Stop robbing my pharmacies, junkie motherfuckers!!!

[ladyfoxfyre]

Just got a frantic text from a friend while I was at work today:

"We were just robbed, I think I'm going to pass out."

For the umpteenth time in 3 months, another pharmacy in my area has been robbed by junkie scumbags looking for as much oxycodone they can lay their hands on. They're jumping over counters, holding guns to people's heads, and in one instance a couple years back, beating a 70 year old pharmacist with a crowbar.
I have known people who work in every store that's been robbed in my district recently. These are stores I've worked at, places I've spent a lot of time in. These are my friends.

And I am sick and fucking tired of wondering when it's my turn, wondering if every guy who walks up to the pharmacy with a funny look on his face is about to pull a gun on me. I'm tired of wondering if the piece of paper he's sliding towards me says "Amoxicillin 500mg" or "Give me everything in the safe and nobody gets shot." I'm tired of my pharmacists being afraid to work alone at night because they too know it's just a matter of time, and they don't want to be alone when it happens.

Walgreens experienced so many robberies that they stopped carrying all forms of oxycodone in their regular stores. Now they have one store in each district that will stock it, with a 24/7 armed guard in the store. One guy I know put up a sign when he was working overnights alone that said he didn't keep it in stock. Didn't stop the guy who put a gun to his head, and it made us all sick to watch the video of him pleading for his life for well over 10 minutes, wondering if this psycho was going to blow his brains out. The guy eventually found some in the bins and left with it.

But it's not just overnighters that have cause to be concerned now. In June, a Sweetbay in my county was robbed at 11:30 in the morning. The one that got hit today was 1pm with 2 female techs and one pharmacist while patients were sitting in the waiting area.

I mean, what the fuck?

[FoieGrasIsEvil]

It's definetely an issue, especially since Oxycontin is so addictive and expensive. I wonder if there are equally effective painkillers that aren't so damn sought after or narcotic.

[Mr. Moto]

Yeah - that truly sucks.

It hits a little close for me - my cousin is going through hell right now because his wife got strung out on the stuff working as a nurse. She lost her nursing license, almost landed in the clink for stealing tons of oxy from the hospital, had to go through rehab, and now their marriage is pretty much over. He's wringing his hands because he knows his kids have to come first in whatever happens next, and he's a bit at a loss on how to help them.

Awful stuff.

[An Arky]

Yeah, I've thought that perhaps somebody needs to do some sort of societal cost/benefit analysis on that stuff. It sure seems like a whole bunch more people are fucked up because of it rather than not fucked up because of it. Of course, people in real pain shouldn't have to suffer because of a bunch of addicts, either.

[Mr. Moto]

Living with pain is no joke. And with really bad pain and an end-of-life issue, addiction becomes something health care workers typically don't worry about quite as much.

The real sticking point is with terrible acute pain, or a long-term painful chronic condition that resolves in time. These present the real challenges in pain management. Winding up with an addiction this way is just a real mess all around - and adds a huge complication to the lives of people just trying to get healthy again.

And then there are the dickheads who never are in pain and just grab hold of these drugs for kicks. That's hard to defend.

[JayRx1981]

It's definetely an issue, especially since Oxycontin is so addictive and expensive. I wonder if there are equally effective painkillers that aren't so damn sought after or narcotic.

Methadone is a fantastic pain-killer, with few of the "high" benefits one typically gets from other opioid narcotics. It's a naturally long-acting drug, so you can't circumvent a long-acting tablet release mechanism like you can with other CR opiates (Oxycontin, Avinza, Kadian, fentanyl lozenges). Unfortunately, it's notoriously difficult to properly dose and has other issues and stigma attached to it which prevent most physicians from using it (even though, compared to oxycontin, it's dirt cheap since it has been generic for years now).

The previous pharmacy I worked in was robbed on Memorial Day, while I was there. What did the guy want? Oxycontin. Fortunately, he believed us when we said we had none (we really didn't) and demanded something else instead, which we gave him and he bolted.

It's sad, really, since many people do benefit from these medications.

[Qadgop the Mercotan]

Methadone is a fantastic pain-killer,
It's the first narcotic I tend to prescribe when a long-acting opiate is indicated.

But it does take a lot of practice to figure out the dosing, and ya gotta make sure their kidneys and livers are in good enough shape, or dosing it will get even tougher.

There are no easy answers to the problem of chronic, non-malignant pain. Narcotics are one tool in myoolbox, but not the first one I reach for. And for patients with a significant addiction history, they probably should not be reached for.

There's very little actual need for a drug like oxycontin. It's widespread use is due more to marketing than to unique benefit over other available meds.

[Spectre of Pithecanthropus]

It's definetely an issue, especially since Oxycontin is so addictive and expensive. I wonder if there are equally effective painkillers that aren't so damn sought after or narcotic.

And then when you or someone in your household does have a legal script for it, or a similar drug, it can be damn hard to find a pharmacy that can fill it.

[Spectre of Pithecanthropus]

It's definetely an issue, especially since Oxycontin is so addictive and expensive. I wonder if there are equally effective painkillers that aren't so damn sought after or narcotic.

I asked my doctor about that, wondering why, 100 years more or less after they started controlling narcotics, they haven't been able to come up with non-narcotic substitutes that are equally effective against pain. He told me that the way brain processes pain and pain relief is so tightly bound to the way addiction works that such a breakthrough was unlikely even in the long term.

[Spectre of Pithecanthropus]

Yeah, I've thought that perhaps somebody needs to do some sort of societal cost/benefit analysis on that stuff. It sure seems like a whole bunch more people are fucked up because of it rather than not fucked up because of it. Of course, people in real pain shouldn't have to suffer because of a bunch of addicts, either.
"Addicts" and "people in real pain" are not necessarily disjoint sets. It's more than possible to become hooked through therapeutic use, after which you can hopefully be titrated down.

