Recently the L.A. Times has been running a series of articles about deaths caused by the excessive use of opioid painkillers, generally pointing the finger of blame at the doctors who wrote the scripts. In fairness, it does seem that the business model for some of those doctors is little more than a pill mill, but in other cases I wonder how an MD should be expected to know that a patient has just seen two or three other docs and gotten two or three prescriptions already.
It also seems to be the case that currently there is no cumulative tracking of opioid sales that would enable dispensing pharmacists to easily verify that the customer who just walked in with a brand new and legal prescription hasn’t presented two or three other prescriptions at two or three other pharmacies that same day.
By contrast, although with the exception of two or three states no prescription is needed, Sudafed sales seem to be tracked more thoroughly. It’s my understanding that some form of state issued ID, or its equivalent, has to be swiped and the information in the UPC code includes the total amount of pseudoephedrine in the package. Presumably this data persists in a database someplace, so the pharmacist can refuse to sell to you if you’ve reached your monthly quota. There’ve been cases of people being arrested for inadvertently going over their monthly quota of Sudafed.
In my opinion that’s an overreach of law enforcement, at least in cases such as that. But on the other hand, why couldn’t the same tracking system be used for controlled substances? Based on my experience in the past as a patient, you don’t have to show your ID every time you fill a prescription for a controlled substance. I suppose they have to verify your ID the first time they dispense the medication for you, but that’s it. By contrast, you do need your license to buy Sudafed, every single time. A drug which requires no prescription but might be used to manufacture meth, is more closely tracked, in some ways, then an actual controlled substance which could be, in fact, actual pharmaceutical grade meth!
So by adding opiates to the system they already have for logging the sales of meth precursors, couldn’t they pretty much end the problem of doctor shopping?
They already have a record of you buying it. It’s prescription only - and has to be written (for oxycodone - can be called in for hydrocodone(but I think still reduced to writing)). Several states (if not more) have put into place tracking systems that are supposed to prevent doctor shopping. CVS now has signs claiming they reserve the right to check some database that seems like it is designed to prevent this.
Sudafed is OTC - so without the logbook - they’d have no record of it - unless you paid by CC.
Put another way - if the cops saw you leaving a pharmacy with a drug - and then went in to ask who you were - if you got opiates - they’d be able to tell you (not sure about HIPPA stuff - I mean in theory) - without the logbook - they wouldn’t for sudafed.
As an aside, most stuff you can dig up says you are limited to 3.6 grams per visit, 2 visits per month. That does seem to be a rather low limit. The maximum adult dosage given on preparations like sudafed is 240 mg/day (eight 30 mg tablets). 3.6 grams is 15 days at that dosage. So the limit seems to be exactly the max dosage for a single adult for a monthly period. That sounds good, especially since most people probably don’t take the max dosage for an extended period, but what about somebody that’s buying the stuff for an entire family during allergy season? Suppose I buy a box of it, misplace it, and buy another?
I’m betting that a lot of people have gone over the limit, and just had to straighten things out with a phone call or something. If they really busted you over it, something tells me we’d have the courts clogged with cases at that low a limit.
I can personally attest that, in CA, currently, If my Sch II is not yet ready to be refilled by one drug store, I cn take it to another store and get it filled. (one shop was out of stock and I had to wait a week to get one of the 3 - the next month they told me I had to wait that week again, and again - I am NOT driving there and back 2x because they screwed up once.
I cannot take it to another Wal-Green, but I can take it to a CVS - there is no inter-action among the chains - and If I find a dozen independent pharmacies, I’m set.
Here, it is strictly on the prescribing MD to find out if you are seeing another MD for the same script.
I will say that the reason for the over-kill cross-checking of pseudo-ephedrine is a bit more critical - it is the feed stock (I believe) for Meth - and the society is willing to go to further extremes to stop Meth than it is to stop opiates (and, as the news stories note, those who abuse opiates tend to be self-limiting)
But how on earth is the MD to know–IOW what constitutes due dilligence here? Of course I realize urine and blood tests may be able to reveal an already high concentration of opiates in the user’s system, but that wouldn’t work if the “patient” is really trying to get the drugs for someone else.
Yes, until the MD is comfty with your drug consumption pattern(s), expect to get stuck a few times - first, a new patient needs a baseline against which to compare future blood levels of whatever - and if you indicate that you use certain classes of drugs (or the MD suspects you do) you will get tested.
After that, the tests have 2 functions: are you taking things the doc didn’t give you? Unless you’re rich enough to buy it on the street, it’s an easy guess that there is another doc involved.
The second reason for the test is to make sure you ARE taking the drug - if I prescribe something for this horrid, horrid, constant pain and you come in, I’d damned well find that stuff in every nook of your circulatory system. No vicodin in you? Um… how about morphine? OH? I give you vicodin and you take morphine? I didn’t give you the morphine… Wanna guess how many more times you’ll get an analgesic from me?
If you know a doc did the intern thing in an ER, don’t bother trying to scam that one - maybe a small country doc.
Now you know why some docs simply refuse to write opiates, benzodiazepines, and other high-abuse drugs.
I don’t look forward to moving - my prescription shopping list reads like a narc’s dream bust - 2 sch II opiates, 2 benzodiazepines, and an anti-depressant just to round things out.
