Please explain the "logic" behind the new pain medication prescription rules.

Factual Questions
1

Because of injuries received in a motorcycle wreck in 1988 and the resulting calcification of vertebrae in my back plus another twenty years of physical damage from work and play, my doctor made me stop working and further damaging myself. I haven’t been free of pain since 10:22 AM Pacific time 1988, just
varying levels. Because of this I take Hydrocodone (vicodin) almost daily. Without it I pretty much do nothing, which is hard to do for someone that worked pretty much continuously since early teens.
Because of this my doctor would write 90 day scrips and handle this with phone calls and faxes. Well a new federal law went into effect on the first of this month that says I must go to my doctors office and receive a hard copy to take to the Pharmacy. Each month. Now the doctor is only two blocks from the pharmacy so it’s no big deal. Gonna be there anyway.
I’m told this is to prevent abuse of pain medication. What I don’t understand is HOW. I know we are all used to our gubber-mint coming up with ill conceived policies that effect 100% of us to try to fix a problem that only effects 10% of us, but the thought process behind this one eludes me. I would think the people that don’t have a problem would be more likely to for go the hassles then the people that do.

Anyone able to explain this?

2

They want to put railings and possible staircase at Kaaterskill Falls, a natural treasure depicted in many famous painting of the Hudson Valley and highest waterfalls in NY. It has also been the sight of many deaths. When I asked a local hiking group why was this being done now the answer I got it it’s a election year. Perhaps that’s where your answer lies as to why as well, hopefully you will find better relief from pain.

3

The rules are so the doctor can do a more thorough evaluation to confirm the patient still needs the medication. Force the doctor to actually see and talk to the patient, and don’t give out a lot more medication than is needed.

You are right that this unfortunately is a negative impact for people like yourself who aren’t abusing the system. But there is at least a reason for it.

4

Seems to me that the decision to use pain meds is a decision between a patient and doctor. If abortion is a right, why isn’t pain relief?

5

While unfortunately many people do have legitimate needs for long term prescription meds, many people do abuse the system. I know a woman who used to get prescriptions for pain meds from four different doctors, having each one filled through a different pharmacy. Like you, she’d get 90 day prescriptions, and not have to actually see any of the prescribing doctors for months at a time. On days when she did have to go in, she’d have to stop taking some of her meds so that she didn’t go in all doped up and arouse suspicion. I’m guessing it’s people like her that ruined it for people like you.

6

The whole prescription process is insane. I’m sorry to hear about your injury. I understand as I’ve been in awful pain since 2003, mine resulting from a back injury at work and further complicated by FBSS (Failed Back Surgery Syndrome). Like you I started on Vicodin, but over the years have had to move to stronger and stronger medication. I’m currently on Oxycodone and like you I have to visit my doctor every single month for a refill. There is no calling in a script which is insane in my opinion.

A bit of unsolicited advice, be very aware of changes in your body due to the long term effects of the pain killers. My body stopped producing testosterone becausefof the chronic narcotic use. I’m on hormone replacement therapy now, but for the longest time I was very depressed as I watched my sex drive disappear, I gained weight and became very lethargic. The doctor at that time said they were expecting this, Shame she didn’t give me a heads up. The pain is pretty much under control for the most part these days, but I struggle everyday with massive lethargy due to the consumption of the opiods.

I wish you luck, fighting pain everyday is a tough battle. Knowing it is never going away is difficult to come to terms with. Stay strong and remember, you’re not alone.

7

Wait. You were getting three month scrips on Vicodin, and I have to go in every month to pick up my Ritalin one? Psh.

8

People don’t crush up and snort abortions, so there’s that. But maybe we can keep it out of this thread.

Anyways, back when I was on Adderall, my doctor would write me three one month scripts, each one future dated. That is, if I saw her today, she would give me one with today’s date, one that said 11/10/2014 and one that said 12/10/2104. Then, I would bring them all to Walgreens and they would hold on to all of them. Scripts for controlled substances, at least in WI, expire, by law, in 30 days. However, the pharmacist can sit on them (IIRC) for a year. Each month I would call Walgreens and tell them I would be there that day and they would fill it for me.