[jhinman]

Narcotics are one tool in myoolbox, but not the first one I reach for. And for patients with a significant addiction history, they probably should not be reached for.


If I rember right you are a doctor in a prison. I would expect narcotics would be really fun to persribe just for logistic issues.

[FoieGrasIsEvil]

Isn't part of the problem with these narcotic painkillers that the person that is given a legitimate scrip for a legitimate pain issue becomes dependent on the drug in such a way that the body "tricks" the mind into believing that the pain still exists, even when it doesn't anymore, thereby continuing to feed the addiction because the patient is still reporting pain to the doctor?

[Ferret Herder]

Methadone is a fantastic pain-killer, with few of the "high" benefits one typically gets from other opioid narcotics. It's a naturally long-acting drug, so you can't circumvent a long-acting tablet release mechanism like you can with other CR opiates (Oxycontin, Avinza, Kadian, fentanyl lozenges). Unfortunately, it's notoriously difficult to properly dose and has other issues and stigma attached to it which prevent most physicians from using it (even though, compared to oxycontin, it's dirt cheap since it has been generic for years now).
A local suburb just shut down a 'methadone clinic,' even though they only take patients with private insurance programs (intended to mean to the suburbanites: no junkies on public assistance) and do provide to patients with legitimate pain issues. The locals didn't think that was appropriate for their community, regardless. :rolleyes:

<semi-hijack> On the topic of Oxycontin, I know I've told this story here before but I'll do it again. I'm on a research review board (IRB for those who know the terminology) for the medical center I work at. We review research involving human subjects being done at our institution. One study a few years back wanted to research Oxycontin versus some other pain treatment for arthritic knees or something like that. Anyway, the issue was that the subjects would be given a plain-looking pill to take daily for weeks; neither they nor the doctor would know which drug it was because the sponsoring company would send code-numbered bottles of meds that all looked like each other. At the end of the study - they would stop taking them. Cold turkey.

I was one of the people on the panel who objected strenuously. We sent the study back telling them the sponsor needed to create "tapering" doses of the drugs being used and wean them off the drug. The response we got was that they didn't think it was needed, and their means of following up was a phone call 3 days after dose stoppage, and they'd deal with it then if needed.

One of our members worked in anesthesiology, and he was the most knowledgeable and vocal on the subject. His rant was a thing of beauty and sadly I would do no justice if I tried to remember it and reproduce it here. We found it cruel that they would go ahead and put subjects through withdrawal just because they didn't want to be bothered with tapering them off the meds slowly. We sent the study proposal back with our commentary. I don't recall it coming back to us again, but I wasn't going to every meeting at that time.</hijack>

[Qadgop the Mercotan]

Isn't part of the problem with these narcotic painkillers that the person that is given a legitimate scrip for a legitimate pain issue becomes dependent on the drug in such a way that the body "tricks" the mind into believing that the pain still exists, even when it doesn't anymore, thereby continuing to feed the addiction because the patient is still reporting pain to the doctor?
It's not quite so clear-cut.

Gross oversimplification follows:

Narcotics work pretty good on acute pain, and relieve it well, with minimal risk of dependency. Any resultant physical addiction is pretty easily treated with a taper.

And inadequately treated severe acute pain often results in nerve remodeling changes, which can cause long-term chronic pain. So it's important to treat moderately severe acute pain, with narcotics if necessary.

But often for chronic non-malignant pain, the med works at first, but eventually the effect diminishes, the patient requires more narcotics to get the same level of relief, etc etc until the patient is on enough morphine to kill an elephant, is constipated to hell and back, us tremendously physically addicted (and maybe psychologically too) and still has the same pain he started with.

Plus, for certain susceptible individuals, narcotics not only relieve physical pain, but the resultant euphoria reduces mental, emotional, spiritual pain too. And when the narcotic wears off, they want relief from those pains too! And the patient tends to not recognize the nature of these non-physical pains, but somatizes them into physical complaints.

Plus a lot of other stuff and factors, etc. ;)

It's complicated. That's why I went thru training until I completed the 21st grade, and still do continuing education, including on how to treat pain. And I'm still learning slowly in this area.

[smiling bandit]

If I rember right you are a doctor in a prison. I would expect narcotics would be really fun to persribe just for logistic issues.

I don't know how it is for him, but at the local jails, every pill has to be accounted for, while every inmate receives his invidually, and supposedly signs for it, and the whole system is a huge mess.

[Qadgop the Mercotan]

A local suburb just shut down a 'methadone clinic,' even though they only take patients with private insurance programs (intended to mean to the suburbanites: no junkies on public assistance) and do provide to patients with legitimate pain issues. The locals didn't think that was appropriate for their community, regardless. :rolleyes:
Sounds like a "methadone maintenance clinic". These places usually treat opiate addiction (heroin, oxycontin, etc) with high doses of methadone, not to treat pain, but to maintain their addiction with a less problematic drug. They're becoming more and more targeted to the well-heeled addict rather than the down and out skid-row junkie. :rolleyes: Methadone maintenance has its role, but I'm not a big proponent of it. It's interesting to hear they're treating pain too.

Any doctor with a DEA number for Sched II can prescribe methadone for pain. But it takes special licensing and certification to be able to prescribe methadone for an addiction.

[Qadgop the Mercotan]

I don't know how it is for him, but at the local jails, every pill has to be accounted for, while every inmate receives his invidually, and supposedly signs for it, and the whole system is a huge mess.
Sounds like our system in prison too!

[wring]

Sounds like our system in prison too!
ditto correction center, even circa 1990 and before.

