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  #1  
Old 09-08-2012, 12:27 AM
obbn obbn is offline
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DEA required drug test of chronic pain patient

Hello Everyone,

A brief bit of background, I am a chronic pain patient. I have been prescribed scheduled narcotic drugs since 2003. Currently I am using morphine, percocet and amphetamine (the later to keep me awake during the day as the other two make me so tired). In the past I have been prescribed everything from Fentynal to Vicodin. So I was somewhat confused at my last doctor appointment.

I have a great relationship with my doctor that could be described as a friendship. This is important as it would be very hurtful to think he had a reason to not trust me. I went for my monthly appointment to get refill prescriptions for my medication (they can't be called in). At each of these appointments I always bring in my current prescriptions so the doctor can visually see how much I have left and so he knows I am taking the meds as prescribed. This time at the end of the appointment he casually said, "Next appointment I need you to submit to a drug test. It is a DEA requirement that patients getting the drugs you are on be tested to make sure that they are being taken and not sold", he then went on to say that this is something that we should have been doing all along, but "I know you're taking them so I haven't bothered". He then went in to explain that he wanted to make sure that all his paperwork was in order in the event of an audit by the DEA.

So, no big deal, I have no problem peeing in a cup and being tested as I take my meds as prescribed and would never even think of selling even a single pill. (besides, I wouldn't even know who to sell one to even if I wanted to. The same with pot. I don't smoke it, but even if I wanted to I wouldn't have a clue where to get it. Yeah I've become old and boring). The thing I want to know is does the DEA require those of us on these powerful narcotics to do an occasional drug screen? I have never been asked to do this, nor have I ever heard of it. I do know that the doctor does have to submit paperwork to the DEA regarding his prescriptions. I live in Central Florida and apparently the buying and selling of prescription drugs is a huge problem here, so on the surface it sounds plausible. I would really hate to think the doctor who I trust so much and have developed a friendship with over the years suspects me of something and is using this story to cover his suspicion. But then again, he gave me advanced notice of the test, which would totally go against that line of thinking. By giving me notice, that tells me he knows I am doing what I should be doing and he had no worries. If he did, then it would stand to reason that it would be a surprise test to confirm something.

I apologize for the long post, but I thought it was important to give as much detail as possible. If this really is a DEA requirement doesn't it just sound like it is a violation of some sort of civil right? I mean how can it be legal for the DEA to randomly test an individual without any shred of wrongdoing? Kind of funny though, first time I have ever heard of anyone being tested to make sure they are using drugs!
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  #2  
Old 09-08-2012, 12:42 AM
Joey P Joey P is offline
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I can't say I've ever heard of something like that. Besides, you have a 30 day notice, so even if you were selling the drugs, all you'd have to do is take them for a few days before the appointment.

I almost have to wonder if the doctor is (currently?) under some kind of investigation. Either he over prescribes and needs to prove that his patients aren't dealers or maybe it's something routine and the DEA picked some of his patients that are taking more controlled substances then normal and asked him to submit a test from them.

If have a decent relationship with your pharmacist, you might ask him. There's a good chance he has an idea as to what the DEA is up to in your neck of the woods. He might tell you it's totally normal or something more along the lines of "Yeah, I've heard/read about them doing that in X types of situations" or "Nope, that seems really odd, I deal with the DEA all the time and I've never heard of that"
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Old 09-08-2012, 12:50 AM
Joey P Joey P is offline
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Not DEA mandated, but an example of someone (private practice) doing it on her own...and charging the patients. She was doing it to (mainly as far as I can tell) to make sure the drugs weren't being diverted. http://www.jenniferschneider.com/art...er_UDTests.pdf
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Old 09-08-2012, 01:22 AM
obbn obbn is offline
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Originally Posted by Joey P View Post
I almost have to wonder if the doctor is (currently?) under some kind of investigation. Either he over prescribes and needs to prove that his patients aren't dealers or maybe it's something routine and the DEA picked some of his patients that are taking more controlled substances then normal and asked him to submit a test from them.

Interesting thought although I doubt it. My doc is a family practice and not a pain clinic practice. Most of his patients are there for the sniffles and routine stuff. I have chosen to have him manage my pain because he has done an outstanding job at keeping it under control, while at the same time working with me to get the right combo of medications and with his help I have drastically reduced the amount of medication that I am taking every day. It is rare to find a doctor who is willing to take all the time necessary to listen to your concerns and then take the time to research the most obscure things to help. Hell, I have asked many questions here about my pain and asked for suggestions on how to control it. When I get a good suggestion I share it with my doc, he never blows it off and takes the time to investigate the suggestion. If anything, he has encouraged me to reduce the amount of drugs I'm taking and try alternative methods of pain relief, such as a tens unit.

As far as the possibility of him checking to make sure the meds aren't being diverted like in your link, that could be a possibility. If it is I can't think of a single reason why he would even remotely suspect that. If anything I am anal about making sure he visually sees my meds and how many are left and such. I have even turned down refills, knowing I had enough (barely) left until next month. Just recently I mentioned the morphine doesn't appear to be working as well as it use to. He asked if I wanted to increase my dosage, as we both know my tolerance is building. I declined staying that while it will certainly work, the higher dose now will just increase my tolerance a year down the road. Since I am only 45 and there doesn't appear to be any surgical fix on the horizon I thought it best to try to keep my dosage as low as possible for as long as possible. Otherwise I might find at 60 nothing will a work to control the pain. While there is no "limit"on the amount odd narcotics one can take, if you get doses high enough eventually you will stop breathing. Granted, that will solve my pain problem, but would be a bit inconvenient. To sum up, I believe I have done everything one can do to instill confidence in a practitioner that the medication they are prescribing is being used responsibly. And as mentioned, I have developed a friendship with my doctor and it would be hurtful to think someone you consider a friend has questions or doubts about your character. But, if so I have nothing to worry about.
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Old 09-08-2012, 01:59 AM
Ambivalid Ambivalid is offline
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Originally Posted by Joey P View Post
I can't say I've ever heard of something like that.
Really? Just google "DEA drug tests pain patients" and see what comes up. His doc is not alone, apparently.
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  #6  
Old 09-08-2012, 02:43 AM
Lancia Lancia is online now
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I was under the care of a pain doc for a couple of years after a back injury. I was always required to submit to a drug test whenever I was on narcotics. He liked to tweak my meds a lot, so some months I was motrin or tramadol and others on darvocet or norco. I would only get the drug screen when I was on the controlled pills. I only failed once, when my back wasn't bothering me and didn't want to take the norco, and had forgotten about the test. He gave me a lecture, and stated the same reasons in the OP: to make sure I was taking them and not selling them. I had a good relationship with him and he refilled my script anyway.

So obviously not an isolated incident, although I have no idea if he was acting on orders from the DEA.
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Old 09-08-2012, 04:01 AM
obbn obbn is offline
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Originally Posted by Lancia View Post
I was under the care of a pain doc for a couple of years after a back injury. I was always required to submit to a drug test whenever I was on narcotics. He liked to tweak my meds a lot, so some months I was motrin or tramadol and others on darvocet or norco. I would only get the drug screen when I was on the controlled pills. I only failed once, when my back wasn't bothering me and didn't want to take the norco, and had forgotten about the test. He gave me a lecture, and stated the same reasons in the OP: to make sure I was taking them and not selling them. I had a good relationship with him and he refilled my script anyway.

