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Dr. Bob is Robert Hsiung, MD,
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Posted by rxnurse on December 9, 2003, at 1:56:01
In reply to Re: What happens in treatment center, posted by panic_attack on December 7, 2003, at 9:13:20
Mandybella:
I just read about your situation, and may have some useful info for you. Depending on what state you live and work in, you may be able to enter a diversion program set up by the state Board of Registered Nursing. They can help you find dignified treatment and detox facility and help you keep your job and license at the same time. The good thing about the program is that it is 100% confidential. No one would know except the Board and you! You would need to take a leave of absence from your job, for medical reasons. You are not required to tell your employer anything about your personal situation. You will need your doctor to write a letter verifying your medical leave, without any details why, and also use that letter to collect disability payments while you are not working. All the doctor's note has to say in order to collect disability from the state is that you are off work because of depression or whatever. You are not required to say it's for addiction treatment. With professional help, you can find appropriate in-patient treatment centers and pay with insurance or payment plans. Usually the state funded public facilities are scary, private facilities tend to be cleaner and better staffed. Do what's best for you to get help before someone at work finds out and sends a complaint to the Board of Registered Nursing about your problem. If that happens, you may lose your license or be suspended from practice. I'm an RN as well, and I know how stressful working is! Take care of the situation before it goes completely out of control, you deserve it!
Posted by KimberlyDi on December 9, 2003, at 17:06:28
In reply to What happens in treatment center, posted by Mandybella on December 5, 2003, at 16:20:34
Mandybella:
A treatment center will taper you off the ambien, safely, while pushing you to attend group therapy to learn coping methods besides drugs or alcohol. There's a program for nurses that I'm surprised that you don't know about. It's very strict and you have to attend meetings afterwards but it will save your job if you save yourself first.
Good Luck. I met some wonderful nurses in treatment. On both sides of the clipboard.
KDi in TX
> I have a major addiction to ambien. I take 20-30 a night--that is pills, not mg. I keep trying to taper but nothing works. Of course, I have blackout periods when I remember nothing, and my husband knows but says very little. I know I need to to into treatment, but what do I tell my job. I am a nurse and I cannot afford to lose my job. I do not take the drugs from work. I get them over the internet. If I went into a treatment center, could I have a private room or do I have to give up all my rights and possessions? I was in psych once because of major depressiion and overdose attempt and I could not even keep my dental floss. I just do not know what to do, but I know I cannot keep on the way I am going. Thanks
Posted by KimberlyDi on December 9, 2003, at 17:11:27
In reply to Re: What happens in treatment center, posted by rxnurse on December 9, 2003, at 1:56:01
Excellent advice RxNurse. :)
> Mandybella:
> I just read about your situation, and may have some useful info for you. Depending on what state you live and work in, you may be able to enter a diversion program set up by the state Board of Registered Nursing. They can help you find dignified treatment and detox facility and help you keep your job and license at the same time. The good thing about the program is that it is 100% confidential. No one would know except the Board and you! You would need to take a leave of absence from your job, for medical reasons. You are not required to tell your employer anything about your personal situation. You will need your doctor to write a letter verifying your medical leave, without any details why, and also use that letter to collect disability payments while you are not working. All the doctor's note has to say in order to collect disability from the state is that you are off work because of depression or whatever. You are not required to say it's for addiction treatment. With professional help, you can find appropriate in-patient treatment centers and pay with insurance or payment plans. Usually the state funded public facilities are scary, private facilities tend to be cleaner and better staffed. Do what's best for you to get help before someone at work finds out and sends a complaint to the Board of Registered Nursing about your problem. If that happens, you may lose your license or be suspended from practice. I'm an RN as well, and I know how stressful working is! Take care of the situation before it goes completely out of control, you deserve it!
Posted by rxnurse on December 9, 2003, at 21:40:50
In reply to What happens in treatment center-Great Post! » rxnurse, posted by KimberlyDi on December 9, 2003, at 17:11:27
Thanks KimberlyDi!
I live in California and here we have a pretty solid diversion program with a high success rate. Being an RN is super stressful, and we often forget to take care of ourselves because we are so busy caring for others! I too suffer from major depression and recently had to quit a good job because I was not taking care of myself mentally nor physically.
