Found Nanny’s Buprenorphine and Naloxone Film
June 1, 2023 5:31 AM Subscribe
We love our nanny. She’s been with us for a year and she’s wonderful. Recently I came home to find an unused packet of Buprenorphine and Naloxone film. Internet research tells me that this is treatment for opioid abuse. What do we do?
I am positive the answer is talk to her, but I’m not even sure where to start. This is a zero judgment zone, I have family members and friends who have struggled with opioid addiction and the last thing I want to do is make her feel like she has done something wrong. If she is getting treatment, that is good. However, I have some concerns that this addiction could have been happening while she was taking care of the kiddos. How long do you take something like this? I’m mainly struggling between truly caring for her and wanting the best for her while being genuinely freaked out about the future of my children’s care.
What do I even ask? Maybe a lot of it isn’t my business. But what is? What would you do?
I am positive the answer is talk to her, but I’m not even sure where to start. This is a zero judgment zone, I have family members and friends who have struggled with opioid addiction and the last thing I want to do is make her feel like she has done something wrong. If she is getting treatment, that is good. However, I have some concerns that this addiction could have been happening while she was taking care of the kiddos. How long do you take something like this? I’m mainly struggling between truly caring for her and wanting the best for her while being genuinely freaked out about the future of my children’s care.
What do I even ask? Maybe a lot of it isn’t my business. But what is? What would you do?
FWIW buprenorphine is also used to treat chronic pain, not just opioid dependence.
posted by fox problems at 5:51 AM on June 1, 2023 [14 favorites]
posted by fox problems at 5:51 AM on June 1, 2023 [14 favorites]
This is a zero judgment zone
Then don’t judge her. You don’t mention anything like “Oh, this casts [previous incident] in a whole new light…”, so I assume there’s no other reason you have to suspect that she’s anything but the wonderful nanny you’ve happily employed for a year.
Forget you saw it. It’s none of your business if she’s providing you the service for which you’re paying her.
posted by Etrigan at 5:55 AM on June 1, 2023 [10 favorites]
Then don’t judge her. You don’t mention anything like “Oh, this casts [previous incident] in a whole new light…”, so I assume there’s no other reason you have to suspect that she’s anything but the wonderful nanny you’ve happily employed for a year.
Forget you saw it. It’s none of your business if she’s providing you the service for which you’re paying her.
posted by Etrigan at 5:55 AM on June 1, 2023 [10 favorites]
If it's a prescribed medication, as a parent of four, I'd say it was none of my business except, as staggernation mentioned, as something that might pose a risk to the kids, so if I found it in a place where they might have been the ones to stumble upon it, I would give it back and say something like, "I found this on the _______. Thought you might need it. Please be careful not to leave things like this where the kids might find it."
posted by Well I never at 6:30 AM on June 1, 2023 [25 favorites]
posted by Well I never at 6:30 AM on June 1, 2023 [25 favorites]
This medication can be used for years, so you can't assume she was abusing opioids while working for you. In fact, it is more likely that, after struggling with opioid abuse, she got into treatment and started getting her life together, including getting a job which she has been able to do competently for the last year. So support her treatment by addressing ONLY the safety concerns related to leaving medication out where kids can get to it. Otherwise, MYOB unless she offers to share more about her recovery journey. This is what zero judgment behavior looks like.
posted by eleslie at 6:46 AM on June 1, 2023 [15 favorites]
posted by eleslie at 6:46 AM on June 1, 2023 [15 favorites]
Given that relapse rates are quite high for opioid addicts in treatment, I would have real concerns about this person continuing to care for my kids. This isn't really a matter of judgement, more about protecting your children from known safety risks. I'm not exactly sure what I would do in your situation, but I think close, careful monitoring is certainly warranted.
posted by alex1965 at 6:51 AM on June 1, 2023 [3 favorites]
posted by alex1965 at 6:51 AM on June 1, 2023 [3 favorites]
You found your nanny Medication Assisted Treatment(MAT) for opiod abuse, which means all you know is that she likely has a history of substance abuse and was responsible enough to seek treatment for it. MAT can be taken forever after abuse. It is the most effective way to treat opiod abuse. Just so you know as you seem like you do not know alot about this topic, these medications can't really get you high in the same way that opiods do and their goals are to prevent cravings that cause relaspe.