So obviously not an isolated incident, although I have no idea if he was acting on orders from the DEA.
Well, great to hear I'm not the only one. I guess I can safely remove my tin foil hat now. Thanks!
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Old 09-08-2012, 04:59 AM
Troppus Troppus is offline
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Sounds like you are a high functioning and intelligent user of narcotics, which is atypical at this point. I visit a busy pain clinic for the occasional steroid shot, and since I'm intolerant to narcotics, I'm generally the only person in a packed waiting room who is not zombified and drooling. No offense to those with chronic pain, but to my untrained eye many pain clinic patients are either drug seekers or incoherent from meds. So if you are together, ambulatory, and well-spoken in a region notorious for prescription drug problems, you may stand out. Take that as a compliment, understand that a general practitioner may feel the need to cover his posterior, and continue to enjoy your good relationship with someone who helps you.
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Old 09-08-2012, 05:04 AM
grude grude is offline
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Originally Posted by Lancia View Post
I was under the care of a pain doc for a couple of years after a back injury. I was always required to submit to a drug test whenever I was on narcotics. He liked to tweak my meds a lot, so some months I was motrin or tramadol and others on darvocet or norco. I would only get the drug screen when I was on the controlled pills. I only failed once, when my back wasn't bothering me and didn't want to take the norco, and had forgotten about the test. He gave me a lecture, and stated the same reasons in the OP: to make sure I was taking them and not selling them. I had a good relationship with him and he refilled my script anyway.

So obviously not an isolated incident, although I have no idea if he was acting on orders from the DEA.
None of those meds are even schedule 2, I'd have told him that if he wanted to pee test me to bump me up to something decent
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Old 09-08-2012, 05:54 AM
obbn obbn is offline
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Originally Posted by Troppus View Post
Sounds like you are a high functioning and intelligent user of narcotics, which is atypical at this point. I visit a busy pain clinic for the occasional steroid shot, and since I'm intolerant to narcotics, I'm generally the only person in a packed waiting room who is not zombified and drooling. No offense to those with chronic pain, but to my untrained eye many pain clinic patients are either drug seekers or incoherent from meds. So if you are together, ambulatory, and well-spoken in a region notorious for prescription drug problems, you may stand out. Take that as a compliment, understand that a general practitioner may feel the need to cover his posterior, and continue to enjoy your good relationship with someone who helps you.
Thanks for the compliment. I have done everything I can to avoid becoming "zombified" by the drugs. Thankfully the only serious side effect that seems to plague me is constant lethargy from the opioids. As mentioned above I am taking amphetamine to counter the lethargic effects of the opioids. The addition of the amphetamine has changed my life as I am now able to stay awake all day. The only sad part is I seem to be developing a very rapid tolerance to the drug and unfortunately there are no alternatives once this becomes totally ineffective. Truth be told, the use of the narcotics scares the crap out of me, but I don't have much in the way of options. Without them the pain is intolerable and if I could find a solution other than drugs I would pursue it. I broke my back while working and am now fused from L3 to S1, a really bad place to be fused. The doctors not only can't find a solution, but they can't seem to identify the cause of the pain. Other than, "let us cut you open for the third time and take a look around" they haven't come up with much. Each surgery seems to leave me in a bit worse shape than before, so I am in no hurry to let them poke around in me without some sort of objective.

As far as the drug seekers, I just don't get it. For some reason I have never gotten a high off the pain meds (except once in the hospital on Demerol via an IV, sent me to the moon) so I just don't get the attraction. To me they are an evil necessity and I constantly ponder the damage that is happening to my body from years of taking these things. But it could always be worse. Hell, I could have been paralyzed. I lost my much loved career and the injury cost me a marriage, but today I am married to a wonderful woman and I have much to be thankful for, others aren't so lucky.
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Old 09-08-2012, 08:08 AM
md2000 md2000 is offline
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Maybe he heard of a friend or through the grapevine of some doctor being audited and decided he'd better tidy up his practice.

Maybe he'd made the exception because since you were not one of the walking dead, and I presume could carry on a coherent conversation, and did not seem to be asking for more and larger doses, you obviously did not fit the category of users or user/reseller. Nevertheless, he needs to get his shit in order should the DEA look at his records.

I assume the test will notice levels, so at the least you have to take the full prescribed dose for at least a week before the test to look like you are properly taking you meds?

I had a friend in med school many years ago who told be about his volunteer time in a downtown medical clinic. He mentioned there were a lot of "patients" who came in faking describing all the symptoms that called for narcotic muscle relaxants and painkillers (but an exam showed none of the physical symptoms). Usually the only give-away he said was the way their face dropped when they got a prescription for a non-narcotic drug.
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Old 09-08-2012, 09:04 AM
Joey P Joey P is offline
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Originally Posted by Ambivalid View Post
Really? Just google "DEA drug tests pain patients" and see what comes up. His doc is not alone, apparently.
Nope, really never heard of it. But since reading about it (when I made my second post), I have. Seems like a combination of two things. To make sure the patient is actually the one taking the drugs as well as to see if they're taking any other (illegal) drugs. Some reports say that it's because other drugs may interfere with how well the prescription PKs do their job, but I have to wonder if at least part of it is because it gives the doctor the some leverage to suggest the the patient (at least in the case of non-chronic..'hey doc, I'm 20 and my back has been hurting for a week') is drug seeking.

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Maybe he'd made the exception because since you were not one of the walking dead, and I presume could carry on a coherent conversation, and did not seem to be asking for more and larger doses, you obviously did not fit the category of users or user/reseller. Nevertheless, he needs to get his shit in order should the DEA look at his records.
I would think not being "one of the walking dead" might suggest to a doctor that the OP wasn't taking their meds. Of course, plenty of people can take their meds, especially after growing a tolerance to them over a period of years or months and be perfectly coherent. But, my point is, someone that was 'the walking dead' obviously isn't diverting them.
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Old 09-08-2012, 12:46 PM
Simple Linctus Simple Linctus is offline
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Not only is this very common (and yes, it's the DEA's fault) my understanding is that if they find even cannabis in your urine you will almost certainly be dropped immediately as it will mark you as an illicit drug user.

Of course there are many people who don't receive enough opiates to deal with their pain, and therefore also self medicate with cannabis, without knowing this, and then get screwed over for life. Potentially if you hand around people smoking cannabis you can yourself test positive. Oh and the tests sometimes come up positive for stuff anyway completely randomly.

Normally there's an agreement at US pain clinics that you have to sign acknowledging this, I think.

Fortunately this is all completely necessary and effective, because the DEA has managed to entirely prevent illegal drugs from being sold or consumed anywhere in America.
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Old 09-08-2012, 01:24 PM
md2000 md2000 is offline
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Originally Posted by Joey P View Post
...