Most of the nurses I know who have entered the diversion program were addicted to heavy narcs like Demerol or Fentanyl, which they were taking from their place of work. I have never heard of anyone having such a high tolerance nor abusing Ambien. Seems as though doctors were pushing it because it had a lower abuse potential and was safer altogether than barbiturates and benzos for a sleeping aid. Are you getting the Ambien from a physician, or an online pharmacy? If you could safely detox from it, maybe you could re-evaluate your personal situation and attack it with a clear mind? It's impossible to solve problems when you are under the influence, let alone struggling with life altogether. There are lots of resources available online about nurses or any medical professionals and chemical dependency/mental illness. There are special forums and chat rooms just for nurses to share their problems and get advice from someone who can relate. Try going to Google.com and search nurses in diversion or chemical dependency and nursing. You really need peer support right now, and it is available!
Take care of YOU!!!!!!!
Posted by bsj on December 9, 2003, at 22:28:07
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 9, 2003, at 21:40:50
"Most of the nurses I know who have entered the diversion program were addicted to heavy narcs like Demerol or Fentanyl"
Just a comment on Demerol:
I went to the ER once in excrutiating agony from a kidney stone; they gave me a Demerol injection and sent me home with a script for it. I don't remember the entire week following. I couldn't imagine anyone being able to work on Demerol; I sure couldn't. That's some seriously mind-warping stuff.
Posted by rxnurse on December 10, 2003, at 0:24:27
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 9, 2003, at 22:28:07
No kidding! We don't even give it anymore in the ER because people were coming in asking for it, straight up! One nurse I know was injecting up to 200mg, at work. That is A LOT of Demerol, not to mention a usual dose is 12.5 or 25mg intramuscularlly. Also, Demerol can cause a severe, life threatening reaction because of it's neurotoxic metabolite, normeperidine. Substance abuse among health care professionals is serious and quite scary. It's a really stressful job to take care of others all the time, but using strong drugs at worse is really scary.
Posted by bsj on December 10, 2003, at 4:21:24
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 10, 2003, at 0:24:27
"No kidding! We don't even give it anymore in the ER because people were coming in asking for it, straight up!"
That's funny. You have to wonder where these people come from.
I've experienced a good many opiates, but none ever had anywhere near the effect of Demerol. I can't even say it felt good--I don't remember; it was complete oblivion.
"Substance abuse among health care professionals is serious and quite scary. It's a really stressful job to take care of others all the time, but using strong drugs at worse is really scary."
I keep wondering how they could get away with it for any length of time. AFAIK, CII stuff has to be ridigly accounted for, and you think they'd install cameras in drug storerooms.
Posted by krazybirdlady on December 10, 2003, at 9:46:51
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 10, 2003, at 0:24:27
wow, rxnurse...i too have to wonder how even health care professionals can get away with this for any extended period of time? and obviously it must go on for quite some time to get to doses that high, as well as manage to function through it. these drugs must be accounted for somehow, right? or are there ways around it? i know that in a pharmacy it could theoretically be done, maybe for a short time...but not for long. are hospitals so swamped with work that this can go unnoticed? especially drugs like that, and injecting them to boot....such a stressful career you guys have, i know. no wonder they have programs set up, and i'm glad to hear that. not sure if we have any help like that here in Canada. i sure hope so...
Posted by bsj on December 10, 2003, at 11:17:59
In reply to Re: What happens in treatment center-Great Post!, posted by krazybirdlady on December 10, 2003, at 9:46:51
"and obviously it must go on for quite some time to get to doses that high, as well as manage to function through it"
It would take about a year of pretty constant use to build a tolerance so massive that you could slam 200mg of Demerol and survive. That's amazing.
Posted by krazybirdlady on December 10, 2003, at 11:28:56
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 11:17:59
that's scary...once several years ago, iwent to the ER for a particularly agonizing migraine. as a last resort (after other meds did nothing), i agreed to an injection of demerol. slept for the next 19 hrs. had to call in sick to work the next day as i simply souldn't stay awake. can't imagine anyone coming back for more of this....
Posted by bsj on December 10, 2003, at 11:55:38
In reply to Re: What happens in treatment center-Great Post!, posted by krazybirdlady on December 10, 2003, at 11:28:56
When I had the kidney stone, they tried hydrocodone first and it didn't do a thing. Another time, several years later, when I took an arrow in the calf, they gave me morphine; I could function on it fairly well. Supposedly, morphine and Demerol are roughly equipotent; but that's not been my experience. Demerol has far profounder effects than morphine--it produces far more sedation, not to mention swiss-cheesing your memory.
(Early lit on hydrocodone suggested it was also equipotent with morphine, but that's not quite so. I think the current lore is that 15mg morphine and 20mg of hydro are equivalent. That may be so where pain relief is concerned, but
morphine clouds my mind in a way that hydro doesn't.)
