Exactly. The existence of drug abusers should not be an excuse for people to suffer needlessly.
I actually meant provider/prescriber, not pharmacy.
And there’s no comparison between refill too soon and DEA schedule. Refill too soon is benefits’ setup - the pharmacy benefits manager typically has a standard (usually 75%); however, the plan sponsor ultimately decides themselves what their refill too soon criteria will be. DEA license checks are based on federal and state law and are largely completed manually.
RFTS can be checked at point of sale at most retail and mail order pharmacies during the back and forth with the PBM. The process for a DEA schedule check is usually to go out to the DEA website, obtain the schedule based on license number, then compare that against the pharmacy’s files (assuming they actually have that information) and the drug/NDC. From my discussions with several large pharmacy chains, that happens less than 10% of the time. The same is true for refills - many pharmacies allow refills of controlled substances, but that doesn’t mean it’s legal.
And you’re partially right - most hydrocodones are schedule III (including Vicodin); however, methadone, oxycodone and pure hydrocodone as well as certain compounds with 15 or more mg of hydrocodone are considered schedule IIs.
This is the part I’m confused about. You say “that doesn’t mean it’s legal”. Are you referring to the prescriber providing refills for the controlled substance, or the pharmacy refilling the prescription?
This is the first I’ve heard of an actual DEA regulation prohibiting the refill of a controlled script within a certain timeframe. Can you provide a link to the regulation?
Yes, but hydrocodone compounds and methadone/oxy are totally different classes with a different set of regulations that govern their prescription and handling. I thought this thread was referring to hydrocodone and vicodin specifically, since I have never even witnessed a prescription for pure hydrocodone in 10 years of pharmacy. If you’re referring to how CIIs are regulated then those are two entirely different things.
I feel the need to add my experience to the discussion… basically, pain meds have been a lifesaver for me. To make a long story short, after two surgeries performed by a top notch physician, and, after multiple second opinions, I was left on my sofa, writhing in pain that felt like someone slowly twisting a knife in my gut. It never stopped. The only thing stopping me from ending it myself were my children. My physician referred me to a pain specialist. With his guidance, I’ve been able to return to my professional level job part time, avoid disability, & have been able to care for my kids again. It’s been 3 yrs & a good specialist will constantly tweak the meds to avoid tolerance issues. I am grateful the meds have given me the opportunity to live my life again - even if it’s not to the level I previously enjoyed. I am grateful that there are physicians brave enough to treat someone in my condition, too, & fear for those patients who aren’t able to find proper treatment.
Sure. Here is the cite for Class III & IV from the Controlled Substances Act of 1970. The refill window is 6 months, with no more than 5 refills within that timeframe.
The cite for Class II is here.
Ultimately, it’s the prescriber who can’t prescribe multiple fills on certain drugs or more than X number of fills on others; however, it’s also incumbent on the pharmacy not to fill those drugs when they suspect or know that the prescriber has ignored the rule.
I believe you’re mistaken on what the law actually requires. Yes, a controlled med (non CII) has a maximum of 5 refills. That doesn’t mean lifetime for the patient. That means it can only be refilled 5 times total for that specific written prescription and that rx number expires after 6 months. Once the 5 refills are used or 6 months has passed, a new prescription is written where the clock starts over and 5 more refills are permitted. Neither the pharmacies who fill the meds nor the doctors who write the new replacement script are in violation of the law once that new prescription is generated after the first script runs out or expires.
There is not a law that says the pharmacy is required to monitor the prescription refills to ensure that a patient only receives 6 fills in 6 months, once the prescription is exhausted or expired a new prescription is created.
I should say, 6 fills of that medication within 6 months. It’s impossible for the computer system to allow more than 6 fills of that prescription within 6 months. That’s the key difference. When you read “prescription” I think you are substituting medication. For all intents and purposes a prescription is one specific instance of prescribing authority, not the entire consumption of that medication.
I should also say I read your initial response as alleging that the pharmacy was required to ensure a refill did not occur within X days of the previous fill. There is no such law to my knowledge, only pharmacist discretion if they feel the fill is too early.
I don’t think I implied that someone could get just one fill of any controlled substance in their lifetime, nor did I mean to. If that’s the way it read, that was certainly not my intent. Given how many people have multiple surgeries or other discrete events where they need pain meds, that’d be ridiculous.
Oh, well - I’m going to bow out of this conversation. It doesn’t seem to be adding to the thread.
I didn’t read your post that way.
Ever have a migraine?
Migraines are painful and even temporarily debilitating for many. But there’s a common OTC drug which works on most people, and an injection for others. I have not heard of Vicodin etc being commonly used for a migraine.
It’s not getting a script of Vicodin which is so very hard. It’s getting repeated refills.
Many of the posters here want repeated refills.
I have been prescribed Vicodin for migraine several times. It works pretty well, except sometimes when I have a migraine I can’t stop throwing up, so then it’s no use. But when I can take oral medication, it’s a valid choice.
Then I’m still unclear on what the pharmacies and prescribers are doing which you alleged was illegal. They aren’t doing anything illegal
Really?? Vicodin? I’ve never heard of it being prescribed for migraines before. It certainly has never helped me in that regard. Not at all.
I was prescribed Lortab, which is similar to Vicodin, for migraines. It worked pretty well for me for years, until my migraines started to change in character. I think that’s the key though, migraines can be fairly different from person to person and even somewhat variable for an individual. It doesn’t surprise me that different medications might be useful in treatment.
Migraines have two components: vasoconstriction and pain.
Many drugs can “intercept” the vasoconstriction, and help to avoid the pain. But if the progress has gotten to the point to where pain begins, many migraine drugs do NOTHING for pain.
Imitrex and the triptan class of drugs were the first migraine medications that could work on the headache even after the pain started. If triptan treatment is successful, no pain killers are needed.
That’s a perfect world, though.
There are many grades of migraines. For some people, there are OTC remedies that are effective. For others, the very idea of using OTC products for the brain-searing experience is ludicrous.
~VOW
There is a new school of thought that chronic migraine is just that, a chronic condition, like, heaven forbid, herpes. You may not always be having symptoms or pain, but you always have the disease and it’s there in your system, waiting to flare up when it is triggered (a doctor here calls it “a state of constant sensory sensitivity.”
I don’t want to hijack the OP’s thread, but to continue to discuss Vicodin, my neurologist once briefly considered switching me to Oxycontin, but changed his mind. He didn’t say why. I don’t really have a preference as long as it is effective and I can keep it down.
Don’t blame the Docs, blame the lunacy of US drug control policy and the politicians that drive the issue.
My sister-in-law is a chronic pain Doctor and yes, they do have to treat everyone (at first) as an addict lying to get their next fix. A lot of addicts do exactly that. Consequently, the Doctors are under intense scrutiny from the DEA. There is no trust in the system anymore and the assumption on the part of the gov’t is that you, your husband, I and everyone else in the USA is an addict or dealer willing to do anything to get the drugs for use or for sale. Her office (as I recall) requires MRI’s and other medical documentation showing the injury or illness just to get in the door, and a broken toe won’t cut it. It’s not that she doesn’t care, or that she doesn’t want to help, it’s that her license is on the line for EVERY SINGLE PATIENT.
It’s so bad now, that hospitals are reluctant to give anything stronger than OTA pain medications for surgical patients! Much less patients with inoperable terminal cancer receiving palliative care. The official gov’t position seems to be that it’s better you be in screaming agony than you become an addict when you are already in end-of-life care. It is insane.
I’ve heard you can take a couple days in Mexico and go shopping to get what you need at fairly reasonable prices and without the stigma or assumption that you’re a member of the Cali cartel. Theoretically. Don’t hypothetically do it in Tijuana though, there’s a scam there that involves pharmacies selling you stuff then having you arrested before you cross back to the US. You get hit up for a “fine” to not face a drug transportation charge, and the “confiscated” drugs go right back to the pharmacy that sold them to you, to await the next US “sucker” trying to get medicine. I hear Cozumel is very nice and has lovely scuba and snorkling.
Regards,
-Bouncer-
What I would like to clarify is, assuming that there were no legal consequences, would doctors in general actually mind giving junkies pills they fancy so long as they were honest with you, knowing that by handing out pills to them you could also treat the pain patients properly.
It seems to me that if patients suffer becuase of skepticism then the answer is to be less skeptical and never mind what addicts get up to.
Of course ideally the drugs would be legally avaliable to anyone who wanted them for recreational reasons, and then you could know that anyone coming to you as a patient was very unlikely to be scamming you.
All I know, from my experience in pharmacy forums, is there are enormous numbers of Americans who are being under medicated and seeking desperate solutions, while at the same time it consumes the most pain pills on earth by far! Something doesn’t add up…