That's all you know.
Do you have concerns about this person's behavior otherwise? Have they been a great nanny? If so, Then the answer is call tell her that you have the medication, remind her to not leave meds out bc that could be very very very bad and maybe ask how she's doing in a genuine way.
Please talk to her immediately bc these meds are given in limited quantities and she likely needs it!
posted by AlexiaSky at 6:51 AM on June 1, 2023 [11 favorites]
That's all you know.
Do you have concerns about this person's behavior otherwise? Have they been a great nanny? If so, Then the answer is call tell her that you have the medication, remind her to not leave meds out bc that could be very very very bad and maybe ask how she's doing in a genuine way.
Please talk to her immediately bc these meds are given in limited quantities and she likely needs it!
posted by AlexiaSky at 6:51 AM on June 1, 2023 [11 favorites]
Leaving it out to be found by children is a problem you can and should address. One thing you could do is provide a secure place to keep her things.
Having/taking this medication is not really something you get to decide is a problem. You don't get to know why they need medicated management of opioid withdrawal, and certainly should not go directly to assuming the worst case scenario. Why would you, even? If you are this horrified at the thought of your nanny at some point undergoing and then discontinuing (according to normal medical protocols) pain management while working for you, what other conditions are they not allowed to treat or stop treating? ADHD? Depression? Diabetes? Did you clarify any of that pre-employment?
Pain management patients are so thoroughly shamed and abused by the same people who are supposed to be helping them, there's probably not much you can do to make it worse, but try not to. Pretty much everyone you've ever known who's had serious surgery, or serious cancer, has probably had to navigate (or choose not to) some level of opioid dependence and you don't know about it because it's been so weaponized, when opioids are often the ONLY way to literally not torture someone. It's a pretty shitty treatment with really unpleasant consequences, but it's (mostly) all we've got.
There are a lot of doctors who are inappropriately prescribing Suboxone, as well, or not really following the indicated timelines because inventing reasons for patients to come back over and over for refills and office visit fees is pretty lucrative, so it's even possible that your nanny thinks they are following best practice for post-treatment withdrawal management even years after the original treatment. But even that is not your business; you only know about this because of an accident that created a privacy violation.
posted by Lyn Never at 6:56 AM on June 1, 2023 [14 favorites]
Having/taking this medication is not really something you get to decide is a problem. You don't get to know why they need medicated management of opioid withdrawal, and certainly should not go directly to assuming the worst case scenario. Why would you, even? If you are this horrified at the thought of your nanny at some point undergoing and then discontinuing (according to normal medical protocols) pain management while working for you, what other conditions are they not allowed to treat or stop treating? ADHD? Depression? Diabetes? Did you clarify any of that pre-employment?
Pain management patients are so thoroughly shamed and abused by the same people who are supposed to be helping them, there's probably not much you can do to make it worse, but try not to. Pretty much everyone you've ever known who's had serious surgery, or serious cancer, has probably had to navigate (or choose not to) some level of opioid dependence and you don't know about it because it's been so weaponized, when opioids are often the ONLY way to literally not torture someone. It's a pretty shitty treatment with really unpleasant consequences, but it's (mostly) all we've got.
There are a lot of doctors who are inappropriately prescribing Suboxone, as well, or not really following the indicated timelines because inventing reasons for patients to come back over and over for refills and office visit fees is pretty lucrative, so it's even possible that your nanny thinks they are following best practice for post-treatment withdrawal management even years after the original treatment. But even that is not your business; you only know about this because of an accident that created a privacy violation.
posted by Lyn Never at 6:56 AM on June 1, 2023 [14 favorites]
Hey. I want to say that while I agree with the substance of the comments above, they feel a bit judgemental of you in a way that I don't understand. You seem to have respect and regard for your childcare provider, and I think your reaction of concern about your kids is a fair one and you have nothing to beat yourself up over. It is a lapse in judgement to leave medication lying around. Indeed, if it had been a dangerous or controlled medication unconnected with potential previous issues with addiction, you would still have grounds to be concerned and want to have a conversation. Kids put things in their mouths. Accidental poisoning is a serious issue with young children. A conversation is indeed reasonable (and can and should be unconnected with why the medication might be in use.) Your nanny has a right to her privacy and you have a right to want to clarify and discuss issues that might relate to the safety and well being of your kids. It seems like both of these things can coexist.