[Ferret Herder]

Sounds like a "methadone maintenance clinic". These places usually treat opiate addiction (heroin, oxycontin, etc) with high doses of methadone, not to treat pain, but to maintain their addiction with a less problematic drug. They're becoming more and more targeted to the well-heeled addict rather than the down and out skid-row junkie. :rolleyes: Methadone maintenance has its role, but I'm not a big proponent of it. It's interesting to hear they're treating pain too.

Any doctor with a DEA number for Sched II can prescribe methadone for pain. But it takes special licensing and certification to be able to prescribe methadone for an addiction.
Article here (http://www.chicagotribune.com/news/local/chi-methadone-clinic-berwyn_a-majul23,0,6261973.story) - Berwyn's aldermen voted to allow the clinic, residents turned out to protest, all of the aldermen roll over and revoke their decision. The article mentions that the clinic has a branch in Evanston, which is a fairly upscale suburb in most places. Also, the owner of the other clinic and of the planned one is a resident of Berwyn, so one would think she has a vested interest in keeping her community nice.

This article isn't clear but other news reports did make it sound like it wasn't entirely for addicts, but I could be wrong.

[Indygrrl]

Sounds like a "methadone maintenance clinic". These places usually treat opiate addiction (heroin, oxycontin, etc) with high doses of methadone, not to treat pain, but to maintain their addiction with a less problematic drug. They're becoming more and more targeted to the well-heeled addict rather than the down and out skid-row junkie. :rolleyes: Methadone maintenance has its role, but I'm not a big proponent of it. It's interesting to hear they're treating pain too.

Any doctor with a DEA number for Sched II can prescribe methadone for pain. But it takes special licensing and certification to be able to prescribe methadone for an addiction.

I can't say I'd want a methadone clinic in my own neighborhood, but I'm glad that one exists not too far from me. It's not for everyone, that's for sure, but it does seem to work well for me. I haven't abused opiates since I began MMT. You trade an addiction for a dependence, and personally, I find it much easier and healthful to be on a controlled amount of methadone than out on the street paying tons of money for drugs and taking as much as I want (not safe and a great way to OD).

It's not exactly a fun place to go though. The motives for being there are not all good ones, unfortunately. As far as I know, our clinic does not treat pain and they take many steps not to overmedicate. You have to go through paperwork and doctor's orders to be stepped up even a little bit. And again, IMO, it's better to be a little overmedicated on a drug that you are being supervised on than to be out on the street taking whatever you want. In no way is it a perfect system, but for a lot of us, it is a hell of a lot better than the alternative.

And the nifty thing about methadone is its ability to block other opiates once you are at a therapeutic dose. It's pretty hard to abuse opiates once you are on MMT, at least for me. And I know I never would have stopped otherwise. YMMV

[DoctorJ]

Last year a couple of geniuses tried to rob a pharmacy in a nearby community. According to the security cam video (which friends of mine have seen) one of them got out of the car and watched out while the other one drove to the edge of the parking lot, aimed at the pharmacy's front door, and floored it. The impact didn't breach the door, but it did manage to send the driver's face into the windshield, because this young scholar neglected to put on his seat belt before his ramming maneuver.

Providence protects idiots, so the guy was addled for a few seconds but recovered quickly. He backed the car up and made another run at the door, which didn't give way completely but opened enough for one of them to get inside. Unfortunately, it also sent him once again face-first into the shattered windshield, because even after his previous misadventure he still didn't put on his seat belt.

It's a testament to the humanity of his partner-in-crime that he passed up the chance at a wide-open pharmacy and drove his now-unconscious buddy to the hospital.

[Mama Tiger]

And....my Google ads are for oxycodone and vicodin. :smack:

I've got a chronic pain issue from nerve damage in my foot due to multiple surgeries in the same small area. I take a regular dose of oxycodone (plus gabapentin) to calm it down, and it works like a charm for me. I've taken the same (quite small by pain management standards) amount for the four years I've been treated by the pain specialist, but I'm also insanely careful about not taking more than the absolute minimum to maintain the pain at a tolerable level -- the only time I can recall being completely pain-free in the last five years was when they had me on morphine for a few days after a knee replacement last year.

So it really pisses me off that people abuse a medication like this, and rob pharmacies and injure or kill completely innocent people, all to get high off something that makes a huge difference in my quality of life. I'm in nice, polite suburbia, and as far as I know the pharmacies around here are all robbery-free, but they still often don't carry my medication; sometimes I have to check 2 or 3 in my area to find one that has it. I'm sure it's for safety reasons.

I'm sorry your friends/coworkers are being robbed like that, ladyfoxfyre. It's a lousy situation all the way around.

[DoctorJ]

Sounds like a "methadone maintenance clinic". These places usually treat opiate addiction (heroin, oxycontin, etc) with high doses of methadone, not to treat pain, but to maintain their addiction with a less problematic drug.
If they're actually treating pain, they may well just be a "pain clinic". I don't know how common those are elsewhere, but around here narcotic abuse is so rampant that most of our chronic pain treatment is provided by dedicated clinics.

I haven't written for a long-acting narcotic (including methadone) in the three years I've been in private practice. Around here if you write one script for oxycontin, you have ten people in your office the next day with beat-up folders of medical records, essentially normal MRIs, and sob stories about how they got kicked out of all the pain clinics. (It gets out through the pharmacies.) It's really that ridiculous. I get one or two patients a day like that anyway.

That's one of the reasons why I'm getting out of private practice and getting back into academics. It's just exhausting.

[FoieGrasIsEvil]

I can't say I'd want a methadone clinic in my own neighborhood, but I'm glad that one exists not too far from me. It's not for everyone, that's for sure, but it does seem to work well for me. I haven't abused opiates since I began MMT. You trade an addiction for a dependence, and personally, I find it much easier and healthful to be on a controlled amount of methadone than out on the street paying tons of money for drugs and taking as much as I want (not safe and a great way to OD).