I would think not being "one of the walking dead" might suggest to a doctor that the OP wasn't taking their meds. Of course, plenty of people can take their meds, especially after growing a tolerance to them over a period of years or months and be perfectly coherent. But, my point is, someone that was 'the walking dead' obviously isn't diverting them.
Yes, but a doctor would (should?) know how zombie-like a person would be based on their consumption level. If the profit motive came into play, the person would be asking for higher doses, occsasionally "lose" their meds and need an early refill, etc. I hope the doctor is looking for give-away symptoms.
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Old 09-08-2012, 02:23 PM
Colibri Colibri is offline
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Since this involves legal advice, it's better suited to IMHO than GQ.

Colibri
General Questions Moderator
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  #16  
Old 09-08-2012, 02:25 PM
t-bonham@scc.net t-bonham@scc.net is offline
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Originally Posted by obbn View Post
Interesting thought although I doubt it. My doc is a family practice and not a pain clinic practice. Most of his patients are there for the sniffles and routine stuff.
This may be part of the reason. You will stand out in the doctor's records from his other patients, as receiving a much higher level of scheduled pain medications. That would be a red flag to any DEA person auditing his records, so your doctor may just be being proactive in getting this drug test into your records.

If he was a pain specialist, you wouldn't stand out so much. (But then, such drug tests may be standard practice for a pain specialist's patients.)
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Old 09-08-2012, 02:26 PM
grude grude is offline
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I talked to someone who was on fentynal patches, didn't like the way they felt and asked to quit the patches and go back on darvocet which they did well with before they were escalated to the patches. Big mistake as apparently asking for something in particular was a red flag, even something as laughable as propoxyphene. They got dropped and had to find a new clinic, went to the ER because of their withdrawal etc.
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Old 09-08-2012, 03:21 PM
cynyc cynyc is offline
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I knew somebody once who was on oxycontin for pain. Or said he was. He told me some story about his having to meet with the DEA and his doc. I didn't get it and didn't pursue that line of conversation because it seemed so Out There. So I guess it happens.

The irony is that the latest research indicates that pain sufferers are being under-medicated due to substance abuse paranoia. My reg doc won't even give me Tramadol so I have to go to a pain mgt. clinic now. But I don't want meds. I want to be fixed. :-(
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Old 09-08-2012, 05:46 PM
PandaBear77 PandaBear77 is offline
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At work (where I read medical records ALL day) I've never really seen a chronic pain patient that *didnt'* have to submit to an occasional drug test. I always figured it was just the doctors covering their asses, though, I've never heard of it being a DEA requirement, but it wouldn't surprise me if that were true.

FWIW, I have seen a lot of chronic pain patients get busted for pot. Most (but not all of the time) their doc will give them a second chance and then dump them if they test positive for it again. What always surprises me is the number of people who get warned after the first positive result and STILL keep smoking it.
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Old 09-08-2012, 06:20 PM
aruvqan aruvqan is offline
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Originally Posted by PandaBear77 View Post
At work (where I read medical records ALL day) I've never really seen a chronic pain patient that *didnt'* have to submit to an occasional drug test. I always figured it was just the doctors covering their asses, though, I've never heard of it being a DEA requirement, but it wouldn't surprise me if that were true.

FWIW, I have seen a lot of chronic pain patients get busted for pot. Most (but not all of the time) their doc will give them a second chance and then dump them if they test positive for it again. What always surprises me is the number of people who get warned after the first positive result and STILL keep smoking it.
I have a great relationship with my doc, and I pee in a cup about once a year. About once a year the office asks me to bring in my bag o'meds. Oddly, the only time I ever got a call about a discrepancy was when I was freshly off byetta and not yet on lantus I got asked why I wasn't renewing my needle scrip by the pharmacy.

I got to chatting with the training nurse because I asked to be taught how to mix insulin/use a standard syringe even though I use lantus - I figured with our traveling, I might have to revert to classic old school insulin sometime. [better safe than sorry]
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Old 09-08-2012, 10:56 PM
obbn obbn is offline
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But I don't want meds. I want to be fixed. :-(
QFT and amen brother. They can have their damn drugs if they can find a way to fix me. I did about an hours worth of work today around the house and the last 5 hours have been pure hell. Here I am a 220lb full grown man and I have been lying on the couch with tears streaming down my face, even though I have 60mg of morphine in me and two 325/10 percocets and they aren't working. Hard to fool the kids sometimes that Dad is okay when I am crying because of the pain. Please take care of your back people, you don't want this problem.
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Old 09-09-2012, 12:10 AM
Curiosity Kills Her Curiosity Kills Her is offline
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I haven't heard of the DEA being involved before this post but my state has really cracked down on prescription narcotics, partially because there's a huge methadone problem here and there have been more prescription related overdoses than than those from illegal drugs.

I've been very lucky considering I've been bounced around from PCP to PCP after the one I'd established a trust relationship with died of cancer. I'm especially lucky in that I've done and said things that have worked against me like showing up after two weeks of sleep deprivation begging for something, anything to knock me out while wearing a Grateful Dead shirt. If I'd been in my right [and well-rested] mind I'd have thought that one through a little better. I also went in saying Demerol wasn't really doing it for me but that a friend had let me try one of his prescribed morphine pills and that seemed to work so... could I switch to that instead? That got a few raised eyebrows but my long-term prescription history really speaks for itself. I only take narcotic pain medication on rare occasions, and only refill a couple of times per year.

In April as a result of new state laws I had to meet with my doctor for what was basically a drug counseling session. I was given a stack of paperwork I had to fill out where they asked a number of questions about pain levels, narcotic usage, family history and mental health. I think the whole thing was designed to make sure the doctor has a clear understanding of the patient, their usage patterns, and their risk of addiction. I had to pledge with a long list of "will nots" and consent to things like reporting for drug testing at the whim of the doctor. At the end of the appointment my doctor told me that based on my exceptionally low addiction risk and my prescription history she thought it would be a waste of time and money to have me submit to a drug test. She then asked if I needed anything written for a refill since I was there. I did not. Incidentally, I found out later that my supervisor's wife was given the drug test by the same doctor, so she obviously wasn't opposed to ordering them.