posted by jeszac at 7:15 AM on June 1, 2023 [34 favorites]
posted by jeszac at 7:15 AM on June 1, 2023 [34 favorites]
Yes, handle this as a "your medical treatment and medications are none of my business, but please don't leave any medication out where my children can access it" issue. If she needs more secure storage for her medication or anything else while she's at your place, offer that to her.
posted by Stacey at 7:20 AM on June 1, 2023 [17 favorites]
posted by Stacey at 7:20 AM on June 1, 2023 [17 favorites]
We love our nanny. She’s been with us for a year and she’s wonderful.
when I was in my late teens and overall doing pretty good in life etc (good grades, no arrests etc) I happened to foolishly leave a bag of marijuana on the kitchen counter one night (I must've been stoned or something). This was maybe 1978 so a time when DRUGS were still considered deadly-dangerous-THE-ENEMY.
Fortunately, it was my mom who found the bag. And unlike my dad, she had a somewhat nuanced take on marijuana (ie: she'd read enough to know it wasn't the DEMON WEED the mainstream was painting it as). So rather than go punitive or even stern, she just said, "I think you misplaced something," and she showed me the bag, following with, "I trust you, I'm proud of you ... but that was pretty stupid. If that's what marijuana does to your brain, maybe you shouldn't be messing with it. But I can't make that decision for you." And then she handed me the bag.
I learned my lesson. I never left a bag of marijuana in the kitchen (or any other obvious place) ever again.
posted by philip-random at 9:11 AM on June 1, 2023 [5 favorites]
when I was in my late teens and overall doing pretty good in life etc (good grades, no arrests etc) I happened to foolishly leave a bag of marijuana on the kitchen counter one night (I must've been stoned or something). This was maybe 1978 so a time when DRUGS were still considered deadly-dangerous-THE-ENEMY.
Fortunately, it was my mom who found the bag. And unlike my dad, she had a somewhat nuanced take on marijuana (ie: she'd read enough to know it wasn't the DEMON WEED the mainstream was painting it as). So rather than go punitive or even stern, she just said, "I think you misplaced something," and she showed me the bag, following with, "I trust you, I'm proud of you ... but that was pretty stupid. If that's what marijuana does to your brain, maybe you shouldn't be messing with it. But I can't make that decision for you." And then she handed me the bag.
I learned my lesson. I never left a bag of marijuana in the kitchen (or any other obvious place) ever again.
posted by philip-random at 9:11 AM on June 1, 2023 [5 favorites]
Maybe it's not the most politically correct answer, but yes I do think it's okay to ask your children's caregiver if they're in treatment for opioid addiction and what the timeline is there, especially if they're leaving their meds around where the children can find it. Let's not pretend that opioid addiction is the same disease as diabetes or ADHD. She is responsible for the wellbeing of your children, of course you're going to ask her about it.
As for how to have the conversation, I like the way you started here: "I’m not even sure where to start. This is a zero judgment zone, I have family members and friends who have struggled with opioid addiction [...]". I prefer to give a head's up about hard conversations over text before sitting down in person. Before you do talk to her, figure out the goal of your convo, and what you imagine the outcome will be if you hear something you don't like. If she was using while watching your kids, then what? If she doesn't want to answer any of your questions (absolutely her right), then what? It sounds like you mostly want reassurance that she is still the best caregiver for your kids and that she herself is doing well, so I suggest coming from a place of concern as much as possible.
posted by pumpkinlatte at 9:54 AM on June 1, 2023 [12 favorites]
As for how to have the conversation, I like the way you started here: "I’m not even sure where to start. This is a zero judgment zone, I have family members and friends who have struggled with opioid addiction [...]". I prefer to give a head's up about hard conversations over text before sitting down in person. Before you do talk to her, figure out the goal of your convo, and what you imagine the outcome will be if you hear something you don't like. If she was using while watching your kids, then what? If she doesn't want to answer any of your questions (absolutely her right), then what? It sounds like you mostly want reassurance that she is still the best caregiver for your kids and that she herself is doing well, so I suggest coming from a place of concern as much as possible.
posted by pumpkinlatte at 9:54 AM on June 1, 2023 [12 favorites]
Recently I came home to find an unused packet of Buprenorphine and Naloxone film.
