Pre-employment drug screening

Will buprenorphine show up in drug tests? Can nurses take Suboxone? Can I do drug court on methadone or buprenorphine? My PO says NO medication-assisted treatments.
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SbySW_1988
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Pre-employment drug screening

Post by SbySW_1988 » Sun Mar 25, 2018 11:25 am

Hello Everyone, first I just want to say that even though this is my first post, I am not new here. I have visited this message board on and off since about 2009 when I first heard of Buprenorphine. Over the years, I feel like I've gotten to know some of you really well, (Amy, Rule, JennJen, etc. and of course Dr. J) even though I've never chimed in on any of the conversation. A quick background... I first started having a problem with opiates about 10 years ago, after getting a bottle of Percocet 5/325 for having my wisdom teeth out. While I only needed about 5 or 6 of them for the post-op pain, I was given a bottle of 30. Being the curious teenager who had experimented with alcohol and marijuana, and knowing that one could "catch a buzz" off Percocet, I decided to try taking a few of the leftover pills at once. I still, 10 years later, have a distinct memory of that evening, lying back in my bed, itching, thinking "damn I wish I could feel like this all the time!". It gave me the feeling of well being and decreased inhibitions of alcohol without all the haziness, loss of coordination, and the hangover. Anyway, it was all downhill from there, as y'all can imagine. Jumping ahead a number of years, I finally got on subs under the care of a physician in summer 2014. My first doctor was not very good but a year later, I switched to a wonderful doctor who I kept all the way through last summer of 2017. I was actually forced to leave her because I lost my job and could no longer afford the visits or the meds. Luckily, over the years, I was able to stockpile enough meds to last me through today. Which brings me to the story/question I would like to post here today.

I recently applied for a job as a technician/apprentice for a medium sized plumbing, electrical, HVAC company here in the Midwest. The interview went really well and they said they would like to hire me pending the results of a background check and drug screening. The background check was no problem, as I was blessed throughout my years of active addiction to avoid legal trouble. The drug screening, as you might imagine, was a little more worrisome. However, the days leading up to the test, my mind was put a little more at ease from what I had read online, including here, saying that most standard pre-employment screenings are simple 5 panel tests for illegal street drugs, or at most, 10 panel tests which still don't screen for bupe. Basically, only highly safety sensitive positions, such as a bus driver, airline pilot, etc. would be tested for bupe. Anyway, fast forward to the day of the test. They had me report to an urgent care doctor's office in my town, so I was relieved that it wasn't the actual employer giving the test. When they brought me back, I immediately said, "out of curiosity, what drugs to y'all test for." The nurse was very nice and immediately pointed to a piece of paper with a list of the substances on the test. I started scanning down the list. So far, so good. Then, I got to the very bottom and my heart sank. Buprenorphine. Shit. While I was reading the list she asked me if I was taking any prescription medications they needed to be aware of. Since I did not have a valid scrip at the time, I said no and proceeded into the bathroom to take the test. I figured I'd just go through with the test and then just wait for the phone call saying I did not get the job because I failed. Now let me say, I was expecting that I was going to give them the urine sample and they would have to send it to a lab, etc. and I would just walk out of the office that day and they wouldn't have the results back for a few days. But much to my surprise, after giving the cup to the nurse, she peeled a sticker off the side and began reading the results. SHIT. I was even more nervous now. I just stood there waiting for the inevitable question. Finally after about 2 minutes she says, "are you sure you don't take any prescription medications?" I say, "Nothing that was on that paper you showed me...why?" She says, "Because you're showing positive for Buprenorphine. Did you take any Buprenorphine recently?" Calmly I replied, "yes m'am, I did take some recently. I did have a prescription for it in the last year but I have not had one recently." She said, "Well honey you did have a prescription for it, right? I'll be here all evening so if you can go home and grab your old bottle and bring it here and show me, you'll be fine." I was amazed. Luckily I did keep some of my old baggies with the pharmacy label on them, including my last one I had filled before leaving my doctor. Furthermore, it was from 9 months ago so it had not expired yet. I ran home, grabbed that and brought it back. I told the nurse that it was the most recent scrip "bottle" I had saved but I pointed out that it did not expire till July 2018. I watched her write down next to where she had wrote "POSITIVE" next to Bupe "Patient has prescription for Buprenorphine" and signed her name next to it. She could not have been nicer and sweeter to deal with, and I thanked her very much and went on my way. She reassured me as I was leaving, "You'll be fine sweetie. Have a good weekend!"

Now, I apologize for the short story, but here is the question I have that some of you with experience may be able to answer for me. First let me say I was surprised that this drug screening tested for bupe, given what I had read. I was also surprised how chill the nurse at the testing facility was about it. I mean on one hand, the scrip from last July was technically legally mine and had not expired yet. I guess I just figured with the way many people treat addicts these days that I would have gotten crap for not having a current valid Suboxone scrip. Now to my question. Will the urgent care center that administered the test report to my employer that I tested positive for Bupe but provided a valid prescription? Or will the they just report "pass" versus "fail". Are there any legal guidelines as to what information they can give to the employer? I signed a couple papers in the doctor's office, and looking back I was stupid not to actually read what I was signing. I guess I just assumed I was signing off that the urine given was actually mine. Scrip or no scrip, I am worried about my employer finding out I am taking Subs. Even if they legally can't not hire me for taking a valid doctor's prescription, I feel like they can and will find a reason not to hire someone deemed a drug addict, given all the recent stigma.

Anyway, I've rambled on long enough. What are y'all's thoughts? Now that I've taken the plunge and posted, I will try and come around here more often. Y'all are awesome and you've helped me over the years more than you know :D

SouthBy

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Re: Pre-employment drug screening

Post by jennjenn » Sun Mar 25, 2018 1:13 pm

That is a very good question! Will they just say u passed the screen or will they say u passed with a prescription for buprenorphine..... hopefully someone will know the answer to this. U definitely got a cool person that did ur test!

I posted on ur Introduction thread, but was curious about the answer to ur question also. I hope u get the job! Keep us updated :)
Jennifer

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Re: Pre-employment drug screening

Post by Amy-Work In Progress » Sun Mar 25, 2018 2:02 pm

I am honestly not sure. I believe when you said ok to being tested, they are allowed all of the information.

Now the nurse that was so nice at the urgent care place... If they send all of the prospective employees there, she probably does have a good idea of what this company accepts and doesn't accept. If she is saying, you'll be just fine, she may know that based on previous prospective employees who were hired.

I also want to remind you that addiction is considered to be a disorder that falls under the umbrella of the Americans with Disabilities Act. (ADA) There is now legal precedent that people on buprenorphine cannot be passed over for hiring because they are on buprenorphine. Volvo just settled with the EEOC in the workers favor and they were given a job at Volvo.

My thought is that because of the ADA, employers will be getting the message that they can't avoid hiring those of us with a prescription for buprenorphine products, which, as far as they know, you have! Keep us posted!

We're so glad that you are here posting! Nice to finally meet you! :)

Amy
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SbySW_1988
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Re: Pre-employment drug screening

Post by SbySW_1988 » Mon Mar 26, 2018 8:01 am

Thanks for the responses. I should find out the results this week, and whether or not I got the job so I will let you know. That Volvo case is interesting. I wonder if there comes a point where safety is sensitive (e.g. an airline pilot) where an employer can say no mind altering substances, prescription or not. And how specific substances are chosen, and how that fits in with the ADA.

Also, does it surprise anyone that Bupe was on a pre-employment drug test for an entry level job in the trades? I'm just curious since all the info I seemed to find online said that it would not be.

Cheers,

SouthBy

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Re: Pre-employment drug screening

Post by suboxdoc » Mon Mar 26, 2018 5:56 pm

A great post with all sorts of interesting things to think about....

Last first, the ADA issues are nullified if the addiction-related illness directly interferes with the ability to do the job. So airline pilots are held to different 'disability standards' than, say, bankers. In the same way, a hospital or healthcare company COULD refuse to hire an anesthesiologist with a history of drug addiction, and a bank COULD refuse to hire a person diagnosed with gambling addiction.

I use the 15-panel cup in my office regularly. It has buprenorphine, other opioids, methamphetamine, cocaine, amphetamine, benzos, THC... crazy what you can test for, for about 5 bucks. The test is based on antibodies that recognize certain molecules, and they are 95% accurate. Some docs instead opt for the $1000 test, which is mass spectroscopy and 100% accurate. THOSE decisions are the basis for high healthcare costs!

The nurse signs off on the test and the form you filled out. Next, the nurse sends that info to the medical review officer, who may or may not be paying any attention. If that person is overworked and lazy, he/she may just sign every single thing that lands on the desk, in which case the employer will get a test that essentially is rubber-stamped 'passed'. If the MRO is actually thinking, then he/she might think 'hmmm' and look a little deeper. But if the nurse documented that you disclosed the prescription, then the story ends there, and you won't have any problem.

Except... every state now has a 'PDMP'-- prescription drug database--- where we can see every controlled substance prescription for our patients. This may or may not be an issue... you are not a 'patient' of that MRO, so he/she would not have the right to look you up, at least in Wisconsin.