I’ve never even considered the possibility of asking for some controlled drug "for my brother, who is in too much pain to come in personally.
I can’t imagine that would conceivably work, unless the doc has previously seen the brother and I and has seen us both for years.
Don’t know if an RN could be sent around with the drugs and instructions to draw for every high-abuse drug and, should situation warrant, start an IV drip.
Actually, that might be an excellent test: well, because xxxxxxxx is too xxxxxxx, we can’t xxxxxx, but we can control the pain with an IV drip.
If a person is in horrible pain, they probably will jump at anything that will take the pain away; if they are looking for recreation and/or re-sale potential, an IV is not going to be accepted.
I’ve never had a doc try offering a drip - I wonder if that trick is ever used?
The over-the-counter drugs can be bought in quantities. IIRC they are then processed to make the “good” stuff. So, the goal in logging these purchases like Sudafed is to limit the volume someone can acquire without a lot of trouble. OK, you can buy a 2-week supply; but you aren’t going to take half of what’s on the shelf, then walk to 10 other pharmacies and do the same. You can get enough for a pollen attack, but not enough to make a commercial batch of street drugs.
As for prescription opiates - I’m sure any state that does not have a database tracking system for key prescription drugs, it’s likely inertia and they are probably contemplating a system or actively working on it. As mentioned, the data is already available, it’s a matter of collecting and analyzing (and flagging) the data.
A friend consulted on such a system for one Canadian province. It even reported which dotors prescribed beyond the normal range - which would earn the doctor a caution from the provincial health authorities, or loss of opiate prescription privileges.
I am on two “controlled” drugs 1 for pain the other anxiety and in Nyhad to sign paperwork stating i would not accept scripts of any type , even blood pressure meds from any dr but my primary. If I saw a specialist he had to have my primary write the rx, as well as I had to bring in my meds twice a month to be counted, always had to fill at same pharmacy and show my license
Indiana is now adopting these same procedures.
I could understand if I had a criminal record, but I’ve never even had a traffic ticket. It pisses me off.
How silly - your pain meds are for orthopedic reasons? [like most of mine are for joint issues, or pre-existing back damage, and the pseudogout in my feet which is considered a form of arthritis] If so, why the frell isn’t the medication prescribed by your ortho?
And the whole BP meds have to be prescribed by the pain specialist is bullshit, they should be overseen by a cardiologist.
I agree, pain management ‘controls’ are stupid. If someone like bmalion or any number of us on the boards who have very specific origins for pain we are obviously NOT seeking meds for drug abuse and shouldn’t have to deal with that sort of bullshit.
I am so freaking lucky my doctor believes me and works with me. He has never required me to jump through hoops - he knows what my various conditions are, and has no problem with me going to a podiatrist for my pseudogout, an orthopod for my joint issues, my cardiologist for my BP and related issues, and him dealing with the migraines, and assorted whatever crap is going on with me. [I am sure it helps that you can pretty much see all my joint issues clearly in xrays, MRIs and some of them are visible externally with no imaging required. I have been informed that I have an insanely high chronic pain tolerance.]
It is so rediculouse that the law needs to track an otc hoping to slow down meth production its not my job to povide you a users guide to the dope man assuming that my purchase was not for its intended use i am not a user nor law offender but now am profiled as such and whats worse is the horrible treatment from the pharmacy personel that is pissed to have to babysit an otc product there has to be a better way lets face it when your in agony due to sinuses nothing works but sudaphed all the other crap just doesnt compare i dont feel i desrve to be treated like a criminal for medicating my illness while the kid in line behind me is waiting anxously for his narcotics that his freinds are pacing the parking lot for there share so they can go sell then to some teenager maybe someone you no. our systems prioraties are ass backwards.
When writing opioid prescriptions it’s been my experience that it’s based on trust. I have to see my doctor every month to get refill prescriptions as that’s the law. He can’t call them in. Every month I bring in all of my meds and set them on the counter so he can see them. It is apparent that not only am I not selling my medication, but that I’m also not taking more than what’s prescribed.
Recently doc wrote me a script for a three months supply of oxycodone. 540 pills. I don’t think he would do that for just anyone, we’ve built up a trust over the years. But the same goes with the pharmacy. I doubt that if I was a first time customer that they would have filled an order that large without asking a few questions.
What I do find strange however is how difficult it is to get needles from a pharmacy. I need them for a medication and they always seem to give me a hard time, always very suspicious. They’ll hand me a huge bottle of pills, but seem all paranoid when I ask for needless. (this is at a new pharmacy, not the one I usually go to)
Remember that controls are not just about preventing trafficking. They are also about making sure you don’t end up with an addiction, which is a very real risk for anyone with access to these drugs (including doctors.)
There’s one script I had that was injectable, came in vials. No big deal, I’ll just run into Walgreens to get the syringes. There’s no prescription needed in WI, but I was still given a bit of a hard time about it. To the point that I even ran out to my car and brought the vials in so he could see that I had a good reason for them (and still asked why I didn’t just get them from the place where I got the script filled). When he finally decided I was OK, he asked me how many I wanted, I was just going to take 2 packs (20), but not wanting to go through that again any time soon I took a box of a 120. I’ll probably have them the rest of my life since I don’t use that med anymore.
I wish I had asked for BD syringes. The Walgreens brand one suck.