Where did you find it? Is there any chance at all that perhaps the nanny left it out on purpose, so that the conversation might be prompted in a way that did not require them to initiate it? I can see this as an avenue some might take.
This is such a difficult situation. You have to discuss it. You can't just let it go. And you must be prepared for the possibility that you may not be able to keep your nanny, once you have the conversation. Pumpkinlatte has a good script there. I hope it all turns out in a way that is OK for everyone.
posted by I_Love_Bananas at 11:32 AM on June 1, 2023 [1 favorite]
Where did you find it? Is there any chance at all that perhaps the nanny left it out on purpose, so that the conversation might be prompted in a way that did not require them to initiate it? I can see this as an avenue some might take.
This is such a difficult situation. You have to discuss it. You can't just let it go. And you must be prepared for the possibility that you may not be able to keep your nanny, once you have the conversation. Pumpkinlatte has a good script there. I hope it all turns out in a way that is OK for everyone.
posted by I_Love_Bananas at 11:32 AM on June 1, 2023 [1 favorite]
I am curious where you found it as well, too. There’s a big difference between finding empty meditation packaging in a trash bin versus left on a counter versus was peeking out of her purse and I got curious.
posted by Silvery Fish at 12:00 PM on June 1, 2023 [6 favorites]
posted by Silvery Fish at 12:00 PM on June 1, 2023 [6 favorites]
First of all, her medical/health issues are her private issues, unless she choses to share them. There is nothing about being treated for substance use disorder that in and of itself makes her a bad person, irresponsible, or dangerous to your kids. She's taking a prescribed medication for a diagnosed condition. Not your business.
If she's leaving prescription medication in a place accessible to your kids, that is something to have a conversation with her about, and would be the same if it was any other medication, I would assume.
posted by gingerbeer at 1:41 PM on June 1, 2023 [2 favorites]
If she's leaving prescription medication in a place accessible to your kids, that is something to have a conversation with her about, and would be the same if it was any other medication, I would assume.
posted by gingerbeer at 1:41 PM on June 1, 2023 [2 favorites]
Maybe it's not the most politically correct answer, but yes I do think it's okay to ask your children's caregiver if they're in treatment for opioid addiction and what the timeline is there, especially if they're leaving their meds around where the children can find it
I would tread extremely carefully here as this line of inquiry is potentially illegal.
It's not a crime to be in treatment for addiction, it does not mean that one can be fired for using legally proscribed drugs, and it does not mean that employers can grill employees about their treatment.
Definitely talk to the nanny about leaving medications out where children can access them.
posted by oneirodynia at 1:45 PM on June 1, 2023 [8 favorites]
I would tread extremely carefully here as this line of inquiry is potentially illegal.
It's not a crime to be in treatment for addiction, it does not mean that one can be fired for using legally proscribed drugs, and it does not mean that employers can grill employees about their treatment.
Definitely talk to the nanny about leaving medications out where children can access them.
posted by oneirodynia at 1:45 PM on June 1, 2023 [8 favorites]
And just so it's clear: people can become addicted to legally prescribed painkillers through no fault of their own. Yes she may have become addicted while working with the kids- people get injured, people have dental surgery, people get whooping cough or cancer. These are all perfectly normal things I was given prescribed opioids for. I would hope that if I had ever become addicted I would be able to get treatment without being judged for taking prescription medicine*.
*not directed at the OP
posted by oneirodynia at 1:52 PM on June 1, 2023 [4 favorites]
*not directed at the OP
posted by oneirodynia at 1:52 PM on June 1, 2023 [4 favorites]
This is hard. I think it's totally normal that you would feel fear and anxiety about this. Chronic opioid use IS associated with higher risk behaviors, poor judgement, etc. That's real. I feel like it's good to talk this out with friends and process it emotionally, and, if the person is a good babysitter, then move on.
