What is the reason you run out of medications each month? Usually a prescription is written to last for 30 days.
It sounds like you are on a medication like Norco/Vicodin or Tramadol...These are the only ones that allow for actual refills.
How many are you given each month and what does the prescription read for instructions (like take x amount every x hours)
A Pharmacist is a part of your health care team and it is a red flag to be running out of meds each month. It's one thing to fill your meds 1-2 days in advance, but there is absolutely no reason to need a medication that is supposed to be for 30 days, 10 days early.
The Pharmacist does have the right to not fill your prescription as well as even alert the state and/or DEA in that your Dr. is allowing this to happen each month.
I would caution you in that with regulations getting more strict that this may all come crashing down in the future and your Dr. may get into trouble for letting you do this month after month.
There are many other ways to help lessen one's pain from exercise, PT, injections, acupuncture, massage, ice, heat, TENS unit, biofeedback, just to name some...
IF you have take your medication on schedule, and then tried literally every other thing to try and get the pain down, then you need to contact the Dr. to ask them what to do. This should be done instead of taking more pills than prescribed.
By doing this each month, which means that you are getting a higher dosage of meds certain days, and then nothing for some days, this is only going to make your pain levels that much higher and harder to treat.
I'm also surprised that your insurance company allows for such early refills as well. Just an FYI but most states now have a Prescription Monitoring System so that any Dr. or Pharmacist can see when/where you are filling your medication, how early each month, and whether you pay cash/use insurance. My point in stating this is that if you try to go someplace else they will be able to see this.
I'm not trying to scold, just trying to say that you need to work with your Dr. on getting a better plan in place to handle your pain issues. As well as making sure you have a realistic view of what chronic pain is..this means that we will always have pain and a level 5 or so is acceptable after taking meds. By using other modalities, this can help lower your pain level a bit as well.
I wrote all of this to caution you in that it may be where the Dr. decides this isn't working and cuts you off altogether and then it will be on your medical records that you aren't taking the meds responsibly which could make it where another Dr. does not prescribe anything for ppain that is controlled.
That is the long answer...LOL...Again, we all know what it's like to be in pain...I hope you can figure this out with your Dr. soon.View Thread
It looks like you are replying to two different people and since you included my screen name I will address what you are saying..
I'm not sure where you can make a determination about someone's medical or pain issues from their chosen screen name????
Your pain is no more "severe" than mine or anyone's on here so please do not confuse the conversations as I responded to the specific things you mentioned that the "DEA" is doing and this is simply not true.
Did you read the link I gave you? That is straight from the .gov website. There is not any law by the DEA that states that patients must see their Drs. every month period.
And I'm not sure what you are saying about how I take my medications? Yes, I take them as prescribed and never take more. This is pretty simple to do and has absolutely nothing to do with what my pain levels are. It has to do with following a Drs. orders and not running out of my meds and not breaking that trust with my Dr. who expects me to not just decide for myself how many pills I should take.
I am given a certain amount each month to where the max of my breakthrough meds is 8 a day. Since I am also on a long acting med...I only use my BT med when needed so I have great flexibility. I would never think of taking more than the 8.
Making it seem like it is "ok" or normal for people to just do what they want and take more than prescribed and run out of meds is just not the case. IF someone is having greater pain, there are many other things to do to help that pain level come down than just taking a pain pill. If that person has done all they can and are still in terrible pain, then they should call their Dr. or the Dr. on call if after hours and ask what to do.
Whether someone has an actual written pain contract or not with their Dr. there is an "implied" one that we can follow instructions and realize that our Drs. are being monitored by the state and the DEA and what we do can affect them. If someone runs out early and then is begging for the DR. to give them another prescription before the 30 days, that Dr. would have to then try to explain this on your medical records.
It has nothing to do with an "ax" to grind with anyone...It's just about how people would never think twice about just taking more thyroid or heart medication but for some reason people think that they are more knowledgeabel than their Dr. and can just change their prescription and take more pain meds. This is why it takes awhile for Drs. to trust new patients as too many people think this is ok.
You are the one who seems to be very upest with myself, the DEA, Drs. etc.
Believe me, I've been without a PM Dr. after my 2nd fusion surgery and in excruciating pain and didn't have any medication to take except Advil and Tylenol. I just pressed forward and in a few months I was able to find a new Dr. and go from there.
