the board.  And finally, I learned that in the case of any trouble– an argument with a coworker, a car accident, or a bad fall on a slippery surface– the first thing to do is RUN to the lab and drop a urine specimen.

Up until now, licensing boards have all done pretty much the same thing with addicted healthcare workers;  put them in traditional treatment, monitor them, limit their licenses for some period of time, and require aftercare that includes twelve step meetings and group therapy.  But now we have Suboxone… and I have wondered for some time whether licensing boards will see Suboxone treatment as ‘good enough’, or would instead have a ‘double standard’ for the treatment of addiction;  one for the general public, and another for healthcare workers.  And it appears that the ‘double standard’ is where we are headed, at least in the areas of some unfortunate healthcare workers.  Read on:
My doctor is weaning me off Suboxone because I’m getting my RN license back-supposedly.Why do I have to get off Suboxone? Can I practice being an RN while taking Suboxone? Is Vermont the only state that doesn’t allow nurses to practice on Suboxone?He says Oregon’s the only state in the union that allows medical pros to practice and take suboxone,ie;md’s&rn’s
They can take their license and stick it! I’d rather take suboxone,be sane and be in no trouble legally.Can I just tell mt doc to stop the detox and go back up to 1 or 2 a day.My life’s been great the past 5 years and it’;s because of suboxone.I have not taken any drugs-none-and not had one drink of ETOH.I’ve passed all piss tests and Suboxone counts in my blister pack.So,am I being unreasonable? What’s in it for my doctors getting me off suboxone? I think there’s an alterior motive going on.Can I switch to another MD who dispeses suboxone-I mean writes?’ll just go the street route until I find another doctor and that won’t take long-I think.Jesu christ I’m pissed and scared.Suboxone works and I’m a poster boy for the good parts of using suboxone.I know it’s got a bad rap with diversion,but I can honestly say I’ve never sold or bought one pill of subox.Well,I’m gpoing to buy 20 pills tomorrow to get me thru this month.I’ll be traveling around the country-the east coast doing photos for some company(s) and do not want to be stranded strung out.Please respond to my questions ASAP-It would be greatly appreciated.You can see me on the Baltimore Sun’s article(5part) by Doug somebody re; suboxone.My name is Tom Zarvis and there’s two picf mr.
Why do I have to stop taking Suboxone to get my RN license back?Is Oregon the only state that allows nurses and MD’s tp practice while on suboxone?I don’t want to stop because nothing’s gone wrong in my life since going on suboxone.Can I just go to another MD and tell him I’m not a nurse or don’t give a shit about being an RN and stay on the Suboxone forever? Fuck it I’ll go the street route again-it’s just as cheap with the way ins. pays in Vermont-fuck it,I quit.
This is an issue I feel strongly about… but one that I have no control over.  I do have a meeting coming up with a person who is working on a new ‘impaired physician’ program for Wisconsin;  we’ll see what sort of attitudes I run into when I bring up ‘Suboxone’.  I’m not optimistic;  as many people who read this site already know, there is a great deal of ignorance and stigma out there.  I would have absolutely NO problems with a doc on Suboxone treating me;  I can understand how there are patients out there who would not want a ‘doctor/addict’ as a doctor (to each his own), but if you don’t care about the addiction part, you shouldn’t care about the Suboxone part.  People on Suboxone feel NORMAL.  Can Suboxone make a person ‘high’?  Yes!  If it is taken intermittently, or by someone not opiate-tolerant, it has a potent opiate effect.  But to take it intermittently a person would have to take it and then avoid it for a week, experiencing withdrawal the whole time… and then take it again.  There are probably about five people in the world who could pull it off.
To answer the questions… State licensing boards have one mission– to protect the public.  There is no ‘right to practice’ for doctors and nurses, and so there is very little if anything one can do when facing off with the board.  There was no Suboxone issue when I went off to residential treatment in 2001;  had that been an option, and had I been educated about the issue, I would likely have chosen Suboxone.  As I have mentioned several times, I was a slow learner in treatment, and was held for over three months in an ‘open ended’ program where you stay until they decide you are better.  I went through treatment with a number of other nurses, docs, pharmacists, and dentists, and since then many have relapsed.  When one has adopted the medical model of addiction, there is a ‘shift’ in thinking that occurs where suddenly it seems very foolish, taking an illness that is treatable with medication and choosing to make some patients avoid the medication, and instead use mental power alone to keep the illness in remission.
But as I was saying… the best way to approach a medical board in my opinion (providing you aren’t in Texas, where the medical board should probably be indicted) is to just do what they say, and avoid getting an attorney or doing anything else that irritates medical boards.  This is a clear case of ‘picking one’s battles’;  I just do not see a battle being won in that situation.
I had no idea that Oregon was so ‘enlightened’, but good for Oregon!  I will certainly do what I can to work toward change from an educational standpoint as the opportunity arises.  The problem as you all know is that we are seen as ‘unstable people’, and the more angry and pushy we get, the more we make the case for those who don’t think we should be trusted to have a say in our treatment.
If there is anyone out there who has had an experience with a licensing board over Suboxone, please post a comment and let us all know.  As for the RN in Vermont, don’t throw your career away– at least go before the board and speak your case.  Finding a new Suboxone doc won’t be the hard part– it will be convincing the board.  But you never know– maybe they will be enlightened on that particular day.