If they COULD look you up, my concern would be that your prescription is too old to be valid. You said the script expires June of 2018 I think? The expiration is a year after the script is dispensed, so if that was your last bottle, your last script was in June of 2017. An astute MRO might notice that the script is too old to be considered valid (we all assume buprenorphine is written at most monthly).

Along the same line, I wonder if the form used by the nurse has a space where she writes the date that the script expires? Probably not.

All things considered, I suspect you're OK, assuming you're not applying to be an airline pilot! Let us know...

You had a good nurse-- someone who understands the complexity of trying to move beyond a problem, and chose to lend a hand.

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Re: Pre-employment drug screening

Post by SbySW_1988 » Tue Mar 27, 2018 4:25 pm

Dr. J, Thanks for your reply! My gut feeling was going with a lot of the things you confirmed, but the anxious mind that so many of us here deal with often wanders quickly to the worst case scenario. It actually seems like a smart decision for the company to opt for the $5 test over the $1k one, as they can test for far more substances for a fraction of the price. I learned early on from hanging around and reading this message board the differences (or lack thereof) between the expensive lab tests that show "levels" and the simple test for the presence of the substance. And early on in treatment, when I was calling around looking for a doctor, if anyone told me on the phone they used the expensive lab test, I would move on to the next one.

I have a couple lingering questions though that I hope you can clarify. First of all, does every test like the one I took go through a MRO? And I am assuming said MRO works for the urgent care office where I took the test? I do believe I read something about larger companies, such as trucking agencies having their own company MRO but I would not think that a smaller local contractor would have one on their payroll. Second, you say that in this case, having provided my prescription to the nurse who signed off on it, the employer will get a test rubber stamped "Passed". Do you know if there is a law preventing the office from sharing the details of the test with my employer, or is it just standard practice to give a "passed" vs "fail". I realize there are HIPPA laws protecting medical information, but as I stated in my initial post, the only reason I am worried about this is because I did sign a paper before giving the test which I did not read carefully, and I am worried I signed away my HIPPA rights for that particular test. I still have not heard back about the job, so I am obviously a little worried. Nonetheless, I will keep y'all posted.

To answer your question, I watched what the nurse wrote down and I'm 99% certain she did not write down a date. She basically wrote "patient has bupe scrip" and signed her name. I do realize that I am not quite doing things "by the book", if you will, by stockpiling meds and not currently taking them under a doctor's care. But to me, what I am doing is better than having to go off my meds and risk slipping back into active addiction due to being laid off from work. Now that I have the training to get this job, or hopefully another one like it, I plan to get back with my old doctor for at least another year and will talk with her about tapering if/when I am ready.

Thanks again for the response!

SouthBy

PS- No I am not applying to be an airline pilot... it is an entry level job with a medium sized, locally owned Plumbing/Electrical/HVAC company in the Midwest.

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Re: Pre-employment drug screening

Post by Amy-Work In Progress » Thu Mar 29, 2018 10:45 pm

I thought you just might be involved in a new Hitchcock movie! :wink:

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Re: Pre-employment drug screening

Post by SbySW_1988 » Mon Apr 02, 2018 9:37 am

Hey everyone- just wanted to come back with an update. Good news, but not what I was expecting or what everyone seemed to think. First off, I was just offered the job today! However, the HR lady who called me had the full results of the test in front of her, and questioned me about them. It was not rubber stamped PASS/FAIL which surprised me. Luckily she did not question me too hard about it, and I gave an equally vague response and it was left at that. She said something along the lines of "we noticed you tested for some kind of opioid, is this something you are on long term?" I just responded saying, "No I do not plan on taking it long term and if you need my doctor to write a letter saying I am clear to work right now I can certainly do that." and that seemed to put the issue to rest. I was happy- but just surprised they were given the details of the test.

Anyway, I'd like to get anyone's take on this, if they have had any similar experiences and if the doctor's office was in violation of the law sharing this information. Perhaps they were not very pushy with their questioning because they knew if would be illegal to discriminate against someone on meds, and just wanted to make sure I was going to be safe operating machinery.

Hope everyone's week is off to a good start!

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Re: Pre-employment drug screening

Post by Amy-Work In Progress » Mon Apr 02, 2018 11:28 am

Congratulations on getting the job!!! I'm glad it worked out!

I'm afraid I'm dating myself regarding the reference to Alfred Hitchcock. Your user name, SbySW made me think of Hitchcock's classic movie, North by Northwest.

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Re: Pre-employment drug screening

Post by jennjenn » Tue Apr 03, 2018 8:32 am

Congratulations on the job!! I’m so glad to hear that everything worked out with the test results and everyone seemed to be understanding and not too judgy. It’s good to hear a positive outcome!
Jennifer

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