You could ask if that’s an option. You could also look into (legit) online pharmacies. Call your insurance company, they may have an in-house one. For example, United HealthCare has OptumRX. Since 90 days is standard fill for mail order drugs, there may be different rules. Your doctor may have to physically mail the script in though.

9

The danger and the abuse of painkillers really is an epidemic in the U.S.

It is terrible that people who really need those medications are affected by the restrictions. But this isn’t just about preventing drug use/abuse; it’s about saving lives. For comparison, only 10,000 Americans are killed each year by drunk drivers.

Pain relief is a right, and no one is saying that a doctor can’t prescribe appropriate medication. The government is just trying to put in place restrictions that will make it harder for people who don’t need the medication to injure or kill themselves.

10

or others.

11

Drugs are classified by schedule from C1-CV (5)

All the good drugs are in schedule II (you can’t get schedule I drugs - they are drugs like heroin - illegal almost everywhere except the UK and are considered to have no medical benefit) schedule II basically has two types of drugs (that are commonly used in it) - pain killers and speed (adderall and it’s related compounds and ritalin and it’s related compounds).

Right now on the black market oxycodone is considered the “best” drug that can be purchased. They go for a $1.00 a mg in most places. Hydrocodone can be addictive, but most addicts turn to oxycodone (or OxyContin - which is no longer crushable - so you need twice as much to get the same high - but it lasts twice as long).

Doctors are very often hesitant to prescribe Schedule II Drugs. They will sometimes make you see a specialist (for ADHD or take a drug test for opiates). Most doctors view hydrocodone as less harmful and it requires less paperwork (in a way) and covering their ass.

Basically they wanted to make Hydrocodone as hard to get as Oxycodone. Not only did they do that, but the also recently took tramadol (which was Rx, but not scheduled) - and scheduled it. That means doctors like my friend who is a resident can no longer write prescriptions for it - as residents (well at least in her program/hospital/state) don’t have DEA numbers and can’t write for controlled substances - this means she has to find an attending - which takes time from her already overworked day - or prescribe something less effective (which I don’t think there is much in that category - especially for the pregnant women she deals with).

There are more rules on the different schedules and more penalties. Some have to be kept in safes, but schedule II means you need to go every month to get your drugs. Amazingly - as someone else pointed out - a doctor - at least in my state can’t post date a prescription - which totally defeats the one purpose of the law (sort of - my doc only does two months - while Schedule III is I think 3-6 refills possible.

Also - although it can’t be “called” in there is a new system that some pharmacies and doctors have access to that is apparently some “secure” computer system that is somehow supposed to alleviate the concerns with a prescription being called in.

In short I think the main purpose for these rules is clearly there is an opiate epidemic in this country. Not only that, but there is little awareness of opiate induced algesia. Oddly enough - many if not most people on opiates for long terms don’t actually need it, but think they do. When they stop their pain medication - the pain comes back - so obviously they think “wow I really need this drug” - it occurs in the same place the injury is, but if they wait a few days - the pain is no longer there (it is similar to withdrawl - and is real pain - not imaginary). This keeps people on pain meds unnecessarily for years sometimes - as I believe it is only recently that this has been become better understood.

So the government had to do something to appear to fight the opiate problem. I believe that changing a drugs schedule only requires a publication in the federal register - so it takes them virtually no work to make it look like they are doing something:

Move tramadol (which is kind of an opiate) and hydrocodone up a notch.

It does little to solve the real drug problems at the street level - most of the addicts I know want oxycodone - some can’t even get high off hydrocodone (after they’ve built up enough tolerance). At least where I live there is virtually zero demand on the black market for hydrocodone and overwhelming demand for oxycodone.

The new prescription databases have made doctor shopping very difficult if a doctor checks it (it lists all your prescriptions - except ironically suboxone - which is used to get off opiates).

It also makes diversion more difficult (99.9% of oxycodone on the black market comes from people selling their scripts). As doctors get scared of being higher up on the list of those who prescribe schedule II drugs - they are more likely to ask for drug tests (to make sure you are taking them - which is obviously easily fooled) and pain management agreements.