It's not exactly a fun place to go though. The motives for being there are not all good ones, unfortunately. As far as I know, our clinic does not treat pain and they take many steps not to overmedicate. You have to go through paperwork and doctor's orders to be stepped up even a little bit. And again, IMO, it's better to be a little overmedicated on a drug that you are being supervised on than to be out on the street taking whatever you want. In no way is it a perfect system, but for a lot of us, it is a hell of a lot better than the alternative.

And the nifty thing about methadone is its ability to block other opiates once you are at a therapeutic dose. It's pretty hard to abuse opiates once you are on MMT, at least for me. And I know I never would have stopped otherwise. YMMV
Amazing.
Get on with your bad self.
Good job kicking the nod.
Now keep it.
Sounds like you are.

[FoieGrasIsEvil]

It's the first narcotic I tend to prescribe when a long-acting opiate is indicated.

But it does take a lot of practice to figure out the dosing, and ya gotta make sure their kidneys and livers are in good enough shape, or dosing it will get even tougher.

There are no easy answers to the problem of chronic, non-malignant pain. Narcotics are one tool in myoolbox, but not the first one I reach for. And for patients with a significant addiction history, they probably should not be reached for.

There's very little actual need for a drug like oxycontin. It's widespread use is due more to marketing than to unique benefit over other available meds.

Is it due more to marketing or to unscrupulous prescribers (ie, doctors)?

There has got to be a profit motive in there somewhere, as I imagine Oxycontin is cheap to produce but not to sell.

This is a one-off, but anymore I feel generally that we are an overprescribed. over-medicated nation.

My son is a little "hyper"!

No! He has ADDHD! Treat him with this chemical!

(No belittlement of honest conditions implied)

[Qadgop the Mercotan]

Is it due more to marketing or to unscrupulous prescribers (ie, doctors)?
Marketing. The manufacturers were recently fined hundreds of millions of bux for inappropriate, misleading, incorrect advertising. I think criminal prosecutions are being considered also.

[teela brown]

It's a testament to the humanity of his partner-in-crime that he passed up the chance at a wide-open pharmacy and drove his now-unconscious buddy to the hospital.

Bet when the unconscious crook woke up with a bashed-up head, he really wanted that Vicodin.

[Qadgop the Mercotan]

That's one of the reasons why I'm getting out of private practice and getting back into academics. It's just exhausting.
Practice/Resident training in a teaching hospital? Or something else?

[DoctorJ]

Practice/Resident training in a teaching hospital? Or something else?
Resident/student training in a community hospital (the same one I work in now). We have a satellite FP residency program from the state school (my alma mater). I've been working with them for a while as a volunteer, and they asked me to come on as full-time faculty.

Small pay cut; big pain-in-my-ass cut.

[Qadgop the Mercotan]

Small pay cut; big pain-in-my-ass cut.
Hmmmm.

To work with drug seekers, or to work with residents?


[channeling Jack Benny]I'm thinking, I'm thinking![/channeling Jack Benny]

[mks57]

Article here (http://www.chicagotribune.com/news/local/chi-methadone-clinic-berwyn_a-majul23,0,6261973.story) - Berwyn's aldermen voted to allow the clinic, residents turned out to protest, all of the aldermen roll over and revoke their decision. The article mentions that the clinic has a branch in Evanston, which is a fairly upscale suburb in most places. Also, the owner of the other clinic and of the planned one is a resident of Berwyn, so one would think she has a vested interest in keeping her community nice.

This article isn't clear but other news reports did make it sound like it wasn't entirely for addicts, but I could be wrong.

If it's such a perfect town, then they don't need police, fire, or medical services, either. Think of all the money that could be saved. Heck, they probably don't need sewer or sanitation services.

[Second Star to the Right]

Pharmacies in my area have been getting hit, too. I don't think mine is a likely target because its in a busy grocery store in the middle of a busy shopping center, but you never know.

I'm a technician, and get daily phone calls asking if we have Oxycodone 30 mg in stock, the blue ones, not the white. (That part confuses me. It's the same medication, different manufacturer, thus the difference in color. Why does it matter?) Last Saturday I got 3 calls in a row within 5 minutes, from 3 different males who I think were together. I didn't work Sunday but one of the techs told me they got several phone calls that day as well.

It's crazy shit. Per the pharmacists I work under, the answer is always no, we don't have them in stock. If we answer yes to one of these callers, within a couple of hours we get flooded with people with scrips for Roxicodone 30 mg, #360 or #240 or some other crazy high number. Those things go for like $15-20 per pill on the street, and we're located fairly close to some really shitty neighborhoods that are crawling with drug seekers and addicts.

We do have 2 or 3 regular patients who we are familiar with and regularly get prescribed the medication, and we do fill it for them. If we get a new patient with a new prescription, we deal with it on a case by case scenario. It's at the pharmacist's discretion whether we fill it or not.

What I'm curious about is the doctors who prescribe this stuff. It's not like people are bringing us fake prescriptions, they're legitimate. Why is a 20ish year old kid, who looks perfectly healthy and doesn't appear to be in any sort of discomfort(and I know not all pain can be detected by looking, but come on ) getting prescribed this shit? Do the docs get kickbacks from the drug companies? Or just get tons of patients when it gets out that Dr Whoever hands the stuff out like candy? (Note I'm not including people who legitimately need the stuff. Please don't think I'm underestimating what people who live with constant pain deal with.)

Anyways, sorry to hear that, ladyfoxfyre. Hope you(or I) don't have the same experience your friend did.

[Qadgop the Mercotan]

What I'm curious about is the doctors who prescribe this stuff.
No kickbacks from drug companies, that I'm aware of.
Some docs are pill docs, who will prescribe anything for a cash payment, then fake records to document a need. They are few but very popular.

Some docs are easy to con.

Some docs are intimidated by aggressive patients, or just want to please their 'customers'.

Some docs started out prescribing them for what they thought were legitimate needs, and got sucked deeper and deeper into providing more and more, and just can't seem to say 'no more'.

[Moirai]

And....my Google ads are for oxycodone and vicodin. :smack:



Where the hell was the Internet when I was using?!?

:D

[Algorithm]

Where the hell was the Internet when I was using?!?

:D
As far as I know, the sites that advertise they are selling hydrocodone/oxycodone are all scams. There are forums here and there discussing online pharmacy web sites and it seems to be pretty widely understood that you cant just send cash and expect to actually get either of those drugs in return.

[chorpler]

As far as I know, the sites that advertise they are selling hydrocodone/oxycodone are all scams. There are forums here and there discussing online pharmacy web sites and it seems to be pretty widely understood that you cant just send cash and expect to actually get either of those drugs in return.

I don't know about now, but back in 1999 and 2000 you could. One of my contacts at a local methadone clinic showed me a bunch of Internet pharmacy bottles full of hydrocodone. They were from sites that did "phone consultations" where the doctor would talk to you over the phone and prescribe the drugs, then the affiliated pharmacy would mail them.

I think several states have cracked down on this since then though.

[Nava]

Is it due more to marketing or to unscrupulous prescribers (ie, doctors)?

Marketing has a big part in it. SiL was amazed when I was able to get information off her own Pharmacopea (sp?) showing that this drug which the nice medical visitor (aka salesman, in other trades) had convinced her was the next greatest thing for chronic pain has been in the market for years, only under other names and made by other companies. He was pushing a generic as if it was a brand-new thing; a lot of her coworkers bought into it (a pharmacist friend remarked on sales for that particular brand going up).

She's been taking her "medical visitors" with a hefty chunk of salt since.

[Dangerosa]

Resident/student training in a community hospital (the same one I work in now). We have a satellite FP residency program from the state school (my alma mater). I've been working with them for a while as a volunteer, and they asked me to come on as full-time faculty.

Small pay cut; big pain-in-my-ass cut.

My clinic doctor is leaving clinic work because of the pain-in-the-ass nature of the work - his bitch is insurance companies, not addicts, but I'm sure he gets his share of "I pulled my back and have terrible pain."

[ladyfoxfyre]

I'm a technician, and get daily phone calls asking if we have Oxycodone 30 mg in stock, the blue ones, not the white. (That part confuses me. It's the same medication, different manufacturer, thus the difference in color. Why does it matter?) Last Saturday I got 3 calls in a row within 5 minutes, from 3 different males who I think were together. I didn't work Sunday but one of the techs told me they got several phone calls that day as well.

It's crazy shit. Per the pharmacists I work under, the answer is always no, we don't have them in stock. If we answer yes to one of these callers, within a couple of hours we get flooded with people with scrips for Roxicodone 30 mg, #360 or #240 or some other crazy high number. Those things go for like $15-20 per pill on the street, and we're located fairly close to some really shitty neighborhoods that are crawling with drug seekers and addicts.

We do have 2 or 3 regular patients who we are familiar with and regularly get prescribed the medication, and we do fill it for them. If we get a new patient with a new prescription, we deal with it on a case by case scenario. It's at the pharmacist's discretion whether we fill it or not.

What I'm curious about is the doctors who prescribe this stuff. It's not like people are bringing us fake prescriptions, they're legitimate. Why is a 20ish year old kid, who looks perfectly healthy and doesn't appear to be in any sort of discomfort(and I know not all pain can be detected by looking, but come on ) getting prescribed this shit? Do the docs get kickbacks from the drug companies? Or just get tons of patients when it gets out that Dr Whoever hands the stuff out like candy? (Note I'm not including people who legitimately need the stuff. Please don't think I'm underestimating what people who live with constant pain deal with.)


Are you me? I could have easily described this as both my daily work experience and my exact thought process. I've been noticing crazy high quantities on the stuff lately too, but only in the past year. And yes, the"blue ones". I have heard that the "blue ones" are much easier to crush and abuse.

And yes, I'm getting a shitload of under 25 year olds with scripts for #240, #360, etc. It's getting really insane.

ETA: And, you live and work in my town. Maybe you are me....;)

[Quartz]

Psst! You've just dropped to Guest status.

[Indygrrl]

No kickbacks from drug companies, that I'm aware of.
Some docs are pill docs, who will prescribe anything for a cash payment, then fake records to document a need. They are few but very popular.

This is something I don't understand. Back when I had legitimate chronic pain from endometriosis and adenomyosis, my docs would barely prescribe 20 of the lowest mg hydrocodone a month. And I was in daily, exhausting abdominal pain. If ever I had a real reason for heavy pain meds, this was it, but no amount of proof of my condition would convince them to prescribe me anything. It was like they were super paranoid about the DEA coming down on them.

This led me to go out and find my own sources, which is part of why I think I got addicted (that and unfortunate genetics). I really believe that a lot of addicts start out as desperate pain patients who can't get the medication they actually need. You'll do anything when you have pain like that. And those pill docs know it, which is why they can charge you $200 for an appointment every two weeks. And they know you'll get addicted, which keeps you going even once your pain is gone.

Anyway, there are at least two doctors in Indianapolis who have been busted multiple times for unscrupulous prescription writing. We're talking cash only docs that have waiting rooms full of junkies. They make the news and then two months later you hear that they are back in business. How the heck do they get away with it?

[Second Star to the Right]

Are you me? I could have easily described this as both my daily work experience and my exact thought process. I've been noticing crazy high quantities on the stuff lately too, but only in the past year. And yes, the"blue ones". I have heard that the "blue ones" are much easier to crush and abuse.