A possible script for talking to her about it [without the kiddo and when she has the ability to leave directly after if she wants to]:
"We wanted to let you know we found this [give it back to her]. We love how you care for our kiddo and we have no plans to change anything about our working relationship. The door is open if you want to share anything but we respect your privacy and we don't expect you to share your medical history or needs with us. But we are concerned this was left out where [child] could get a hold of it. So we do want to make sure any medications are kept out of reach of [child]. I know this might feel really uncomfortable so we just want to reiterate we love your work here."
posted by latkes at 4:19 PM on June 1, 2023 [4 favorites]
A possible script for talking to her about it [without the kiddo and when she has the ability to leave directly after if she wants to]:
"We wanted to let you know we found this [give it back to her]. We love how you care for our kiddo and we have no plans to change anything about our working relationship. The door is open if you want to share anything but we respect your privacy and we don't expect you to share your medical history or needs with us. But we are concerned this was left out where [child] could get a hold of it. So we do want to make sure any medications are kept out of reach of [child]. I know this might feel really uncomfortable so we just want to reiterate we love your work here."
posted by latkes at 4:19 PM on June 1, 2023 [4 favorites]
She would probably be relieved to hear you say "let's talk". It IS your business, just as it would be if she were a brother or parent. The conversation needs to be had, and you sound as if you are in the proper frame of mind to have it. I really cannot comprehend how your concern is somehow out of bounds because an addiction might have been brought about by factors beyond her control, or because you discovered this while being in places where you shouldn't have been. These are separate issues, and deserve to be dealt with separately.
posted by bullatony at 4:23 PM on June 1, 2023
posted by bullatony at 4:23 PM on June 1, 2023
I would like to be optimistic about this, but a nannying job is very different from many other jobs. If you don't trust your nanny 100%, it won't work.
In my experience with caregivers for my kids, when I overlooked a lapse of judgment like this, there suddenly were many many more lapses of judgment that could not be ignored and ultimately led to a parting of ways. If I were you, I would start thinking about looking for a replacement because it is not likely that things will get better.
I also don't think a conversation is likely to help here. If you had found the medicine in a locked medicine cabinet and she was a live-in nanny, that would be one thing and a situation that is none of your business. The fact that she left it out where you or the kids could find it is entirely another. It's a red flag and unless there are no other red flags, you need to take care of your kids and make sure they're with someone you trust.
posted by luckdragon at 4:33 PM on June 1, 2023 [2 favorites]
In my experience with caregivers for my kids, when I overlooked a lapse of judgment like this, there suddenly were many many more lapses of judgment that could not be ignored and ultimately led to a parting of ways. If I were you, I would start thinking about looking for a replacement because it is not likely that things will get better.
I also don't think a conversation is likely to help here. If you had found the medicine in a locked medicine cabinet and she was a live-in nanny, that would be one thing and a situation that is none of your business. The fact that she left it out where you or the kids could find it is entirely another. It's a red flag and unless there are no other red flags, you need to take care of your kids and make sure they're with someone you trust.
posted by luckdragon at 4:33 PM on June 1, 2023 [2 favorites]
I see two competing ethical principles here. First, we should be compassionate and understanding toward people who are addicts, particularly when they are taking measures to address their addiction. The opioid crisis is a huge societal problem, and we all should support those who are struggling to free themselves from the clutches of substance abuse.
Second, it should go without saying that we have a profound moral duty to protect our children from harm.
In the situation described by the OP, these two principles are potentially in conflict. You don't have to know any addicts yourself to realize that recovery is a fraught process under the best of circumstances, and addicts can (and do) relapse frequently. Those who suffer from chemical dependency often lie, cheat, steal, and generally leave a trail of destruction in their wake.
My inclination is to agree with @luckdragon above. At the very least, the OP should be very vigilant moving forward.
posted by akk2014 at 4:51 PM on June 1, 2023 [2 favorites]
Second, it should go without saying that we have a profound moral duty to protect our children from harm.
In the situation described by the OP, these two principles are potentially in conflict. You don't have to know any addicts yourself to realize that recovery is a fraught process under the best of circumstances, and addicts can (and do) relapse frequently. Those who suffer from chemical dependency often lie, cheat, steal, and generally leave a trail of destruction in their wake.
My inclination is to agree with @luckdragon above. At the very least, the OP should be very vigilant moving forward.
posted by akk2014 at 4:51 PM on June 1, 2023 [2 favorites]
She would probably be relieved to hear you say "let's talk". It IS your business, just as it would be if she were a brother or parent.