The other stupid thing is the one drug that can help addicts (suboxone) is that in order to get it - you have to be able to prove you are an addict - so I know addicts that literally have been off opiates for a week, but feel a need to start using again - they would like to quit and use suboxone - so they actually have to go buy street drugs and take it for a couple days to make sure they fail (well in this case pass) their urine test. Then many of them just keep using the street drug - and the cycle continues.

Some hospitals and states are severely tightening up their requirements - some no longer will even prescribe opiates at the ER.

So then the people that really need them don’t get them - and the people that are abusing them (and need them in their own way) HAVE to get them - which is difficult in some areas. So what do they do?

Well they hear heroin will give a similar high when snorted - they buy it - and guess what? It is even cheaper than oxycodone is on the black market - and many consider it better - hey they think their problems are solved - sometimes they are only needing to spend 1/4 as much for the same high. Then when the snorting tolerance escalates - which sometimes happens much more rapidly than taking oxycodone - they start IVing the drug - just once sometimes - hey that works much better.

Then what happens?

At that point - there is almost no turning back - they are the walking dead and will cause themselves and their family untold harm and devastation.

One doctor prescribing a clueless beautiful young woman hydrocodone for her real pain - ended up with her stealing from her family, me - who loved her, neglecting her children, resulted In a murder suicide - in front of her daughter, her getting at least five other people that I know of addicted - probably close to over $1,000,000 in loses to the tax payers and businesss due to hospital bills when her liver was failing, theft, and the huge - I’m guessing 50+ cops and swat team members were there - her two children are now without a mother, and seven months later me and her family (and presumably the family of the man who killed her & himself) are devastated. She never made it to the heroin stage, but she was actually advised by a doctor to start taking it instead (I was there and heard it myself) in order to save her liver. I offered her part of mine, but they said there was little likelyhood of a non family member being a match - and that some ethics panel would probably deny it - cause shed likely ruin mine too. Oh and that is from the Tylenol that is stupidly put into the pills (yes u can get me without, but an addict takes what they can find) - not the opiates.

The only thing that keeps me alive is knowing her two kids love me and her mother, sister, and I rely on each other for emotional support. I can’t leave them.

Although I am against this change - in reality - it might have saved her - she was never good at going for refills or stuff like that. If it had been a little more difficult for her - and the pain was still there, but not unbearable - she might never had gotten addicted in the first place.

The damage this causes to families is close the worst thing I have seen and the pain of losing her that way has been the worst thing that ever happened to me - by far.

Sorry to kinda go off topic there - I was grieving pretty badly yesterday - it’s been seven months - and I was almost improving - but it’s getting worse - but I did find a support group and went yesterday - and it has been helping.

I guess my point is there are reasons to make doctors think twice before prescribing opiates, but I still think people should be able to get them, and doctors shouldn’t be playing god and being overly judgemental about who is in real pain. Just don’t underestimate the damage that one single prescription can cause.

But I think the short answer to the question is really that this was the easiest thing the government could do to make it look like they were trying to do something.

I doubt it will have any real effect - it could save lives, but it will also cause unneeded suffering in those in real pain - and escalation in the use of heroin in many areas. It is very plausible - I would say more likely than not - that it will actually:

  1. Reduce the prescribing of hydrocodone
  2. Increase the prescribing of oxycodone (not taking into account the other changes that are occurring that will reduce oxy scripts) - which most true addicts prefer - since both hydrocodone and oxycodone are now on the same schedule - if a doctor is going to choose one - he/she might end up using oxycodone instead - as it won’t make a difference in the scrutiny they get. As far as the DEA - state boards stats are concerned - they are now the same thing. So a doctor who would normally prescribe hydrocodone - to avoid the issues of a schedule II drug - might decide to give oxy instead - as it is the same amount of headaches.
  3. Increase the use of heroin
  4. increase the spread of the new non violent mexican based drug gangs that are offering home delivery to heroin users with good service, high quality, no violence, and good prices. They target affluent white suburbs. If someone gets arrested - someone else politely introduces themselves and takes over their customers - there is no pressure.