From a personal perspective I hate these laws. I hate having a new/different doctor's first thought being that I'm a 'drug seeker' when they first hear what I'm prescribed. I am opposed to drug testing. I hate being monitored, and I hate that if I ever move or need to switch doctors again that I could end up with one that's not willing to deal with me as an individual rather than a potential addict. On the other hand, I've seen a number of people that I think were prescribed way too much and ended up abusing their medication. I also ended up getting a little insight into the underground prescription market [thanks to a neighbor that lived there less than a year], and found it disturbing. There is a huge problem with people selling / trading their prescription drugs, and I think it's more prevalent than I was previously aware. Because I've seen the dark side I can appreciate the increased regulation; of course it helps that I'm not negatively affected. I see both sides which leaves me essentially neutral.
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Old 09-09-2012, 12:38 AM
obbn obbn is offline
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From a personal perspective I hate these laws. I hate having a new/different doctor's first thought being that I'm a 'drug seeker' when they first hear what I'm prescribed.
THIS! As mentioned above, I have been in chronic pain since 2003 following back surgery, actually three back surgeries within as many months. The reason I have chronic pain is I have been diagnosed with FBSS (Failed back surgery syndrome). Essentially the surgeon screwed up, not enough for me to sue him (although I probably could, but not really my style), but enough that his work only made things worse. So, I am the way I am today because of a doctor, but that's okay I guess as surgery isn't a perfected art. So, one time I had considered trying a pain management doctor thinking they might have a trick or two up their sleeve that might help. My PCP made the referral and I went to the appointment with high hopes. For the first time in my life I walked out on a doctor, pretty much in the middle of her taking, err giving me the third degree. I had never felt so disrespected in my whole life. From the moment I walked into the office I was treated with suspicion and what I preceived as an almost hostile attitude. I went to this doctor for a consult, never intending for her to ever write me a prescription. Yet, I was still treated like a drug seeker. Finally I had enough and when she started lecturing me like I was a12 year old instead of a 40 year old in pain I calmly stood up, told her she was fired and walked out the door. It is unbelievable how those of us with chronic pain are treated by medical "professionals". I wasn't going to stand for it, she might have people trying to scam her, but that doesn't mean you have to automatically assume that everyone who walks in the door, looking for relief is a drug addict. Perhaps she should have studied to be a DEA agent or cop instead of a doctor.
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Old 09-09-2012, 01:15 AM
Curiosity Kills Her Curiosity Kills Her is offline
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THIS! As mentioned above, I have been in chronic pain since 2003 following back surgery, actually three back surgeries within as many months. The reason I have chronic pain is I have been diagnosed with FBSS (Failed back surgery syndrome). Essentially the surgeon screwed up, not enough for me to sue him (although I probably could, but not really my style), but enough that his work only made things worse. So, I am the way I am today because of a doctor, but that's okay I guess as surgery isn't a perfected art. So, one time I had considered trying a pain management doctor thinking they might have a trick or two up their sleeve that might help. My PCP made the referral and I went to the appointment with high hopes. For the first time in my life I walked out on a doctor, pretty much in the middle of her taking, err giving me the third degree. I had never felt so disrespected in my whole life. From the moment I walked into the office I was treated with suspicion and what I preceived as an almost hostile attitude. I went to this doctor for a consult, never intending for her to ever write me a prescription. Yet, I was still treated like a drug seeker. Finally I had enough and when she started lecturing me like I was a12 year old instead of a 40 year old in pain I calmly stood up, told her she was fired and walked out the door. It is unbelievable how those of us with chronic pain are treated by medical "professionals". I wasn't going to stand for it, she might have people trying to scam her, but that doesn't mean you have to automatically assume that everyone who walks in the door, looking for relief is a drug addict. Perhaps she should have studied to be a DEA agent or cop instead of a doctor.
I am sorry to hear about your situation. I don't have the level of pain you describe, and in my case the intensity of my pain varies greatly, with the most intense occurring least frequently. The first time I got attitude from a doctor was after my PCP died I kept getting switched to new people they hired into the clinic. I liked the first one but she didn't work out for some reason and didn't stay past her trial period. I then got stuck with another one who was extremely hostile, but not in regard to medications. I live in a small town without a lot of options, but a new guy came into town and opened up his own practice. I was going to switch to him but on my consultation we got to talking about my medications. He told me point blank he wouldn't give me my prescriptions - narcotic pain meds and sleeping aids, specifically. It didn't matter to him if I only took 20-40/year - he wouldn't budge. I got the hell out of there, and re-engaged the hostile lady because at least she didn't fight me on that.

I later went to an orthopedist to see if I could get some information that would help get to the root of the problem. When he heard I am prescribed morphine he immediately got attitude with me. "People that have had back surgery get morphine!" Yeah, well I get 20 at a time, only take them at night when going to bed, usually cut them in half when I do take them and maybe get two scripts per year. Fuck off. I hate even telling doctors that's one of the medications I get because my use is so infrequent, but I suspect it would be worse if I didn't mention it and they found out later. The orthopedist made me feel self-conscious enough that when I got home I counted my morphine script out. Out of a #20 script I had 12 remaining. I'd had the prescription for NINE MONTHS. Fuck off, indeed.

My pain management medications consist of ibuprofen, Tylenol 3 and morphine, and I have them available at all times. That doesn't mean I'm always taking them though. Unfortunately I think medical professionals hear that I have them and they get mentally stuck there. Doesn't matter that I may not have touched anything for months before the appointment
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Old 09-09-2012, 01:25 AM
Curiosity Kills Her Curiosity Kills Her is offline
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He told me point blank he wouldn't give me my prescriptions - narcotic pain meds and sleeping aids, specifically. It didn't matter to him if I only took 20-40/year - he wouldn't budge. I got the hell out of there, and re-engaged the hostile lady because at least she didn't fight me on that.
For clarification here - I wasn't asking him for drugs in my consultation, we were talking about him being my primary care physician for the long term, and he said he would never prescribe me those medications in the future.
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Old 09-09-2012, 12:25 PM
FlikTheBlue FlikTheBlue is offline
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Obbn, I'm not familiar with your personal history, or with the doctor who did your surgery. A statistic that I have heard (not from a formal study) is that back surgery only helps about half the time, and usually makes things worse the other half. This comes from a friend of mine who is a pain management physician based on his personal experience with his patients.

I don't post this to cast blame on you for agreeing to have back surgery, but more with the idea that I think ortho spine doctors should do a better job explaining to their patients the success rate of surgery at reducing back pain.

Last edited by FlikTheBlue; 09-09-2012 at 12:28 PM..
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Old 09-09-2012, 12:56 PM
DoctorJ DoctorJ is offline
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It's not a DEA requirement. It may or may not be a requirement of his state medical board.

My state (Kentucky) recently passed a set of laws that put some requirements on our controlled substance prescribing and required our state medical board to create a full set of guidelines. It was all implemented very badly, in that many of the board's guidelines conflict with the state law and there have been tons of unintended consequences that weren't exactly unforeseeable. But they are what they are and we have to live with them.

One requirement from the board is that when I start any controlled substance I have to do a drug test first. I actually really hate that requirement, because it doesn't tell me what I'm supposed to do with it. Will I get in trouble if the test shows marijuana and I ignore it? What about my old folks who get some narcotics but only take them every now and then when their backs really act up? Am I supposed to stop writing for them if their pee test turns up negative?

Overall it's a good law and the regulations are fine. 90% of it is stuff that responsible prescribers were already doing--the problem is that so many were prescribing irresponsibly. But this is one part of it I don't care for.
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Old 09-10-2012, 12:10 AM
obbn obbn is offline
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Obbn, I'm not familiar with your personal history, or with the doctor who did your surgery. A statistic that I have heard (not from a formal study) is that back surgery only helps about half the time, and usually makes things worse the other half. This comes from a friend of mine who is a pain management physician based on his personal experience with his patients.

I don't post this to cast blame on you for agreeing to have back surgery, but more with the idea that I think ortho spine doctors should do a better job explaining to their patients the success rate of surgery at reducing back pain.
You are spot on with you post. Unfortunately I have done much more research on the subject post surgery, rather than pre surgery. I guess I put too much faith in the surgeon who did my surgery and took everything he said at face value. I do remembering asking him what the success rate for fusion surgery was and he confidently told me 85%. Well, post surgery research has led me to discover he was telling me the truth, but the truth he was telling me was not reality. What I have found is that 85% of all fission surgeries ARE successful, however the definition of success is that the hardware was placed correctly and the patient came thru the surgery without any major complications. (mine was a fail, he nicked my dura and put me in considerable jeopardy.) The true success rate of fusion surgery, ie: full recovery, is about 15%. In my case I ended up having three surgeries, the original fusion, one to repair the dura and a third to fuse another level when no improvement was made. For patients that have had multiple surgeries, the success rate is in the single digits. In one study, those who have had three or more back surgeries have a zero percent chance of ever returning to any meaningful type of work. This information was not disclosed to me and would have certainly made me less inclined to proceed with a surgical option.

I remember the asking the doctor what I would be able to do after the surgery and he told me anything I could do before it. Well, he was partially right as I CAN do anything I could do before. I just can't do it for any length of time or on a repetitive basis. I truly believer I was misled by this surgeon and he did not fully disclose the risk. After he nicked my dura I couldn't even get him to return a phone call, even while I lay in the ER, with the medical personnel there telling me that if the pool of spinal fluid in my back bursts, I'm a dead man. I hate to sound bitter, but this doctor's lack of disclosure and total disregard of after care for his patient literally destroyed my life. I have been left in massive pain for the rest of my life, lost my career and watched my marriage fall apart.

Thankfully, I remarried and have a wonderful and very understanding and supportive wife. While I am in pain and very limited in what I can do, I an not paralyzed. I am very thankful for what I have and realize there are many out there much worse off than I am. I would like to take the time to apologize if my posts seem as if I am drowning in self pity. I have my moments where I get very down, but as I have said, it could be much worse and I have a wife who loves me very much. What else could a man ask for?
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Old 09-10-2012, 12:46 AM
Spectre of Pithecanthropus Spectre of Pithecanthropus is offline
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FWIW, I have seen a lot of chronic pain patients get busted for pot. Most (but not all of the time) their doc will give them a second chance and then dump them if they test positive for it again. What always surprises me is the number of people who get warned after the first positive result and STILL keep smoking it.
With regard to some people who do this, it's for the same reason they started (or ramped up) their cannabis use. It's helpful for the pain, although perhaps not as much and not in the same way as opioids, and lacks much of the toxicity and most of the side effects of those opioids (and the NSAIDS they usually come riding in on).
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Old 09-10-2012, 12:56 AM
Ambivalid Ambivalid is offline
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With regard to some people who do this, it's for the same reason they started (or ramped up) their cannabis use. It's helpful for the pain, although perhaps not as much and not in the same way as opioids, and lacks much of the toxicity and most of the side effects of those opioids (and the NSAIDS they usually come riding in on).
At the Institute at which I'm treated for my migraines, a person must agree to regular drug tests as part of the agreement to be a part of their program. This includes marijuana and just about all other illicit drugs. The reasoning for this testing is that use of these substances can contribute to the exacerbaction of migraine symptoms and if/as long as a person is using, the program will not be effective.
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Old 09-10-2012, 01:03 AM
outlierrn outlierrn is offline
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The irony is that the latest research indicates that pain sufferers are being under-medicated due to substance abuse paranoia.
Please share, I hear the exact opposite.
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  #32  
Old 09-10-2012, 12:51 PM
Simple Linctus Simple Linctus is offline
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Might sound insane obbn, but I know that some people who just couldn't get enough drugs to stop their pain decided to pretend to be heroin addicts and got onto a methadone clinic, where they could get considerably stronger doses of opioids than are usually accepted for pain.

Obviously that is the last possible resort, but just an idea for you.

It's also suggested that Kurt Cobain was on heroin for back problems by the way.
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Old 09-10-2012, 01:21 PM
Foxy40 Foxy40 is offline
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I see you're in Florida. In that case, yes, a law was passed last year requiring periodic UDS for patients being treated for pain with narcotics. There are many more rules that came down that we had to follow. Specific prescriptions that can't be forged, mandatory counseling prior to treatment with signature, mandatory visits at least every 90 days, mandatory reporting of patients caught forging prescriptions, etc etc. You can google for all the specifics. Our patients were initially a little annoyed but they got used to it. However, we did weed out almost 25% of our chronic pain patients due to failure of the drug screen. Most weren't for another drug but for not having ANY of the drug in them. Apparently it is a very lucrative business to sell pain pills. If you're seeing a primary care doctor who is still prescribing pain medications, consider yourself lucky. Most will not at this point due to the heavy regulations and huge fines.

Last edited by Foxy40; 09-10-2012 at 01:22 PM..
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Old 09-10-2012, 01:24 PM
Quercus Quercus is offline
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I have a great relationship with my doctor that could be described as a friendship. This is important as it would be very hurtful to think he had a reason to not trust me.
Just some advice, that I hope you won't need, but if anyone who has had to deal with addicts (and I assume lots of doctors, especially pain specialists, have had to), asks you for any kind of verification, you need to learn to never take it as a personal insult. Some addicts are very, very good at lying and convincing others that they're trustworthy, ruthlessly exploiting personal friendships if necessary (of course some are bad at it too; it's not like addiction gives you super powers; it just gives your a reason to find out if you're good at lying to someone and exploit it if you are).

So anyone who deals with even potential addicts is going to quickly learn to 'trust but verify' and make everyone, even their friends, go through these kinds of things, no matter how good the relationship is. It's nothing personal, so don't take it that way. If you must get upset, remember it's not a reflection on you, but on the liars who made the system necessary.

Even if some test is not a strict requirement by a licensing body, a professional might well have some kind of practice they want to put in place, and once they've been burned once, they'll want to extent it to everyone, no matter how good the relationship.
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Old 09-11-2012, 02:11 PM
obbn obbn is offline
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Just some advice, that I hope you won't need, but if anyone who has had to deal with addicts (and I assume lots of doctors, especially pain specialists, have had to), asks you for any kind of verification, you need to learn to never take it as a personal insult. Some addicts are very, very good at lying and convincing others that they're trustworthy, ruthlessly exploiting personal friendships if necessary (of course some are bad at it too; it's not like addiction gives you super powers; it just gives your a reason to find out if you're good at lying to someone and exploit it if you are).

So anyone who deals with even potential addicts is going to quickly learn to 'trust but verify' and make everyone, even their friends, go through these kinds of things, no matter how good the relationship is. It's nothing personal, so don't take it that way. If you must get upset, remember it's not a reflection on you, but on the liars who made the system necessary.