I have had dozens of surgeries as well as been in PM for many years now so please do not play the "my situation is worse than your situation" game. It has nothing to do with what you are claiming the DEA is doing.
I understand that you have had specific problems with getting pain meds because of your previous PM Dr. who got shut down. This tells me (as I already responded on another thread) that they were not doing things by the book. Drs. do not just get shut down when they are following all the rules.
I'm sorry that you had to go through that but to be upset with any new Drs. who feel that you should have other treatments and use other modalities in addition to just opiates doesn't make sense to me.
I certainly hope that you can get the care you need with the new PM Dr. you are seeing.
I just believe as I said in my other post that getting prescribed opiates is not a "right" but a privilege and that it is up to us to follow any prescription that we take, controlled or not, or communicate with the Dr. and then go from there. I personally would never be under the care of a Dr. to where I thought I knew more than they did!View Thread
I happen to think that too many new people to PM think that getting opiates is a "right" when it comes to pain management. That no matter what the pain, they feel that they should start on an opiate. Just 20 years ago (less actually) Percocet 5mg was the most that was given out after a major surgery. For other things you were given a Tylenol 3 or just told to grin and bear it. I had broken bones, surgeries, tendon tears, etc...and in only a few cases did I take a day or two of Percocet.
People have the right to be listened to and helped with their pain, yes, but being put on strong pain meds is something that for many of us didn't happen until years down the road into our chronic pain journey. There are many other medications and ways to treat pain. Opiates have their place, but with them comes great responsibility not just from the Dr. but the patient. So, I say this in my many posts on this particular subject but I am an Independent. I do NOT believe Gov. should be involved in many things but there are some good laws and regulations in the U.S. and I take each and every one of them individually when needed and decide whether I agree or disagree. People start to get up in arms about things without clearly looking at all the details. That is why it is crucial to see whether something is an actual DEA regulation or a state law/regulation, or just a personal choice by the Dr. And even then, everything that I have listed I just don't see as harming those who truly need care. All these laws have not stopped my own care or changed it in any way as well as my PM. He has only been able to care for more patients with others being discouraged more that weren't on the up and up. Just my own thoughts/opinions View Thread
The DEA regulation for Schedule 2 medications and seeing a patient every 3 months has been in effect since 2006.
Codeine 4 is not a Schedule 2 medication. But coming in every 6 months is not unreasonable whatsoever if someone is taking any type of medication. My mom is on BP, Cholesterol, and heart meds and has to see her Dr. every 6 months to monitor not just her health but make any adjustments with medications. So I do not see the big deal in this and would actually be wary of any Dr. who only saw their patient that they are prescribing medication to only once a year.
You can read the information here in regards to Schedule 2 meds and the DEAs rules about appts.
I have been seeing my PM for every 3 months since 2007 so it is not coming from the DEA.
Each state has their own laws and regulations they can make on top of anything the DEA requires. As well as individual Drs. can choose to see a patient more than 3 months if they want.
You mention in your other post that "no other medical condition assumes felonious behavior"....It has nothing to do with one's condition but the medications that one is prescribed.
As pain patients, we must all recognize that prescription abuse has truly become an epidemic. I, for one, do not mind the yearly urine test or pill counts as it is a small price to pay to help my Dr. focus more on those who truly need him and weed out those who's aim is to abuse the meds/system.
As I mentioned, it's the individual states that make many of the regulations for the urine testing or pill counts so it's important to know your own state's laws.
It's also the individual states that have different regulations on the caps of certain meds per month being prescribed. This is not a Federal law. And again, I take each regulation and look at it separately to see whether I agree or not. I happen to agree that short acting meds are not meant to be prescribed long term as someone's "primary" medication. If someone is a true "chronic" pain patient then most all PMs move that patient to a long acting medication to prevent the ups/downs in pain levels and then prescribe a short acting for a "breakthrough" med. That is only meant to be taken sparingly when there are bad days...not every single day and the max every day.
There are not regulations saying that a short acting med "cannot" be prescribed...it's just some states limit the amount per 30 days (for long term usage) and when it's the only med.
As of now there are 42 states that participate in the Prescription Monitoring Program (won't be long for all 50). This is also something I completely approve of as it tracks us by name so that any Dr. (regular or ER/Urgent Care or Pharmacist ) can pull up a history of all medications that have been filled anywhere in the state. This is helping to prevent those who "Dr. shop" or try to use different pharamcies and/or pay cash in one place, use insurance in the other to obtain multiple prescriptions of controlled substances.