Posted by Mandybella on December 10, 2003, at 12:26:46
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 11:55:38
Apppreciate all the input. With the holiidays and all, I am afraid to take the steps to do something about this and I guess I am also afraid to give up my crutch. I get the drugs over the internet, surprisingly easy, but have been spending a fortune. I want to taper down, but every time I think I may be getting better, I take a whole handful again. When you have had long term sleep problems like I have, having a drug that really sedates you is so hard to give up
And I guess I would like to check into some nice hotel like place and have the thing all over. Guess that is not going to happen
Posted by bsj on December 10, 2003, at 12:46:50
In reply to Re: What happens in treatment center-, posted by Mandybella on December 10, 2003, at 12:26:46
"I get the drugs over the internet, surprisingly easy, but have been spending a fortune."
Unfortunately, the DEA has been cracking down on controlled stuff on the net. I only know of two places that still sell hydrocodone; though Ambien may be easier to get. I had to fax a photo ID and medical records to get what I wanted.
Posted by krazybirdlady on December 10, 2003, at 13:41:48
In reply to Re: What happens in treatment center-, posted by Mandybella on December 10, 2003, at 12:26:46
i can certainly imagine what you are paying out to support your use. also you are setting youself up to be seized by customs. no money, no ambien...i understand what insomnia is like, but 30 pills? please let yourself be helped, as i am sure you are living through hell with this. please check into rxnurse's advice...i know for a fact you are not alone...
Posted by krazybirdlady on December 10, 2003, at 13:55:06
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 11:55:38
"the current lore is that 15mg morphine and 20mg of hydro are equivalent." Lore is the perfect word...those equivilancy charts are very deceiving. actually downright garbage, if you ask me. you really won't know how any narcotic will affect you until you actually try it. i have seen people get violently ill on codiene, but tolerate oxycodone just fine. i do know that morphine and demerol can effect you very differently in terms of sedation, pain control, nausea, etc...each person is an individual with individual brain chemistry, hence, the lowest dose rule applies...
Posted by bsj on December 10, 2003, at 14:19:39
In reply to Re: What happens in treatment center-, posted by Mandybella on December 10, 2003, at 12:26:46
"And I guess I would like to check into some nice hotel like place and have the thing all over. Guess that is not going to happen"
If you got the cash, you can find rehabs that treat you like royalty. But ordinary rehab places are pitiful. Supposedly the lot of them subscribe to the addiction-as-disease paradigm, but they treat patients like criminals; it's like a doctor standing over someone in the midst of a heart-attack, chiding the victim for all the fried food he ate.
If you want to avoid rehab, take a few weeks off work and get your husband to help you. Let him control your Ambien supply. If you could get yourself down to 5 or so pills a night that would be a success. You could probably live with that for a while, then concentrate on finding other ways to deal with the insomnia.
Posted by rxnurse on December 10, 2003, at 14:24:46
In reply to Re: What happens in treatment center-Great Post!, posted by krazybirdlady on December 10, 2003, at 13:55:06
Where I was working, all of the drugs including the narcs were dispensed through an ATM-like device called a Pixus. All you have to have is an access code, finger print, patient's name, and what meds you needed. So, nurses could enter false patient names or ones that have been transported to other units or even discharged. If there was any error at all when trying to get a narc out of the Pixus, it sends an alert message to the ER manager's computer and she comes looking for you for an explanation! Everything dispensed by the Pixus is on a database. On other floors the old fashioned narc log book is used which is easier to cheat because it gets passed around the floor and there are margins for error. My friend who used Demerol was mainlining it every day at work in the bathroom. She was never caught, officially. I can'not imagine being loaded at work, much less injecting myself with a needle! I have heard that Demerol in particular, is the most euphoric narcotic. It is a totally synthetic narcotic, and only used now for severe pain or for those who can't tolerate opiates. The major problem with Demerol is it's neurotoxic metabolite, which builds up in the liver. Other nurses choose Fentanyl, which is an opiate usually used during sugery. They say it produces a very pleasant high with some amnesiac effects. I guess anesthesiologists prefer Fentanyl as well. The whole thing is really very sad, for the professions as a whole. We are taught in school to give all to our profession and patients. I didn't learn a thing in school about how to take care of myself mentally nor physically when a work related crisis arose. Nurses in California are grossly overworked and underpaid. What happens when we all get sick from too much work and stress????? This is what's happening to Mandybella. Nothing is more important than your personal well-being and overall health! You can not take care of others if you are suffering. Your work must be somehow affected by the Ambien, someone is going to find out. Do not jeopardize your well-being, please seek professional help. There are lots of superb doctors, nurses and other professionals out there with your same problem. If they can do it, so can you!
