Drug Testing, Prescribed Opiates, and Employment

Im in a methadone maintenance program and am currently at 130 and I have pre-employment drug screen coming up in about a month. I wanted to see how low I could get off the methandone and switch to suboxone. if it is not detectable in a drug screen. Also, I have a prescription for methadone can they not hire me because a Dr, prescribes methadone.? Any thoughts, ideas?

My thoughts:

There are laws that prevent a person from being fired because of certain illnesses or disabilities, but those laws are complicated. Drug addiction is a ‘protected disability’, so theoretically you cannot be fired for being a RECOVERING drug addict. On the other hand, you can be fired you for any other reason, or for no reason at all! So except for the occasional boss who is a total idiot who says ‘I don’t like recovering addicts so I am firing you’, disability law is not involved.

In general you cannot be fired for having an illness… unless the illness interferes with your job. A surgeon can be fired for being HIV positive, as there are just some risks of transmitting the virus during surgery that cannot be TOTALLY avoided– an accidental needle stick during a frenzied attempt to get a suture around the splenic artery, for example.  I used to be an anesthesiologist and miss those days– in the situation I’m referring to, a person came in with a ruptured spleen from a car accident. The blood pressure was stable, but in such a case the intra-abdominal pressure is often holding the spleen together, and as soon as the belly is opened the spleen will pour blood into the belly and the patient will crash…  so the anesthesiologist gets several large-bore lines in the patient, hangs fluids and blood through blood-warmers, maybe even get an infusion of a pressor set up and at the ready to maintain the pressure as best one can when there is a large hole in the spleen…    I loved that work but like the HIV-positive surgeon, it just was not the place for me anymore.  How could I keep all of my attention on the patients under my care, when there were buckets of opiates right next to me under my control?  I think that on Suboxone I would be OK– I think the cravings would be treated so that they would not be a distraction– but I understand, and accept, that I would never be able to convince an employer of that fact.   Alas…. I miss that job, but I am surprised by how I enjoy being a psychiatrist in a different way, and the enjoyment grows as each year passes and I get to know my patients more and more.    OK, enough about me– back to the letter:  A person on methadone can be fired, regardless of getting it legally for pain or from an addiction program, if the job requires operating heavy machinery– because taking methadone, other opiates, sedatives, etc are simply not compatible with operating machinery. Yes, you might feel fine, and even be fine– but it would be so easy for an injured party to file a lawsuit and win by saying that ‘the company had a person taking these drugs, and it says right here on the bottle not to operate machinery!!’ So you will never win the ‘right’ to work while taking impairing medication.

As for drug tests, first realize that methadone shows up in tests for a LONG time– for weeks in some cases. Whether Suboxone will show up is hard to predict; it sometimes shows up and sometimes doesn’t, depending on the manufacturer of the test. I have many patients who have undergone drug testing, and none have come up as positive, but I have purchased test kits that have shown buprenorphine as positive for ‘opiates’. The problem is that you have to list your meds at the start of the test, and if you hide it and then it does happen to show, you are in trouble.  One solution to that problem is to say you take Suboxone for chronic pain; that you use it because it causes less CNS effects (sedation, etc) and you want to be ‘super sharp for your job!!’. Of course you would need your doctor to verify that when he is called by your company.

If you are switching to Suboxone, do it sooner rather than later– get the methadone out of you as quick as you can. And in MOST cases, the Suboxone that you would take would not show up in any test. It isn’t the number of panels on the testing kit– it is the manufacturer of the kit, and there are many manufacturers. I have kits with many different panel set-ups– the companies will make whatever collection of tests that I ask for. I have kits that detect buprenorphine (suboxone), or OC, or methadone, or whatever. If a company wants to test for buprenorphine they could get a buprenorphine test strip for about 3 bucks. But the companies know that they would be challenged for ‘snooping’ into your personal medical history, rather than searching for active drug abuse– that is the only reason they don’t test for buprenorphine.

Wouldn’t it be nice if addiction was treated like any other illness, and you could explain to your employer that you ‘caught’ opiate dependence when your doctor prescribed high-potency narcotics for your back pain, and that now you are under treatment…  and for that, you weren’t fired?  Maybe some day.

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3 thoughts on “Drug Testing, Prescribed Opiates, and Employment”

  1. Good post. I just thought I’d like to add some things and ask a question to SuboxDox.

    The firt thing I’d like to add is that buprenorphine testing is becoming more and more common in law enforcement \ court programs. This is because people who are being prescribed suboxone in rehabs, half way houses, and even out patient programs often sell their pills to opiate naieve people — who of course can get ripped off of even a tiny bit of an 8mg tab.

    The second thing I’d like to add is that I’ve never heard of it being tested for in an employment situation. Methadone is a different story though…like the Dox says, if the job you’re interviewing for requires you to operate machinery, then I’d say they would DEFINITELY test for Methadone. So it would all depend on the type of employment…

    Lastly I wanted to ask a question to SuboxDox — you mention that the person could say Suboxone was being prescribed for chronic pain…I was under the assumption that no doctor is able to prescribe Suboxone for anything other than Opiate Addiction \ Detox \ Maintenance in the United States. Are you sure about this?

    Maybe you meant just plain old bupe in low doses (like temgesic or whatever it’s called) — now that I could understand being prescribed for CPers..

  2. Any doctor can prescribe Suboxone for chronic pain– there is not even need for the waiver, for that use. Most docs don’t realize this, however. It would be the same as any other ‘off label prescribing’, something that is done all the time and is perfectly legal and professional. Patients don’t realize that ‘fda indication’ does not regulate how doctors prescribe– it is intended to guide the use of medication for certian indications. But when a new use for a med is found, many times no drug company is interested in spending the millions of dollars to get the indication– which by the way is required to advertise or market the drug for such a use.

    There are longstanding laws against prescribing an opiate to treat withdrawal– the waiver is to allow docs to do that. But there is no law or regulation or anythying else– except doctor ignorance— that prevents a doctor from using it for chronic pain.

    As an aside, I do see it used for chronic pain more and more; I am also getting more and more referrals by doctors, asking me to ‘switch their patients to Suboxone’ for their chronic pain.

  3. I know you probably get this all the time suboxdoc, and I apologize for my noobishness. I have a question for you so instead of just asking you here and pretending like my problems are a million times more important than anyone else’s. Can I ask you for a better place to post or contact you with my question? I love the blog and it gives me hope.