An employer/employee relationship is most certainly not the same as one with a brother or parent. There are legal ramifications to discussing health issues with your employee that don't exist when talking to a family member. It doesn't matter how well-intended the employer is when approaching an employee. An employer can talk to the employee about actions they have taken (such as leaving out medication). They can't necessarily go further than that. It's probably best to speak with a lawyer if the employer feels that anything more needs to be addressed. Some employer/employee interactions WRT addiction fall under ADA law, for example:
The ADA applies to addiction to alcohol and to the illegal use of drugs differently. Addiction to alcohol is generally considered a disability whether use of alcohol is in the present or in the past. For people with an addiction to opioids and other drugs, the ADA protects a person in recovery who is no longer engaging in the current illegal use of drugs. .
posted by oneirodynia at 5:25 PM on June 1, 2023 [9 favorites]
An employer/employee relationship is most certainly not the same as one with a brother or parent. There are legal ramifications to discussing health issues with your employee that don't exist when talking to a family member. It doesn't matter how well-intended the employer is when approaching an employee. An employer can talk to the employee about actions they have taken (such as leaving out medication). They can't necessarily go further than that. It's probably best to speak with a lawyer if the employer feels that anything more needs to be addressed. Some employer/employee interactions WRT addiction fall under ADA law, for example:
The ADA applies to addiction to alcohol and to the illegal use of drugs differently. Addiction to alcohol is generally considered a disability whether use of alcohol is in the present or in the past. For people with an addiction to opioids and other drugs, the ADA protects a person in recovery who is no longer engaging in the current illegal use of drugs. .
posted by oneirodynia at 5:25 PM on June 1, 2023 [9 favorites]
I’m in a healthcare adjacent field, but not actually a healthcare worker (domestic violence victim advocate). Everyone in my organization has been given Naloxone spray just in case we should ever be around when someone needs it. We were first given it well before the pandemic, so this isn’t something new. And in fact, I was surprised just now to see that it’s supposedly only been available by prescription, because my state actually hands it out like candy to anyone who wants it, in an effort to save lives. So I wouldn’t assume it was definitely for her own personal use. Maybe she has a close friend or family member who she might need to administer it to, and she just carries it on her at all times.
But additionally, the SAMHSA.gov website says the following:
Candidates for naloxone are those who:
- Take high doses of opioids for long-term management of chronic pain
- Receive rotating opioid medication regimens
- Have been discharged from emergency medical care following opioid poisoning or intoxication
- Take certain extended-release or long-acting opioid medication
- Those who have had a period of abstinence to include those recently released from incarceration.
So there are reasons someone who doesn’t have a substance abuse problem might carry it.
posted by MexicanYenta at 8:16 PM on June 1, 2023
But additionally, the SAMHSA.gov website says the following:
Candidates for naloxone are those who:
- Take high doses of opioids for long-term management of chronic pain
- Receive rotating opioid medication regimens
- Have been discharged from emergency medical care following opioid poisoning or intoxication
- Take certain extended-release or long-acting opioid medication
- Those who have had a period of abstinence to include those recently released from incarceration.
So there are reasons someone who doesn’t have a substance abuse problem might carry it.
posted by MexicanYenta at 8:16 PM on June 1, 2023
Naloxone alone is used differently from suboxone (combined naloxone and bupenorphine films)
posted by latkes at 9:59 PM on June 1, 2023 [1 favorite]
posted by latkes at 9:59 PM on June 1, 2023 [1 favorite]
If I were you, I would say “hey I found this and I think it’s yours. Do you want some space in the medicine cabinet for stuff like this?” and let her take the conversation from there. If you have seen no evidence to the contrary, I would not assume she is currently or has been abusing drugs while in your employ. I say this as someone with plenty of former drug addicts in my life, including immediate family.
That said I would also be extra vigilant, which you probably will be anyway.
posted by lyssabee at 10:02 AM on June 2, 2023 [2 favorites]
That said I would also be extra vigilant, which you probably will be anyway.
posted by lyssabee at 10:02 AM on June 2, 2023 [2 favorites]
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posted by staggernation at 5:45 AM on June 1, 2023 [27 favorites]