Posted by krazybirdlady on December 10, 2003, at 15:02:34
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 10, 2003, at 14:24:46
wow, rxnurse..i am amazed that somebody could beat the system to that degree. i know that Dr.s and especially nurses are very overworked and stressed here in canada, much because of government cutbacks to our public healthcare system. but i can only guess as to the drug availability problem. my sympathies to those who succumb to the pressures. i can only imagine what it's like...
Posted by krazybirdlady on December 10, 2003, at 15:18:31
In reply to Re: What happens in treatment center-Great Post!, posted by krazybirdlady on December 10, 2003, at 15:02:34
i am at a loss to describe to you what withdrawl or even tapering from ambien (called imovane in canada) is like as i personally have never seen it. i do know that it was once tauted as a relatively non-addictive drug, and that classification has now been changed. but from personal experience, most people who have taken it either complained that it doesn't work and stopped it, or managed quite nicely on their dose. i have never heard of anyone increasing it to the levels that you have. i guess most folks just give up and go back to good ol' benzos. please take rxnurse's advice and seek out the resources that are available to you. i think you already know that it won't be no hotel. no drinks by the pool. but it can be your lifesaver. i shudder to think of what might happen if customs cut you off cold turkey...
Posted by bsj on December 10, 2003, at 15:35:56
In reply to to Mandybella..., posted by krazybirdlady on December 10, 2003, at 15:18:31
It's said that Ambien is related to benzos; so I'd assume the withdrawal would be comparable. But a site on Ambien addiction lists these symptoms:
Abnormal extroversion or aggressive behavior
Loss of personal identity
Confusion
Strange behavior
Agitation
Hallucinations
Worsening of depression
Suicidal thoughts
Insomnia
Anxiety
Posted by rxnurse on December 10, 2003, at 15:59:54
In reply to Re: to Mandybella..., posted by bsj on December 10, 2003, at 15:35:56
Nothing on that list sounds like fun.
I have taken diphenhydramine or Benadryl for occasional insomnia. It worked well for me, and did not leave me with a hangover in the morning like benzo's do. However, the problem is what is causing the marked insomnia. Usually, this is caused by anxiety, depression or CNS diseases/dysfunctions. Also, once one weans off sleeping meds, many times your brain has to learn sleeping cycles again becaused they have been inactivated by the drugs for so long. Also, many of the old tricyclic antidepressants taken at night will help you sleep soundly.
Posted by krazybirdlady on December 10, 2003, at 16:17:13
In reply to Re: to Mandybella..., posted by bsj on December 10, 2003, at 15:35:56
hmmmm, no real physical withdrawl symptoms listed? not to say that the rest weren't nasty, but i really don't believe that at that dose you wouldn't have the major physical withdrawls..i.e. muscle spasms, vomiting, convulsions...etc...that is to say if you come off cold turkey...must investigate this..
Posted by krazybirdlady on December 10, 2003, at 16:21:07
In reply to Re: to Mandybella..., posted by rxnurse on December 10, 2003, at 15:59:54
> Nothing on that list sounds like fun.
> I have taken diphenhydramine or Benadryl for occasional insomnia. It worked well for me, and did not leave me with a hangover in the morning like benzo's do. However, the problem is what is causing the marked insomnia. Usually, this is caused by anxiety, depression or CNS diseases/dysfunctions. Also, once one weans off sleeping meds, many times your brain has to learn sleeping cycles again becaused they have been inactivated by the drugs for so long. Also, many of the old tricyclic antidepressants taken at night will help you sleep soundly.yes, but not after benzos...tricyclic antidepressants will work for people not aquianted with benzos, but if you are, they don't seem to have any effect at all for sleep. don't know about after ambien though...
Posted by bsj on December 10, 2003, at 17:19:22
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 10, 2003, at 14:24:46
rxnurse:
There's something that happened to me with the Demerol that I've never been able to explain. After making me give up my breakfast, it caused 15-20 minutes of tachycardia--120bpm or so. This has never happened with any other opiate. Could this be some kind of rebound tachycardia from the CNS depression?
Posted by krazybirdlady on December 10, 2003, at 17:41:57
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 17:19:22
when you say "give up your breakfast", do you mean you vomited? the palpitations occured after that? this is not uncommon. adverse reactions to narcotics can cause nausea and an increase in BP and palpitations. true tachycardia is when the heartrate keeps increasing...upwards of 200bpm. then medication is required to slow it. did you receive any medication or did your heartrate decrease on its own? this would be a reaction to the demerol...
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