And yes, I'm getting a shitload of under 25 year olds with scripts for #240, #360, etc. It's getting really insane.

ETA: And, you live and work in my town. Maybe you are me....;)



In case it was keeping anyone up nights, ladyfoxfyre and I discovered via IM we are in fact two separate people who happen to work right down the street from each other.



This is something I don't understand. Back when I had legitimate chronic pain from endometriosis and adenomyosis, my docs would barely prescribe 20 of the lowest mg hydrocodone a month. And I was in daily, exhausting abdominal pain. If ever I had a real reason for heavy pain meds, this was it, but no amount of proof of my condition would convince them to prescribe me anything. It was like they were super paranoid about the DEA coming down on them.


I hear you, and I don't quite get it, either. I have back pain that has been growing steadily worse over the past few years. It got worse after I got rear ended in my car(twice!) by a hit and run driver. So after the accident I finally told my doc about the problem. Was told to use Aleve and a heating pad. Didn't help. Got prescribed Soma, finished the prescription and refill. Didn't help. Put me to sleep, mostly. Got prescribed Diclofenac, finished the presciption. Didn't help.

I finally stopped mentioning the pain because I didn't want my doctor to think I was a drug seeker. I guess it's just a matter of finding the right doctor. Some prescribe it only as a last resort, others hand it out left and right. And I certainly don't want 30 mgs of oxycodone. That shit is wayyy stronger than I could stomach. Just something to dull the pain, especially after a 10 hour workday with a throbbing back. Ugh.

[hotflungwok]

I wish I had some of your docs. I had multiple surgeries on my right foot a few years back, and now I have severe nerve damage in all the major nerves in my right lower leg. Anything that touches my foot causes pain, anything. My doctor wouldn't give me anything for pain after he determined that it had healed. He assured me it would get better. Well, it's been three years, and putting on a sock still hurts like hell. I could definitely use something, if just to help me get to sleep at night.

[Qadgop the Mercotan]

I wish I had some of your docs. I had multiple surgeries on my right foot a few years back, and now I have severe nerve damage in all the major nerves in my right lower leg. Anything that touches my foot causes pain, anything. My doctor wouldn't give me anything for pain after he determined that it had healed. He assured me it would get better. Well, it's been three years, and putting on a sock still hurts like hell. I could definitely use something, if just to help me get to sleep at night.
Nerve pain often responds to such meds as gabapentin, pregabalin, amitriptylene, and others. People with nerve pain issues should ask their physicians if they might benefit from such therapies.

[VunderBob]

I live in a very small town, and the pharmacy was broken into Sunday afternoon.

The perp, in a very long and convoluted story, fled the scene in a car, abandoned it south of town, crossed a very dangerous swamp wearing only blue jeans, and wound up at the house of the pharmacist's brother in law, asking for a ride home north of town, which he got. Drove right past the sheriff's deputies investigating the break-in, too. :rolleyes:

He's still at large, but the perp is known, several witnesses saw the break-in, and the amount of blood he left behind at the scene will be hard to beat for DNA evidence. If he doesn't die from the infections he'll get from swimming the swamp with all those lacerations...

[hotflungwok]

Nerve pain often responds to such meds as gabapentin, pregabalin, amitriptylene, and others. People with nerve pain issues should ask their physicians if they might benefit from such therapies.
See, this is interesting, because the doctor who performed the surgeries told me that there was nothing that could be done for it except waiting. I saw a podiatrist for an ingrown toenail last year, and when I told him the whole story he gave me cortisone shots (ouch) and put me first on neurontin(?) and then lyrica, when the side effects of neurontin proved to be too strong. Unfortunately they really didn't do anything.

[Qadgop the Mercotan]

Unfortunately they really didn't do anything.
Bummer. Chronic pain sucks. :(

[hotflungwok]

Bummer. Chronic pain sucks. :(
The big thing that bugs me about this is that I had to argue with my doctor to give me something for pain, just so that I could relax a bit after I went out shopping or whatever. He kept saying 'We don't want to treat this with drugs'. I don't want to be on pain pills for the rest of my life, but holy shit 10 fucking minutes without pain would really be nice right about now. And I hear about doctors that throw narcotics at people who can spell their name right 2 out of 3 tries, and I wonder what the hell I'm doing wrong.

The drugs that you named, are they different or the same as the ones I named?

[Lynn Bodoni]

And I hear about doctors that throw narcotics at people who can spell their name right 2 out of 3 tries, and I wonder what the hell I'm doing wrong. Everyone seems to want to give me hydrocodone. I can't process this stuff, so all it does is make me somewhat woozy and nauseous. Fortunately, I can take Darvocet.

Can you go to another doctor? I think that pain management is given more priority these days, and it seems that your current doctor isn't with the program. I take Cymbalta, primarily as an antidepressant, but it also helps with my neuropathy. Of course, living with chronic pain is liable to depress anyone.

[Qadgop the Mercotan]

The drugs that you named, are they different or the same as the ones I named?
Gabapentin is Neurontin, Pregabalin is Lyrica, so yes you've been on those.

Amitriptyline is Elavil, a tricyclic. And if you haven't tried a class of tricyclics to see if they help nerve pain, you might want to discuss that with your doc.

[diggleblop]

He's still at large, but the perp is known, several witnesses saw the break-in, and the amount of blood he left behind at the scene will be hard to beat for DNA evidence. If he doesn't die from the infections he'll get from swimming the swamp with all those lacerations...


He shoulda swiped some antibiotics while there.

[hotflungwok]

Everyone seems to want to give me hydrocodone. I can't process this stuff, so all it does is make me somewhat woozy and nauseous. Fortunately, I can take Darvocet.
Darvocet is my drug of choice too. Percocet makes me constipated, naseous, and hallucinate. The week after surgery was interesting.

One thing I've found, is that when I ask for Darvocet by name in a pain medication situation (like when I had a kidney stone a few months ago), I get eyeballed by the physician. I understand that they're supposed to look out for people who want a fix, but cmon, I've got a rock in my urinary tract. I think it's time to make with the good stuff.

Can you go to another doctor? I think that pain management is given more priority these days, and it seems that your current doctor isn't with the program. I take Cymbalta, primarily as an antidepressant, but it also helps with my neuropathy. Of course, living with chronic pain is liable to depress anyone.
Yeah, it sucks. I'm about to move to a different city, so I'm really tight on money right now. I'll have to look into after I get a new doctor there. Maybe I can ask my family doctor about it before I go, though. Moving is going to be a whole adventure in pain, and I sure could use a bit of relief.

[Second Star to the Right]

Sorry to hear of your troubles, hotflungwok, and that just reinforces my feelings on the subject that much more. It's not fair. Some people have to suffer through chronic pain because of doctors who are wary about giving out pain meds, yet others easily obtain pills that they then crush and snort or inject to obtain a heroin-like high(so I've heard), or sell to other junkies and make thousands of dollars. (Literally. As I mentioned in a previous post, Roxicodones go for $15 and up on the streets. A scrip for, say, 240 of these pills, if sold, is worth at least $3600). Amazing.

Thanks for the answer re: docs QtM, and I have another question for you or anyone who cares to answer. I see "pain management clinics" all over town, and most of the scrips for narcotics I get presented with at work come from one of these places. Are these types of places generally known for being quick to prescribe controlled substances, or are some of them legitimate? (I suspect it's a bit of both.) How are they generally regarded by the medical community, by MDs who do not work in such places? What is your opinion on them? (Again, I suspect there are varied answers and opinions as there are with most things.) Thanks in advance for any answers.

[whiterabbit]

I have a close relative who has chronic pain issues and let me tell you the pain management clinic she goes to is totally on the up-and-up. They have a lot of rules about how they prescribe and they do not hesitate to boot your ass if you break them or try to get around them in some way.

[aruvqan]

I love my dads surgeon - she was adamant about his pain control. She said that at the age of 84, after having an illiotomy, a PIC and a PEG installed, they would worry about withdrawl *after* he got out of surgical ICU. Unfortunately he didnt live, but he did not have to deal with inordinate pain while trying to survive [he picked up a secondary infection and just was not able to fight it and heal...but the care in the hospital was amazing.]

[JayRx1981]

I see "pain management clinics" all over town, and most of the scrips for narcotics I get presented with at work come from one of these places. Are these types of places generally known for being quick to prescribe controlled substances, or are some of them legitimate? (I suspect it's a bit of both.)

A bit of both, in my experience. The more reputable ones I've dealt with tend to make their pain patients sign contracts requiring them to go only to that clinic for their pain meds, and some even require the use of a certain pharmacy so that use can be appropriately monitored. It's basically one of those things you just learn through the grapevine and experience in your area. Oftentimes, your PCP will have a good idea of which places are reputable.

What is your opinion on them? (Again, I suspect there are varied answers and opinions as there are with most things.) Thanks in advance for any answers.

My opinion is that they perform a vital function and I wish there were more qualified pain specialists, given the incredibly long wait times for the few that exist now.

[Ensign Edison]

Some docs started out prescribing them for what they thought were legitimate needs, and got sucked deeper and deeper into providing more and more, and just can't seem to say 'no more'.

And some must themselves be addicts, who of course often love to enable other addicts. I was once, without having mentioned pain, unexpectedly given an oxy script for a condition which I'd always treated with OTC advil before. Based on this as well as some visual and verbal clues, I'm certain the doctor was on something.

[Qadgop the Mercotan]

I see "pain management clinics" all over town, and most of the scrips for narcotics I get presented with at work come from one of these places. Are these types of places generally known for being quick to prescribe controlled substances, or are some of them legitimate? (I suspect it's a bit of both.) How are they generally regarded by the medical community, by MDs who do not work in such places? What is your opinion on them? (Again, I suspect there are varied answers and opinions as there are with most things.) Thanks in advance for any answers.
Pretty much what Jay said. They run a gamut.

Some are pill mills that should be shut down.

Some are run by docs who think all pain is the result of an opiate deficiency, and that it's reasonable to give enough opiates to make the patient stop complaining of pain.

Some are quite legit, recognize that opiates are only one of many tools in the toolbox for treating chronic non-malignant pain, and usually they're not the first tool to be reached for. These places use and abide by patient contracts regarding opiate use, and they don't hesitate to tell a patient: "Sorry, you violated the agreement, you'll need to find another doctor".

I find that (painting with an overly broad brush here) pain clinics run by anesthesiologists are pretty good for doing injections for trigger points, facet pain, nerve impingements and similar, but tend to be rather too liberal with opiates and not use enough physical therapy, home exercise, meditation, relaxation, & non-opiate meds.

Conversely, those pain clinics run by physiatrists (doctors specialisting in physical medicine and rehabilitation) tend to be better with non-opiate therapies, and tend to use the opiates more circumspectly. Just IMHO, of course. But I do have some experience with chronic pain treatment and its various philosophies.

[Second Star to the Right]

Thanks for the answers, all. It's good to hear there are some good ones out there. I became suspicious of them after one of our regular patients came to us for advice. He had gone to his appointment for his pain management and found the place closed up, apparently deserted. No cars in the lot, nothing. They evidently closed up shop in a hurry. He's been on oxycodone for some time and would have suffered withdrawal if he abruptly stopped taking it. He did manage to get a scrip for it someplace else.


aruvqan, sorry to hear of your dad's passing.

[diggleblop]

One thing I've found, is that when I ask for Darvocet by name in a pain medication situation (like when I had a kidney stone a few months ago), I get eyeballed by the physician. I understand that they're supposed to look out for people who want a fix, but cmon, I've got a rock in my urinary tract. I think it's time to make with the good stuff.

I think he eyeballed you because Darvocet is about as strong as an extra strength Tylenol.

[DoctorJ]

I see "pain management clinics" all over town, and most of the scrips for narcotics I get presented with at work come from one of these places. Are these types of places generally known for being quick to prescribe controlled substances, or are some of them legitimate? (I suspect it's a bit of both.)
Usually both. Most of the ones I've dealt with are quick to get patients started on at least small doses of narcotics, but they also use other modalities like joint injections, physical therapy, and psychologic counseling.

The good ones around here are EXTREMELY strict. There's a monthly urine drug screen and monthly KASPERs (Kentucky's narcotic-reporting system). They do occasional "pill counts", in which a patient is called mid-month to come in that day with their medication to make sure they have as many left as they're supposed to. It doesn't take much to get kicked out, but it doesn't take that much to stay in, either.

By the way, we have four such clinics in my little town. By contrast, we have seven sit-down restaurants.
How are they generally regarded by the medical community, by MDs who do not work in such places?
Necessary evils, IMO. They've done wonders for a few of my patients with non-narcotic treatments, but more than anything they're where I send someone who needs more narcotic than I'm comfortable writing. I could write the narcs just as well myself for appropriate patients, but I don't have the time or staff to monitor everything properly, especially with the onslaught I'd get once word got out that I was loose with the pain pills. (Word would get out in about fifteen minutes.)

[brujaja]

Qadgop, I'm just curious about something you said back at the top of the thread:
And inadequately treated severe acute pain often results in nerve remodeling changes, which can cause long-term chronic pain. So it's important to treat moderately severe acute pain, with narcotics if necessary.
I'm wondering why the inadequately treated pain results in nerve remodeling changes.

Is it because the pain causes one to unconsciously favor the affected area, causing atrophy and posture shifts? Or does severe acute pain actually burn out nerves? Or something else?

[Leah M]

I think he eyeballed you because Darvocet is about as strong as an extra strength Tylenol.

Yeah, no kidding.

They gave me Darvocet for a massive dental abscess after they jammed wax in the broken tooth spot without any novocaine or pain relief of any kind (my second abscess in a few months, I'm going through major long-term dental work, and no matter how clean I keep my teeth, they keep getting reinfected). I was in the ER screaming in pain, crying so hard I couldn't breathe, and that's what they gave me. It did absolutely nothing. They told me to call my dentist, who wouldn't touch the tooth because it was in such bad shape I needed an oral surgeon, and the surgeon wouldn't see me for a month. Oh, and a child's dose of Penicillin.

I went back a second time a few days later after not being able to eat anything and drink more than water, and they just gave me a second antibiotic.

I get a handful of generic, lowest dose possible Vicodin every month for my endometriosis, and I only got that after almost 10 years of pain and two surgeries that couldn't get rid of it all.

But I've talked to people who got morphine in the ER for a stomachache.

[hotflungwok]

I think he eyeballed you because Darvocet is about as strong as an extra strength Tylenol.
:confused:
Things like asprin and ibuprofen don't do anything to the pain in my foot, but Darvocet does. I was taking 100mg doses, about 2 weeks after surgery, and it got rid of pain that was preventing me from sleeping. Same thing now, no side effects. Is it the same stuff as extra strength tylenol? Cuz it certainly doesn't behave the same.

[Qadgop the Mercotan]

Qadgop, I'm just curious about something you said back at the top of the thread:

I'm wondering why the inadequately treated pain results in nerve remodeling changes.

Is it because the pain causes one to unconsciously favor the affected area, causing atrophy and posture shifts? Or does severe acute pain actually burn out nerves? Or something else?
It probably happens on the molecular level of the nerve fibers involved, involving gate theory and a few other principles that as a generalist I'm no longer up on.

It's unlikely to involve asymmetric use and posture shifts, although those things do cause acute and chronic pain elsewhere.

And the nerves rarely burn out, they just get re-programmed to send pain messages in response to all sorts of non-painful stimuli.

[Qadgop the Mercotan]

And darvocet (propoxyphene) is a relatively sh***y pain med, but it is an opiate, so causes some euphoria, and tends to cause habituation and if stopped after habituation occurs, will result in a withdrawal syndrome.

It was also one of my early opiate experiences, back in college. I loved it, after getting it for back pain. I hadn't known what to expect at all, I thought it was some sort of prescription aspirin. It didn't take my back pain away very much, but it made me feel wonderful.

It's also got metabolites that are somewhat toxic to the liver. I've had it taken off the formulary in our medical system for the above reasons.

[brujaja]

That's really interesting. I am very curious about the mechanism. I'll go do some research. Thanks, Qadgop.

(by the way, have I ever mentioned how much I looove to see words which let Q run free without benefit of a "u"? I love that.)

[aruvqan]

Thanks for the answers, all. It's good to hear there are some good ones out there. I became suspicious of them after one of our regular patients came to us for advice. He had gone to his appointment for his pain management and found the place closed up, apparently deserted. No cars in the lot, nothing. They evidently closed up shop in a hurry. He's been on oxycodone for some time and would have suffered withdrawal if he abruptly stopped taking it. He did manage to get a scrip for it someplace else.


aruvqan, sorry to hear of your dad's passing.
Thanks, I miss him but not painfully so =)

I know that in several cities I have lived in there were shady pain managment clinics and dr feelgoods ... I used to live near a clinic in Norfolk VA that had a full on DEA raid once. I got to watch it from a couple of parkinglots away. Fascinating!