This will be a great business opportunity for them and their business model is interesting and actually seems likely to spread based on both their sort of franchise - employee owned structure. If they weren’t selling drugs - there would be pieces being written up in business journals on their methods.

And having home delivery by polite dealers who aren’t packing guns will appeal to the very users that can’t get off opiates - it isn’t like a dealer from “the wire” - It’s like ordering pizza from papa johns. Although I don’t think they have an iphone app.

12

My elderly mother has been on hydrocodone for years for chronic pain. She has one refill left on her current 'script, which should be filled around the 5th of Nov. Will this refill be honored, or will they reject it, forcing me to scramble to get a last-minute appt (which won’t happen, so I’d like to know in advance of any issue)? If the pharmacy won’t honor it, am I to understand that the doctor cannot call it in either? I need to know these things so that I can make a doctor’s appt now. I guess I’ll have to call the pharmacy tomorrow and ask them. Crap, as if we didn’t have enough to worry about.

How hard will it be for the guys in Washington to change it back, because I get the idea a lot of people, particularly the AARP crowd, are going to get pretty irritated pretty fast. I know dragging Mom out to the doctor’s office EVERY month isn’t going to go over very well. At all.

13

I am not sure how you come to this conclusion, and before any addicts start packing their bags and looking up cheap flights, I thought I should point out that it is most definitely a class A controlled drug over here. and unauthorised possession can lead to arrest. You may have been mislead by the Wiki entry which does not list heroin as such, but does list it under its pharmaceutical name - Diacetylmorphine. This is widely used for pain relief here, although mostly in hospitals.
On the general point about prescriptions - we are moving over to a computer based system for repeat scrips. I log on to my surgery and tick the boxes for what I need - After two days, I can collect them at my nominated pharmacy. There are protocols in place to prevent, or at least reduce overprescribing, and abuse.

I bought some simple paracetamol in the supermarket yesterday and was reminded that I can only buy a maximum of 32 tabs in a single purchase.

14

The ONLY valid answer to your question is to call the pharmacy and see what they say about the one remaining refill. And also ask what they say about renewing the scrip after that. And then do whatever they tell you.

The Feds have their rules. Each state has their interpretations and extensions, and then each pharmacy has their interpretation as well.

Given how important having an uninterrupted supply is to your Mom, are you willing to risk believing some advice here that later proves to be inapplicable to you/her exact situation?

15

I know the plural of anecdote is not data, but I just want to thank you for sharing your story, and I wish more people like you were willing to share their stories with those who ignore the public health crisis that many illegal drugs cause and focus on “The government can’t ban a chemical!” or “I’m an adult and I can do what I want with my body!” or the like. I’ve seen firsthand what substance abuse can do to the families of those involved - not to the extent that you have, thankfully - and I feel your pain.

16

I’ve never understood why anyone should give two shits if someone is abusing painkillers. People like my dad who actually need painkillers on a daily basis due to chronic pain because of messed up back/neck/knees/ankles are fucked because some tools like to dissociate from reality. So what? The actions of some drug-seeking assholes shouldn’t bar people who actually really could use pain medication from accessing it. It’s nonsensical, and completely illogical. Welcome to America.

17

I’m certain that many people abuse the system to get drugs. However IMO, laws and practices seem to be intended to prevent drug abuse first, and to allow people who actually need pain medications to get their treatment second, when it should be the other way along. Access to pain medication should be restricted only to the extent that it doesn’t impact negatively on people needing it.

18

No, it’s people who decided that it was more important to prevent recreational usage of drugs than to treat ill people who ruined it for him.

19

I give a shit because some of those abusing painkillers are out driving cars while they do it.

20

The really stupid thing is that people getting vicodin were already having to see a doctor, a medical professional, to get a script. This is the government second guessing doctors and trying to make them write less scripts through legislation.

And as was said the abusers will just turn to the street, or darknet markets, or whatever to get their drugs. All this does is make life more hellish for legit patients in pain.