Great ! The only medicine. That helps relieve fifty percent of my chronic neck pain (c spine fusion) is now controlled so I’ll have to make monthly trips to the doctor for my prescription which means a nice 20$ copayment monthly instead of quarterly . Wonder if THAT had anything to do with this decision.
I think the DEA is moving in on pain meds now that the writing is on the wall for marijuana.
Tramadol is only a C-IV so it can have up to 5 refills and the rx expires in 6 months. So you’ll only need to go every 6 months.
I think this was more exclusive to tramadol and has most likely been in the works for some time. Tramadol has been flying under the radar for far too long. I, as a regular tramadol user (torn rotator cuff) have mixed feelings about this. While personally I realize it’s going to be a fucking headache now that I wish i didn’t have to deal with, I absolutely understand and agree with this decision. I just can’t believe it took this long. It’s a much more powerful, and potentially terrible and even deadly drug than even many doctors have realized. It skated by with it’s “non-narcotic” status on a chemical technicality; once it’s in your body it’s a fucking narcotic.
People with pets on tramadol shouldn’t see a change. Your veterinarian has to have a DEA license to function, so all they really have to do is switch which cabinet they keep it in and log it all now. Clients should see no change on their end, except maybe the amount they can get at once (looking at you, wiener doggie!).
Ambi - dogs metabolize pain meds a lot differently than their human counterparts do. They generally have to take a lot more per pound of body weight to get the same effect. I’ll bet that dog’s not gorked at all. Just comfortable.
Oh, and at the ER where I work (animal), we’ve been treating it as a controlled substance for several years already. Employees were swiping it when it was just in the regular open pharmacy. So it got locked up and logged.
My husband had enough Valium in the house to plow the whole town, back when the dalmatian had a seizure disorder. I believe she got 50mg a pop. (2-10mg is the human dose, IIRC) 
Thanks for the heads up on the Tramadol, by the way. I don’t have much in the way of coworkers, so this didn’t get to me by office chatter or memo. I’ll be sure I check everyone’s levels and call my patients’ pharmacists to check on the availability of refills, instead of using the automated systems. (Too many of the automated systems never contact the patient or the nurse if there’s a problem with a request.)
Thanks for the explanations about dogs and drugs. I always wondered why my 80lb dog takes the same dose of Tramadol as my 200lb brother. Same goes for Xanax (actually she was prescribed like 4x the Xanax he was)
Mo dog takes Tramadol and it helps him a lot. I’m sure the vet will do what it takes to keep him on it. I took it for a month and saw no relief at all, so I thought it was just too mild a product for humans, guess its just me.
Well, according to the rule publication in the Federal Register, this is just now occurring as a result of a recommendation by the Assistant Secretary at Health and Human Services back in 2010, so I’m going to lean heavily towards no, probably not what you posted.
Unless the town had a few raging alcoholics, in which case, it’s possible your husband’s supply would barely be a blip on the radar. Our pharmacy professor tasked with instructing us (then know-it-all know-nothings) pharmacy students told us that they once ended up with a patient (a very long term alcoholic) who took over 1 gram (I can’t remember the exact figure used, sadly) of diazepam to keep from seizing. Tolerance is a fascinating, if sometimes incredibly scary, phenomenon.
Happy to oblige. If I can save a few headaches, be they pharmacist, prescriber, nurse, and/or patient, it was worth it.
My seven pound chihuahua takes 1/4 pill, and my 190 pound husband takes a full pill.
We are leaving for vacation soon, so I had my husband call the pharmacy to see if his prescription was okay so that he didn’t get bad news the day we were supposed to leave. They told him everything was fine, and since it was time for a refill, got one ready for him.
So all is good.
Tramadol withdrawal is terrible. I am in chronic pain, I need a neck fusion and a lower back fusion. The first doctor I had put me on tramadol, it stopped helping my pain after a few months,I kept taking it because the withdrawal symptoms were agonizing. I see a pain specialist and take a lot of narcotics to manage. I will never touch another tramadol, if that’s all that’s available I’ll take the pain.
Rather than post a separate thread for this, I’ll add it here. Mods, if you could change the thread title to maybe reflect this fact, I’d appreciate it.