Even if some test is not a strict requirement by a licensing body, a professional might well have some kind of practice they want to put in place, and once they've been burned once, they'll want to extent it to everyone, no matter how good the relationship.
Great point. I understand that my doctor has everything to lose if he doesn't follow the rules. I certainly don't want to be an exception to the rules and I have no problem submitting to a test as I am following the prescription directions to the letter. I just wanted to know if this was a requirement for I really couldn't think of anything I had done to violate the trust my doctor put in me. The last thing I would want to do is lose the confidence of the man who has helped me so much.

Also, thanks to everyone for your input, it has been helpful. I do apologize if it seems many of my posts revolve around my injury. It dominates my life and I am trying to deal with it the best I can. Talking about it helps and learning all I can about every aspect of the injury and treatment has been invaluable.
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Old 09-11-2012, 02:17 PM
obbn obbn is offline
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Originally Posted by Foxy40 View Post
I see you're in Florida. In that case, yes, a law was passed last year requiring periodic UDS for patients being treated for pain with narcotics. There are many more rules that came down that we had to follow. Specific prescriptions that can't be forged, mandatory counseling prior to treatment with signature, mandatory visits at least every 90 days, mandatory reporting of patients caught forging prescriptions, etc etc. You can google for all the specifics. Our patients were initially a little annoyed but they got used to it. However, we did weed out almost 25% of our chronic pain patients due to failure of the drug screen. Most weren't for another drug but for not having ANY of the drug in them. Apparently it is a very lucrative business to sell pain pills. If you're seeing a primary care doctor who is still prescribing pain medications, consider yourself lucky. Most will not at this point due to the heavy regulations and huge fines.
Thanks for the response, it sounds like being a doctor has become a real pain in the rear. I am very lucky to have the doctor I do, for not only has he agreed to manage my pain problem, but he has spent countless hours researching treatment options for me and has taken more time than he probably should have listening to my complaints and suggestions. A rare find if you ask me. I have been to a lot of doctors over the last few years and I have never known one to have a more loyal patient base, I feel quite blessed.
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  #37  
Old 09-12-2012, 03:36 PM
Grestarian Grestarian is offline
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I just saw this article in the LA Times (a day late).
It seemed relevant to the discussion so I thought I'd provide a link to it.

---G!

I want a new drug.
One that won't make me ill.
One that don't
Cost too much
Or come in a pill
. ---Huey Lewis (and the News)
. I want a new Drug
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  #38  
Old 09-14-2012, 03:27 PM
Qadgop the Mercotan Qadgop the Mercotan is online now
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Here's a good review commentary on the use of opioids for chronic pain: Opioids for Chronic Pain: First Do No Harm

Key points:
Quote:
1. The volume of prescribed opioids has increased 600% from 1997 to 2007.

2. During roughly the same period, the number of unintentional lethal overdoses involving prescription opioids increased more than 350%, from approximately 4,000 in 1999 to more than 14,000 in 2007.

3. Risk of overdose or death increases with higher doses of opioids, especially in patients who concurrently use other respiratory depressants such as benzodiazepines.

4. There are treatments for chronic pain that are much safer than opioids, including, but not limited to, physical therapy, cognitive behavioral therapy, low-dose tricyclic medications, and treatment of co-occurring psychiatric illnesses.

5. High doses of opioids do not reliably decrease patients’ report of the magnitude of chronic pain, nor do they improve patients’ overall health and function.

Thus it is reasonable to conclude that opioids for chronic noncancer pain are not appropriate therapy for most patients in primary care settings. When other interventions fail or are inadequate, cautious evidence-based consideration of low-dose opioids as an adjunct to other therapies may be considered. Entering into chronic opioid therapy requires a long-term commitment by clinician and patient alike to use this powerful, precious, and dangerous medication with care and diligence. As clinicians and as patients, we need to develop a generous measure of respect for the power of opioids to do harm as well as provide relief from pain.
Primum non nocere! (Kill as few patients as possible)
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Old 09-14-2012, 10:40 PM
Simple Linctus Simple Linctus is offline
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Obviously you shouldn't kill patients unnecessarily, but imo minimising killing ought to be pretty low down a doctor's priorities. After all, objectively speaking killing someone doesn't really harm them, they just cease to be. The major harm done is to the relatives.

Far better to ease ACTUAL suffering and er (slightly) on the side of over prescribing, at least to people who are actually in significant pain. It's very arrogant to deny opiates to folk fully cognizant of the risk/likelihood of dependence who want them anyway; it says something about the pain they're in. I am not accusing you of this by the way, I appreciate that in your practice you are going to be dealing with pill fiends*, just setting out general guidelines.

*Although I have a seperate argument that everyone should be given all the opiates they want, it's not relevant to this.
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Old 09-15-2012, 02:57 AM
obbn obbn is offline
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Originally Posted by Qadgop the Mercotan View Post
There are treatments for chronic pain that are much safer than opioids, including, but not limited to, physical therapy, cognitive behavioral therapy, low-dose tricyclic medications, and treatment of co-occurring psychiatric illnesses.
Thanks for the response. From all I have read on the boards here your medical opinions are well respected and informative. However, I wish the above statement was a reality for me. If there are other non-drug therapies that could ease the pain enough so I could function I haven't been able to find them. The only relief that I get from a non-drug source is via the use of a TENS unit, although the relief is very temporary and only effective under half the times I use it. Massage therapy does seem to help as well, but is also very short lived, not to mention very expensive and not covered by insurance.

The only option the doctors have given me besides the meds is surgery. The problem there is they don't seem to be real sure of what they are attempting to accomplish. Rather it seems that the surgeons want to open me up, poke around and see if that makes it any better. After three surgeries I am just not willing to go through another without a clear objective and a reasonable chance of success. However, I haven't given up and I continue to ask questions and search the Web everyday, looking for some sort if new technology or some surgical breakthrough. Haven't found one yet, but there is always tomorrow. In the meantime I will have to continue with the status quo and hope that the continued use of these opiods isn't causing irreparable harm to my organs and trust that I won't stop breathing in my sleep, for that would really ruin my day.

Last edited by obbn; 09-15-2012 at 03:00 AM..
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  #41  
Old 06-02-2013, 07:44 AM
JESS-A-MA-KESS JESS-A-MA-KESS is offline
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Originally Posted by obbn View Post
Hello Everyone,

A brief bit of background, I am a chronic pain patient. I have been prescribed scheduled narcotic drugs since 2003. Currently I am using morphine, percocet and amphetamine (the later to keep me awake during the day as the other two make me so tired). In the past I have been prescribed everything from Fentynal to Vicodin. So I was somewhat confused at my last doctor appointment.

I have a great relationship with my doctor that could be described as a friendship. This is important as it would be very hurtful to think he had a reason to not trust me. I went for my monthly appointment to get refill prescriptions for my medication (they can't be called in). At each of these appointments I always bring in my current prescriptions so the doctor can visually see how much I have left and so he knows I am taking the meds as prescribed. This time at the end of the appointment he casually said, "Next appointment I need you to submit to a drug test. It is a DEA requirement that patients getting the drugs you are on be tested to make sure that they are being taken and not sold", he then went on to say that this is something that we should have been doing all along, but "I know you're taking them so I haven't bothered". He then went in to explain that he wanted to make sure that all his paperwork was in order in the event of an audit by the DEA.

So, no big deal, I have no problem peeing in a cup and being tested as I take my meds as prescribed and would never even think of selling even a single pill. (besides, I wouldn't even know who to sell one to even if I wanted to. The same with pot. I don't smoke it, but even if I wanted to I wouldn't have a clue where to get it. Yeah I've become old and boring). The thing I want to know is does the DEA require those of us on these powerful narcotics to do an occasional drug screen? I have never been asked to do this, nor have I ever heard of it. I do know that the doctor does have to submit paperwork to the DEA regarding his prescriptions. I live in Central Florida and apparently the buying and selling of prescription drugs is a huge problem here, so on the surface it sounds plausible. I would really hate to think the doctor who I trust so much and have developed a friendship with over the years suspects me of something and is using this story to cover his suspicion. But then again, he gave me advanced notice of the test, which would totally go against that line of thinking. By giving me notice, that tells me he knows I am doing what I should be doing and he had no worries. If he did, then it would stand to reason that it would be a surprise test to confirm something.

I apologize for the long post, but I thought it was important to give as much detail as possible. If this really is a DEA requirement doesn't it just sound like it is a violation of some sort of civil right? I mean how can it be legal for the DEA to randomly test an individual without any shred of wrongdoing? Kind of funny though, first time I have ever heard of anyone being tested to make sure they are using drugs!
The only time you are going to get tested is at your appointment so like you said they can make sure you are taking your meds and that you aren't on other drugs because then it would look like you were there for the drugs not for pain. The DEA is not going to pick you out to test you. They aren't worried about the people going to the pain clinic as much as they are with the doctor and pain clinic itself. So most likely your doctor will always give you a heads up because it looks better for them.
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  #42  
Old 08-30-2013, 04:06 PM
Skidda Skidda is offline
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DEA drug testing

Hello All,
I have been in chronic pain for about 6 years and was always using fentanyl and oxycodone and never once had a urine test. Recently my PCP passed away and my pain doc moved away so now I have to start with a set of new doctors who know nothing about what I've been through and the 12 months in a hospital bed, the infection I had and the treatment that took place. Wel enough about that. So I got a new PCP who seems ok and I think he wants to help. He reffered me to a pain doctor so I went to see him. The first thing I did was explain to him all about my health insurance and what the coverage was and how much money I had per year for pain management. He definately didn't like that and I'm sure I ticked him off. The medications I got before were working ok and have many days on the roller coaster so he changed one of my important my meds to something alot less useful, aspirin would be better. I had to do the urine test my first visit. Next visit he doubles the fentanyl because I told him I was tired of the roller coaster ride, he asks me if my PCP would take care of my pain meds (because he can't give me expensive treatments) now that I am stable. Well a few days later I start talking to my imaginary friends due to the fentanyl being dooubled. So I call him and go see him in a couple days and he he starts with the 10th degree because why aren't I freaking out not having fentanyl patch on. All I said to him was "you have no idea where I've been and what I've been through, a couple days without a 25mg fentanyl patch is nothing". So he gives me a script for just enough patches until my next visit and he wants me to bring in the larger fentanyl patches and give them to him............Hmmmmm isn't that illegal? Knowing he doesn't trust me and to prove him wrong I gave them to him. The next month I get a bill for $1,200.00 from the lab who did the tests. I call the insurance company and I was not happy, they tell me it's not covered and it's written in your policy and usually the doctors office calls to check if it's covered and obviously they didn't. I have one of the better insurance companies in my area Blue Cross Blue Shield. Now I have to get into it with his office about this and they knew they had to call my insurance because they wanted me to have an MRI and I told them I had to go to a certain place or it would cost me $200.00. Needless to say I won't be seeing him any more and I'll find another but I am thinking about the medical marijuana useage. Medical marijauna is legal here in MA and I do have a card so do I be my own doctor?
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Old 08-31-2013, 04:41 AM
usedtobe usedtobe is offline
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As I mentioned in another thread, Walgreens has upped the reporting/hoop-jumping for certain Sch II drugs - oxycodone being one. Your Percocet contains oxycodone, and, depending which amphetamine, it may also trip this new set of hoops.
I am on MS Contin (morphine sulphate E.R.) and dilaudid (Hydrocodone). Have not been advised to expect test. Due to kidney failure, I get blood work drawn every couple of months - no "pee in the bottle" test has been added.
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Old 04-05-2014, 11:39 PM
alleyfl alleyfl is offline
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Hi I am bed bound suffering with ALS **(LOU GEHEIG_) I have been on pain patches and pills for at le

Not sure if I am replying proper. My Doctor for the third time two weeks ago had my caregiver sign for me , like a contract for taking pain meds . It was actually printed out from some where in Illinois I live in Florida. It explain about going to one pharmacy ( though I was thinking of changing I called Walgreen they don't do narcotics anymore. I did call my insurance and they said I am allowed to use two different pharmacies of I need to .)

Couple weeks ago my Doctor did not give me a copy just said we can check your urine without notice to see if you are taking your drugs correct. The Dr. that ordered the urine test is same Doctor that wrote my scripts three of more years ago. I am paralyzed. I think they want to do it for records .incase they ever had trouble , got audited , just to cover their backs a it seems a lot of Doctors do nor want to help people in pain. I suffer bad missing just one time. About two weeks after receiving my third paper the lady that comes to my home to do my blood was coming next morning to pick up urine. I take my meds the best I can I *( Caregivers must put them into my mouth ) and I would never sell any I would not even know how to do such a thing. I am trying not to feel bad that I am not trusted and my caregivers and that they are just doing the random urine test to cover their butt.
Quote:
Originally Posted by obbn View Post
Hello Everyone,

A brief bit of background, I am a chronic pain patient. I have been prescribed scheduled narcotic drugs since 2003. Currently I am using morphine, percocet and amphetamine (the later to keep me awake during the day as the other two make me so tired). In the past I have been prescribed everything from Fentynal to Vicodin. So I was somewhat confused at my last doctor appointment.

I have a great relationship with my doctor that could be described as a friendship. This is important as it would be very hurtful to think he had a reason to not trust me. I went for my monthly appointment to get refill prescriptions for my medication (they can't be called in). At each of these appointments I always bring in my current prescriptions so the doctor can visually see how much I have left and so he knows I am taking the meds as prescribed. This time at the end of the appointment he casually said, "Next appointment I need you to submit to a drug test. It is a DEA requirement that patients getting the drugs you are on be tested to make sure that they are being taken and not sold", he then went on to say that this is something that we should have been doing all along, but "I know you're taking them so I haven't bothered". He then went in to explain that he wanted to make sure that all his paperwork was in order in the event of an audit by the DEA.