I actually hope this will become nationwide one day.
I also have no issue with Vicodin becoming a Schedule 2. It is just as "abused" as any other type of opiate.
The last thing that is coming down the pike that I think is good is that they are requiring more training and certification to any non PM Dr. who wants to treat chronic pain patients (More than 3 months. This moves from acute to chronic). This is very logical to me as PM is an actual specialty. My PM Dr. is both an Anesthesiologist as well as Board Certified in Pain Management. Any Dr. who is treating someone with powerful medications should have continuing education on this to know what they are doing.
Just FYI but it is HIPAA (two As) It stands for the Health Insurance Portability Accountability Act.
And yes, it will most definitely be in your medical records for your new PM or any other Dr. including any in the ER/Urgent Care as well as Pharmacists) to see. Any new Dr. will make sure that your full medical profile is forwarded over. Especially with PM, they will want to see any urine test that were taken and/or failed.
Did you end up telling your old PM the day you took the test that you ran our early and took old medication? If so, that would have at least helped you some by coming clean. But if you just kept quiet hoping you wouldn't get caught and then just let the chips fall, this will look worse I'm afraid.
When taking any medication...controlled substances or not, it is imperative to follow the prescription exactly as written and not even a single pill more. The sophisticated labs that use gas chromatography mass spectrometry can tell to the minute detail whether someone is taking more or even less medication than what they are prescribed. As well as the prescence of any other substance.
With chronic pain, it is so important to not rely solely on your opiate medication to lower your pain levels. There are dozens of other modalities to use to help our pain and even then it's about being realistic to what level is expected. I live with a 5-7 daily on the pain scale and that is using everything from daily exercise, physical therapy, acupuncture, massage, aqua therapy, ice, heat, injections, steroids, biofeedback, TENS unit, eating healthy, counseling, etc.
As well as there are actual muscle relaxers and nerve pain meds that many people have in addition to any opiate.
My point is to not scold...it is to help you in the future and others reading. Drs. are under great scrutiny by the state and the DEA to monitor their patients and expect that they are honest and can follow the prescription exactly. IF someone has greater pain to where they have tried literally everything else for the day, then you (collective you) need to call your Dr. and ask them what to do.
Unfortunately you have seen what can happen when doing things this way. All I can say is to be honest with the new PM Dr. and try to build a relationship where they can trust you again. They may choose to only prescribe non opiates to start and/or go very slow until they see you are going to follow their instructions.
Do you mind being more specific of just exactly "how" the DEA has affected your personal PM care?
The DEA really has some basic but necessary regulations set in place. Each state has their own laws and regulations being passed that can affect pain management.
I have been in PM for over 6 years now and haven't had a single issue with my Dr. prescribing medication. Same thing with my Pharmacy. In 11 years I've never had a single issue through any of my surgeries and care.
I believe in looking at things in a very specific manner instead of just objecting to something for the "sake of it"..
Most reputable PM Drs. are not "afraid" of the DEA as they have no reason to be. They do everything on the up and up and follow protocol and keep good paperwork as well as they treat each single patient differently.
I do know that some people think that if they have pain, then they "deserve" opiates to treat that pain and that is just not the case. It's only been in the last 15 years that opiates have started being used for non cancer pain.
**The one thing that is coming down the pike which I happen to agree with is that they are requiring all non PM Drs. to take continuing education courses as well as certification if they wish to continue treating a patient for actual chronic pain (greater than 3 months which goes from acute to chronic).
This is why many non PM Drs. have been stopping prescribing controlled substances and sending those patients to see an actual PM Dr. As I said, I happen to believe in this as it should be a true specialty just like surgery or being an OB/GYN...I wouldn't go to a Podiatrist to get my spine fused!
I am certainly someone who does not agree with everything that the government does (Federal or State) but I have a problem when people use sweeping generalizations to try and get a point across.
Only people doing illegal things (Drs. or patients) should "fear" the DEA. Pain Management is not going anywhere, it's just getting more detailed.
There is better record keeping and detailed patient charts to have actual reasons to prescribe strong pain medications
There is the Prescription Monitoring Program which is good to find those who are abusing the system.
Annual or random urine tests to weed out those who are not taking their meds as prescribed.
Or random pill counts.
I just haven't found that any of these things have affected my care in a negative way.
Just one person's opinion so I will not be signing a petition that is too generic about the "DEA" in general.View Thread
It stands for the Health Insurance Portability and Accountability Act...
And I'm not sure what you are referring to that is an "invasion" pof privacy. Every Dr. that you go to has the right to request your medical records from the previous ones. Or if you go to the ER or Urgent Care, it's the same thing. Pharmacists are also allowed to contact your Drs. if they feel there is anything of concern or a problem with a prescription.
42 states now have the Prescription Monitoring Program which follows you by your name at any Pharmacy, ER/Urgent Care regardless of paying cash or using insurance. So they can all have access to your prescribing records.
So please share who you think should be left out of the loop?
I can't tell if you are the same person as einalem so if you are, it would help to say something when you switch from Anon to a screen name so people can follow your posts..
Same thing with using punctuaction and paragraphs as it's very difficult to read and it sounds like a big rant by text which is not going to have people taking it seriously enough to have a conversation with you.
Just because one person as yourself has a terrible experience, does not mean that "every" Dr. is out just for money.
And as others have mentioned, please read up on the actual differences between state laws and the DEA which is a federal agency. Marinol and Cesamet are both FDA approved medications that are ok to be prescribed.
But, anything that is smoked or eaten, no matter the state or if it is "prescribed" is still illegal under Federal law.View Thread
I have to disagree that "all" Pharmacies look or treat someone like a drug addict. I have been going to the same Pharmacy for 11 years now and not once have been treated this way. They are a Sam's club so it's not some mom and pop place.
It's all about developing an actual relationship with the head Pharmacist and staff. Get to know them, as well as make sure they get to know you. This way, if there ever is an issue then you are usually given the benefit of the doubt. My Pharmacist made a mistake just last month with giving me double prescriptions by accident but I didn't see it until I got home. So, I turned around and drove back and he felt so badly he gave me a $20 gift card to use and said how thankful he was that I didn't get upset.
What gets a Pharmacist suspicious is if someone is trying to fill their meds early every month, calling incessantly or giving the staff a hard time or being too anxious about their opiates, having controlled substance prescriptions from more than one Dr. and yes, trying to pay cash for meds when someone has insurance.
There are 42 states now that have the Prescription Monitoring Program. This is where you are tracked by your name, anywhere in the state, no matter what Pharmacy you use, ER, or Urgent Care. They can easily look up your prescribing history and if there is something of concern then they have the right to contact your Dr.View Thread
It wasn't something that Bloomberg decided on his own. Many of the ER/Hospitals in the area have been tracking the data and actually complaining about the number of patients coming into the ER requesting and needing pain medications as well as seeing a rise in the abuse and death rate by prescription pain meds and other controlled substances.
NYC's Health Commissioner, ER Physicians, and even First Responders are pleased with this particular legislation as one hospital states:
"In the heat of the moment in an ER, it shouldn't be the ER doctor's role to think through and anticipate the patient's ongoing needs for opioids," Pamela Brier, the CEO of Maimonides Medical Center told The Huffington Post over the phone. "That should be the responsibility of the patient's primary care doctor, or if the patient has a broken limb, the patient's surgeon."
Maimonides Medical Center is a 700-bed, non-profit teaching hospital in Brooklyn that voluntarily decided to adopt Bloomberg's guidelines regulating emergency room painkiller prescriptions
This only applies to the ER.....So as I mentioned earlier, the ER Physician can write that the patient be followed up by another Dr. within the hospital system for ongoing care if needed.
**They are also not prohibited to provide the amount of pain meds they feel is appropriate while being treated in the ER or Hospital to help the patient..This is the most important part to me.
I just believe that a Patient taking opiates should be monitored closely and when someone comes into the ER....they are just quickly being assessed and many times those Drs/Nurses do not have someone's full health history or medical records at their disposal to make decisions about "long term" opiate use. And if someone is being discharged....that means that they are not in a "critical" level of pain or injury anymore that should not need to be given a months worth of opiates.
So, discharging them with 3 days worth of meds seems very fair and they can either come back to the hospital or a free clinic if they are needing further care as instructed (for those low income folks) or sent to follow up with their own Physician for those who have insurance.
Again, there are plenty of things I disagree with when it comes to government control or impeding others to make their own decisions...I just am taking this one piece of legislation and don't see it being anything that is so terrible that it will affect those of us with chronic or even acute pain.
I think that just like with most things, there will be those of us that may agree with something and those that disagree and that is ok and makes for interesting discussions:)View Thread