Effective October 6th, ALL Hydrocodone combination products will move from Schedule III to Schedule II. This rule change applies to combination cough products as well as the combinations including hydrocodone and a non-narcotic analgesic like Acetaminophen or Ibuprofen. As of that date, this will leave Codeine combination products and Tramadol as the only non-schedule II narcotic agents in the US.
The final rule publication in the Federal Register can be found here.
Since I’m posting from work, I don’t have time to go over the details of what this will mean right now, but I’ll get to it tomorrow morning before I go to bed if someone else doesn’t beat me to it.
So, as promised, the ramifications for changing hydrocodone combo products from schedule 3 to schedule 2 are quite a bit more noteworthy than occurred with tramadol:
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No refills. C-II medications aren’t allowed refills. A prescriber authorized in their state to write for C-II medications, with the appropriate type of DEA registration, will be allowed, like with current C-II meds, to write up to 3 individual prescriptions (one for the current month, two for the following months, dated with the specific date they were written AND a specific date when they are allowed to be filled–writing “fill in X days” is not valid) at a single appointment.
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No phone-ins, limitations on faxing in (only Long Term Care facilities and Hospice patients are allowed a faxed C-II, at least in Ohio), and like tramadol, no e-prescribing until both the physician and pharmacy systems are certified to do so, and as allowed by each state’s laws. This one is going to be a huge pain in the butt, given the number of prescriptions phoned in for Hydrocodone combo products currently. I greatly look forward to having to explain to certain area doctors that just because they could do so before, does not mean they can now, no matter what they insist holds up sarcasm sign.
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You are limited in what you can call and have changed on a C-II prescription. Doctor forgot to write your name on the prescription? He has to issue a new one, we can’t call to confirm and add it over the phone. Doctor forgot to sign the prescription? Same deal. Insurance wants a prior authorization so the doctor wants to change the drug over the phone? Only allowed in terms of dosage strength, not drug form. Can’t get ahold of the doctor who wrote the prescription because they’re gone for the day and the one on call is a different prescriber? You can’t change who wrote the prescription.
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We may end up running into stock shortage issues in the pharmacy because, unlike Schedule III and above agents, Schedule II agents can only be ordered by the Person-In-Charge of the pharmacy (the pharmacy manager or whomever holds the power of attorney to do so), and wholesalers, or the DEA, can place limits on how much of a drug you can order at a time/per month. This has to be done by hand (currently, an electronic method, like e-prescribing controlled substances, is in the works but not yet usable, at least here in Ohio), using a very specific DEA form (which is limited to 10 drug products per form).
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Depending on your state’s laws, the PA or CNP writing for your Vicodin, Norco, Tussionex, or Hydromet (to name a few examples) may no longer be able to do so, since not all states allow mid-level practitioners to write for schedule II medications, and those that do can have additional restrictions that limit their ability to do so.
This is potentially going to be a nightmare for everyone involved, so I’d strongly urge anyone reading now to do what you can to be ahead of the game to minimize any impact this might have on you (be you prescriber, pharmacist, nurse, or patient). You’ve got 44 days and counting.
Also, :smack:, I forgot about Pentazocine/Naloxone, Butorphanol Nasal Spray and Subutex/Suboxone in my previous post with regards to non-C-II narcotics (and arguably Diphenoxylate and Loperamide).
With all this hassle, I’m beginning to think that the gene pool needs a good dose of halogen.
Perhaps removing the restrictions, and shortly thereafter, the people causing the problems would be in the public interest.
The big push around here is to have the cops carry Narcan. I just think of it as evolution in action.
So, the DEA is so afraid that junkies might get a fix that they’re going to make it harder for doctors to prescribe pain medications. THAT’S going to go over real well with the elderly, who will be most affected … and who vote the most, too. Did these regs come directly from the DEA or was it a response to legislation?