So, no big deal, I have no problem peeing in a cup and being tested as I take my meds as prescribed and would never even think of selling even a single pill. (besides, I wouldn't even know who to sell one to even if I wanted to. The same with pot. I don't smoke it, but even if I wanted to I wouldn't have a clue where to get it. Yeah I've become old and boring). The thing I want to know is does the DEA require those of us on these powerful narcotics to do an occasional drug screen? I have never been asked to do this, nor have I ever heard of it. I do know that the doctor does have to submit paperwork to the DEA regarding his prescriptions. I live in Central Florida and apparently the buying and selling of prescription drugs is a huge problem here, so on the surface it sounds plausible. I would really hate to think the doctor who I trust so much and have developed a friendship with over the years suspects me of something and is using this story to cover his suspicion. But then again, he gave me advanced notice of the test, which would totally go against that line of thinking. By giving me notice, that tells me he knows I am doing what I should be doing and he had no worries. If he did, then it would stand to reason that it would be a surprise test to confirm something.

I apologize for the long post, but I thought it was important to give as much detail as possible. If this really is a DEA requirement doesn't it just sound like it is a violation of some sort of civil right? I mean how can it be legal for the DEA to randomly test an individual without any shred of wrongdoing? Kind of funny though, first time I have ever heard of anyone being tested to make sure they are using drugs!
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  #45  
Old 04-16-2014, 07:04 AM
Cwofaz Cwofaz is offline
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Las week I've was told 60 days to get the THC out of my system by the pain clinic I have been going to for over a year. They know I'm a state licensed Marijuana Card Holder, and I told them that I used from the start of our treatment. The Dr, who is a great guy said he was sorry but the DEA is cracking down on all of the pain clinics in AZ, and there was nothing he could do for me.

He also has no issue with Medical Marijuana (MM), saw a benefit for it's us in my pain treatment plan.
I tried to go off the Oxycodone and just kill the pain with MM But it didn't work, the pain won.
As others have said Where is it written!!!!!!!!! That the DEA can do this? Is it just the Fed flexing their muscles since they control controlled substances......
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Old 04-16-2014, 09:53 AM
Inna Minnit Inna Minnit is offline
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I don't know if this is DEA mandated, or just a facility policy where I work, but I'm hearing that coming soon we will start requiring all patients on long term narcotic use to sign a Pain Contract. Part of that is random drug testing.

Most primary care providers manage their own patient's pain meds, some do not.

I worked for one physician whose staff told me "S/he doesn't prescribe narcotics." Never? Never. Wow. Totally irresponsible, if true.

I have also heard that the narcotic schedule is being changed. In practical terms for me, it means drugs that currently can be e-scribed or faxed, will need to be hand carried by patients. For patients it adds one more layer of beaurocracy to their pain relief.

Last edited by Inna Minnit; 04-16-2014 at 09:55 AM..
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  #47  
Old 04-16-2014, 10:40 AM
Qadgop the Mercotan Qadgop the Mercotan is online now
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Quote:
Originally Posted by Inna Minnit View Post
I worked for one physician whose staff told me "S/he doesn't prescribe narcotics." Never? Never. Wow. Totally irresponsible, if true.
The doc may have a past hx of addiction/abuse and is not allowed to prescribe narcotics, at least for a while. In such cases, the practice should have arrangements so that needed narcotics can be prescribed for the patient by other practitioners.
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  #48  
Old 04-16-2014, 10:44 AM
llcoolbj77 llcoolbj77 is offline
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Quote:
Originally Posted by Curiosity Kills Her View Post
From a personal perspective I hate these laws. I hate having a new/different doctor's first thought being that I'm a 'drug seeker' when they first hear what I'm prescribed. I am opposed to drug testing. I hate being monitored, and I hate that if I ever move or need to switch doctors again that I could end up with one that's not willing to deal with me as an individual rather than a potential addict. On the other hand, I've seen a number of people that I think were prescribed way too much and ended up abusing their medication. I also ended up getting a little insight into the underground prescription market [thanks to a neighbor that lived there less than a year], and found it disturbing. There is a huge problem with people selling / trading their prescription drugs, and I think it's more prevalent than I was previously aware. Because I've seen the dark side I can appreciate the increased regulation; of course it helps that I'm not negatively affected. I see both sides which leaves me essentially neutral.
I have been a public defender, representing mostly children, for 10 years. In the 8-9 years prior, I had exactly one kid charged with a heroin related offense.

In the last six months, I have had two kids overdose on heroin and die, three kids overdose but pull through, and several kids busted for possession and distribution. Why?

Because they all started taking mom and dad's oxycotin and percocet, or stole grandma's fentanyl patches. The problem is that on the street, oxy and Percocet and fentanyl are WAY WAY WAY more expensive than a bag of heroin. And so the 15yo kid who would have never dreamed of shooting up heroin, but really didn't think taking one of those pills dad got for his wisdom teeth was such a big deal, is now a heroin addict. A dick sucking, train spotting, dead in the gutter heroin addict.

I practice in the richest county in the country. And yet my juvenile clientele is dying from heroin. This is directly a result of prescription med abuse. Period.

I fully agree that some of the laws with respect to drug testing and reporting, etc..., are stupid. But from my personal perspective, it is because it is too little, WAY too late, and WAY too subjective.
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  #49  
Old 04-16-2014, 01:25 PM
phouka phouka is offline
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And it's not just narcotics. I've taken Adderall XR for eight years now for my ADHD-PI. I tend to be frugal with it, partly because I don't want to develop tolerance, and partly because it's expensive as hell. When I moved from CA to TX two years ago and went in for an appointment with my old doctor, I found out that I would have to pee in a cup every six months to get my prescription. Her explanation was that they need to make sure I'm not taking any medications with contraindications for amphetamines (the only big one I could find was "other stimulants"), but she stressed marijuana for some reason.

I haven't been able to find out if it's state law or board regulations, but asking here, it seemed more about making sure I wasn't selling my medication. Honestly, considering how much of a difference it makes in my ability to live like an actual adult, they can take my Adderall when they pry it out of my cold, dead hand. These things aren't for sale.

And, the last time I was due to pee in a cup, no one at the office mentioned it, so I didn't bring it up.
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Old 04-16-2014, 03:51 PM
Blackberry Blackberry is offline
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Originally Posted by phouka View Post
And it's not just narcotics. I've taken Adderall XR for eight years now for my ADHD-PI. I tend to be frugal with it, partly because I don't want to develop tolerance, and partly because it's expensive as hell. When I moved from CA to TX two years ago and went in for an appointment with my old doctor, I found out that I would have to pee in a cup every six months to get my prescription. Her explanation was that they need to make sure I'm not taking any medications with contraindications for amphetamines (the only big one I could find was "other stimulants"), but she stressed marijuana for some reason.
I was just kind of wondering about this. I don't smoke weed, but I was thinking about trying it for insomnia. I've always had insomnia but the Adderall isn't helping, and I think that marijuana would be a better option than Ambien or any other sleep medications I've tried. My doctor doesn't really seem like he would make me take a drug test anyway (he seems pretty relaxed about the whole prescribing drugs thing) but if he did and I was positive for marijuana, it would look like I was a liar since I said I don't use any drugs. Weed is legal here anyway, so it shouldn't even be an issue but that doesn't mean it wouldn't.

On another note, it is absolutely insane that a person could legitimately be using medical marijuana for pain and then have that keep them from being able to get their other pain medications. Drug policy in this country needs to make up its fucking mind.
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