The DEA is doing this, as with tramadol, in response to a recommendation from Health and Human Services, as well as a special advisory panel for the FDA who voted for the move (19-10) to occur. All three groups are doing this, not because they are so afraid that “junkies might get a fix”, but because current data is showing a VERY large uptick in the number of overdose deaths and ER admissions since the 1997 liberalization of pain treatment laws/rules by the state medical boards. Epidemiological data shows that, in 2010 when this was reaching peak levels, we increased from an average of 96 milligrams of Morphine Equivalents in 1997 to 710 milligrams per person (equivalent to 7.1 kg of opioid medication per 10,000 people), with this being enough to supply every single adult in the USA with 5mg of hydrocodone every 6 hours for 45 straight days. In addition, a UN report showed that in 2007, with the US population at about 4.6% of the total world population, the US consumed 83% of the world’s hydrocodone and 99% of the world’s oxycodone. Further, per the CDC, in 2011, drug overdose was the number one cause of injury death among individuals 25-64 years of age, exceeding even the number of deaths attributable to motor vehicle accidents. Of these deaths (41,340), 55% were attributable specifically to pharmaceuticals (22,810) with 74% of that number (16,917) involving opioids and 30% (6,872) involving benzodiazepines, with significant overlap between the two. According to another CDC report, this one from 2012, of the overdose deaths related to opioids, 20% occurred in individuals on doses of less than 100mg of morphine equivalence seeing only a single physician, 40% in individuals on a dose greater than 100mg but still seeing only a single physician, with the final 40% coming from an estimated total of 10% of all treated patients who were doctor shopping (seeing multiple physicians) and often involved in explicit drug diversion activities. 60% of overdose deaths coming from legitimate pain patients is a FUCKING epidemic.
Put simply, your characterizations in this thread of the DEA doing this because they are “so afraid that junkies might get a fix”, or because “the writing is on the wall for marijuana”, are, even if there might be an element of truth to them depending on one’s perspective, so grossly missing the overall point. The DEA, HHS, FDA, CDC, and various State Boards of both Medicine and Pharmacy aren’t doing this because “oh noes, someone might get high!”, they’re doing this because a great many people, including many who you would be unlikely to characterize as “junkies”, are FUCKING dying (113 per day in 2011, 6748 per day not dying but requiring treatment in the ER), every damned day. And since up to this point, a small subclass of prescribers apparently don’t get it and KEEP writing prescriptions liberally for both opioids and benzodiazepines, you either get Congress to pass a law specifically limiting what the prescribers can write for (a bad idea because Congress isn’t filled with medical experts and so would likely end up writing a law which is going to get in the way of the needs of at least some patients, via the law of unintended consequences), or you make it so they have more hoops to jump through if they’re going to write for the stuff.
Neither solution is actually a great one, but at this point what else do you expect them to do? The Vorlon’s “evolution in action” solution, even if it’ll take out even more individuals than we’re already seeing who don’t fit the profile of an “addict” or “junky” or whatever other disparaging names people think of to further kick individuals with a recognized psychiatric disorder (Substance Use Disorder–where we have pretty detailed neurological mechanisms to back up the psychological mechanisms) while they are down?
Is it even physically possible to fatally OD on tramadol? I ask because I read above 400mgs in a 24 hour period seizure threshhold goes down, and supposedly that is equivalent to 40mgs? of morphine which isn’t a fatal amount in a non tolerant person. I have no clue if that fact it has to be metabolized first limits how much gets turned into the active metabolite.
And for the hydrocodone combo meds, it seems like to take a fatal dose you’d have to intentionally take enough to where the acetaminophen would be killing your liver as well.
Or are most of these low dose ODs multi drug ODs where a non tolerant person RXed low dose pain meds then goes and gets passout drunk too or something?
According to this a fatal dose of tramadol is:
Tramadol comes in pills of 50mg and 100mg, you’d almost have to take an entire bottle to reach a fatal dose. That sounds like a suicide attempt, not an accident.
IANAD but i believe tramadols potential lethality lies more in its tendency to negatively (and sometimes unexpectedly) interact with so many other medications. Complications such as suppressed breathing when taken with some meds as well as serotonin syndrome when it’s taken with SSRIs have been reported…
Yup. Hard copy to sign and fax for us. The biggest issue is that our EMR hasn’t caught up with the change and doesn’t print the doc’s DEA number on the script.
Please don’t call your doctor to reissue a valid script. On the user side, there is no reason to do this. I don’t need to field an extra 15 phone calls a day about a non-issue. :smack: