2014 New Pain Medication Laws Dictating To Doctors That They Cannot Prescribe Anything Equivalent 120 Mg Of Morphine Or Higher A Day Per Patient (Page 33)
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I was told Friday by my Pain Management Doctor at my monthly appointment that the DEA was implementing a new law dictating to doctors on how much pain medication they could prescribe per patient per day. It could be equal to no more than 120 mg of Morphine per day per patient and they had to comply within 3 months for all of their patients. I am trying to find out as much information on this as possible. I don't know if my Pain Management Doctor is stating fact or if he is just running scared and if he is stating fact, I don't know if this is federal or state (Alabama) mandated. I spoke directly with the Southeastern division of the DEA in Atlanta this morning and they are not aware of any law of this nature coming into effect and I also contacted another pain clinic locally that has never heard of it either. So I have been trying to reach my Pain Management Clinic and get a copy of the law itself so I will know if it's federal or state and if it is an actual law or just a state regulation and if it's even true but so far no one has called me back so I thought I'd try my luck here and see if anyone has heard of this. This really has me bothered. It looks like either way, true or not, to get adequate pain care I am at least going to have to move out of state if not the entire country. I will ask my questions about that in a different post. But if this is in any way true, and it seems my pain doctor is going to be going by these guidelines whether it is or is not true, it is going to cut my pain meds by almost half. I am on 120 mg of Oxycodone and 8 mg of Dilaudid per day which I was told equals 212 mg of Morphine per day. And before someone decides to tell me that I don't need that much pain medication, I will go ahead and say to you, you don't know me, you don't know what conditions I have that cause me Daily Severe Chronic Pain and other Daily Severe Pain to warrant that much medication, you don't know my tolerance for pain meds, I do NOT take any pain medication to feel high, I ONLY take pain medication to relieve some of the pain as what I am on doesn't even relieve all of my pain, I do NOT drink, I do NOT do street drugs, I see my doctor every 28 days just as I am supposed to, I take my medication as prescribed and the way I am supposed to take it except when I had extreme oral surgery a month ago and I did have to break up my tablets for about a week but they were put on my tongue and NOT up my nose and they were IR tablets so I was fine doing that as I had checked with my pharmacist prior, and you don't feel what I feel or see me lying in bed 24/7 crying from the pain because it is so excruciating and unrelenting so please before anyone starts telling me that I don't need that much pain medicine just stop now before you even start. Those of you that have to live with daily pain will surely understand where I am coming from being this defensive as I'm sure you know you are treated as a drug addict by most doctors even. Thanks in advance for any help with my question.

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85

I've only heard of that when I'VE accidentally listed an incorrect dose once or twice or a dose that wasn't the usual for that patient. Rah called and aid, "Joey, you orders Xanax 5mg for Mrs X. She usually gets 2mg. Did you want her to have .5mg or did you make a clerical error." (I was writing a script while on the phone, the "5mg" came from an oral Valium script.) If I write for Percocet 10/300 in proper form with appropriate signature, how can a pharmacist decide to alter my therapuetic decision? And what about psych drugs? Those doses REALLY are mine to determine and a number of reasons determine what drugs and what doses.

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84

Mona,
If your old Dr. Does not want to make referal out of state. Just set up aNY appointment with a pcp once you get in and they realize what is needed they will refer you to a clinic some also will take over treatment until you get in at least that is what was done for me at the time. They to said they didn't prescribe when I called and I never asked it was just what they were telling everyone that called. However once the Dr. Sees you if they are a good caring Dr. you shouldn't have any problems. I have seen many doctors over the years sadly there are not many good ones so when you do find one hold on for dear life!. I am an easy patient only if they are knowledgeable or listen and are willing to admit they don't know everything and look up and confirm what I have learned before shutting me down. For example you can take Methocarbonal (Roboxian) and Tizanadine (Mobic) rotating these can take care of different parts of body one helps over all and upper body the other is a skeletal and helps lower body so taking both help's all not just half of you. Some doctors and nurses don't realize it. I have had one come back to me the next time I was in and apologized to me after she researched herself. Now that was gratifying!
I research everything and take true advice and never take first opinion unless verified. Some are very intimidated sadly especially some of the nurses.
GOOD LUCK!

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83

True! Those extra two a day are all that's needed and its makes it not just, "oh a little better" but more like: shower daily! Standing long enough to make home cooked meals and keep the apt. Nice and clean, it's make you able to run to the store or post office and other errands, it's just such a big, big difference. And they keep saying or using the word 'addiction' as their excuse for everything. Five years years now and when I self dose it's still six a day-no mire, no less, four has me so out if whack I'm even getting vertigo again which I haven't had in five years! I have tons of documentation showing that instant release is supposed to be every four hours UNLESS opiate naive. The doctors say, oh not for chronic pain! Sorry doc, chronic pain does not make them last two extra hours!

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82

I also get an extended release, sort of, I'm on the 50mcl fentanyl patch every forty eight hours instead of 72. Problem is, while waiting for my first ever oxycodone script to be filled I perused the various med/drug forums and found numerous posts indicating that folks who started on 6 a day, one every four hours, LIKE THE MANUFACTURER SAYS, never need to increase their dose. Me being the brainiac I think I am, went ahead and followed that dose. That was almost six years ago. In the meantime I was taking phenytoin which caused hyper metabolism and ZOOM! I was taking 15-20 a day of the 30mgs. Due to my high (to the govt) dose, I stopped taking other medication I was on for things like sinuses, hot flashes, lethargy, and done other stuff. Decades ago opium was prescribed for many things especially "things pertaining to women" (hormonal, adrenal etc) I figured if it worked back then, no reason to take all that other meds now. Ok so bout a year ago the phenytoin is no longer prescribed and BOOM! my does dropped to 12 a day the first month, 10 a day the second month, 8 the following month and finally back down to six per day and sometimes 5.2. Problem was nurse practitioner wasn't satisfied. She claimed I was an addict and referred me to treatment centers. I asked her how many addicts doses continually drop? I thought it was the other way around. Of course I was fired. My new and current doc knew the story and they earnestly try other things to maintain my relief. They won't go for the six a day though. They said they would be making me an addict. Without the interference of the phenytoin and the hyper metabolism, after almost six years my dose is still 6 per day. I tried to do the right thing and take only four a day and now am in PAWS, even while taking opiates! I've since quit school, my thyroid is low (opiates raise T3 levels), and I go from laying in bed crying to laying on couch crying. At six per day I had a normal life! If little Billy sells his granny's pills that's not my problem and all the prescription overdoses? Admit it! They are suicides due to insufficient medication and inadequate pain relief! TennCare only pays for a ten day supply. And the dope man doesn't count your pills or check your urine. He treats you like a customer.

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81

Hello Mona, I hope you're having a decent afternoon. I'm sorry to hear about the situation you find yourself in after moving to the west coast from SC to help care for a family member! I've been a patient of pain management for more than 20 years (including a move from SC to Ohio). I've learned a few important things along the way I'm happy to share with you. I do have one question. When you told your SC Dr you were moving did she/he send your records to a colleague in Oregon & request an appt for you in your new town? My Dr in SC was familiar with or thought highly of the Cleveland Clinic's Pain Clinic so he sent my records there requesting they take over my pain management needs relating to my significant bladder pain caused by chronic Interstitial Cystitis blahblahblah. A couple days later they replied with an appt date and time. The Clinic's Dr's took me on and I saw them monthly for a medication refill. If you weren't referred to a clinic in your new town I highly suggest you call your previous Dr's office, tell them of your problem and kindly ask for their assistance. In your post you stated the following; "as soon as I call they say they don't prescribe opioids". No Dr's office is going to reveal over the telephone that they prescribe opioids or narcotics or morphine or however you want to word it. Cold calling a Dr's office asking if they prescribe controlled substances for your pain will get you a very swift negative reply. You're going to need a referral from either your PCP, orthopedic, Rheumatologist, Urologist etc..it's going to be up to the referring dr to state in your records that after much trial & error, morphine is the medication that helps you the best. I've gotta run but I will come back and post a couple of websites could be helpful for you. Every state has their own rules and regulations it seems. In the meantime, hang in there and know you're not alone.

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80

If I'm not mistaken rulings of a State Board of Pharmacy are considered to have the force of law. When Federal and State regs class — the more restrictive regs win out — an that is in the law. It bothers me having to write scripts for Klonopin as if they were for Oxycontin, etc.

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79

Not about long acting vs short acting medications. The 2 types take care of completely different types and levels of pain long acting meds help the very deep pain but do nothing for break through pain and vice vs for the short however short can help the deep pain but you would need alot more to manage all of it the combination of both makes it to where someone like me can manage. Long acting meds last 7-9 hours even though listed as 12.. short acting will last 4-6 until body builds individual tolerance and lasts 3-4 hours at the most effective levels. So in hindsight 2 long acting meds and at least 4 short term for 24 hour period shorts you 2 not only that cutting type of med to morphine that is not effective for everyone unless we are no longer individuals shorts you almost all relief all the years working with my Dr to see what kind what strength and how many flushed away to someone that does not walk in my shoes.

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78

Spyz,

I was normally on 80 and 80 of brand Duragesic a month and have weaned down to less than 30% and that is LA. The FDA 120 mg. morphine equivalent is now dictating your physicians. It's not a LAW. It's not the DEA but the FDA has never done this so they are all backing down. Listen these physicians have illness and families. They do not need to go to prison over our pain management either!

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77

Spyz , "oh we never give more than four. For your own good of course," Leads me to believe that you're taking immedicate release tablets and not extended release. When a patient has pain that is severe and they need it managed 24/7, extended release are the best. Some dr give immedicate release for break through pain and some don't. When a patient takes immediiate release and they take it every 4-6 hrs, there is a greater chance of them taking more prescribed, which is not good for the patient. Also the more pills that are prescribed the greater the chance that some will be diverted, which isn't good for the patient and others.

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76

So true! It's about money and lowering our group. If we complain and speak truth we get fired or an asylum for us. Time to stay strong or the only other logical choice is end life now. We MUST remember we have an ally in Christ! I drove myself crazy tryin to explain how and why my dose should be what I think it should be. And in five years it hasn't increased! (My personal dose) not the prescribed dose. All the medical facts back it up and the doctors and silly child nurse practitioners get a glazed look on their face and say, "oh we never give more than four. For your own good of course," HOGWASH! There is a plan in motion and we are the pawns.

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75

john, I apologize for misunderstanding.

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74

chg swabsticks by Chenyanglobal Group

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73

Posters,

Any pharmacist can change your opioid above the physician's written prescription.

Ask one that you do not need to use again and watch it unfold.

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72

BL I was agreeing with you. I have said this many times and it just hasn't sunk into that guy and some others

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71

John, I was replying to P450's statement ''That a pharmacist can look at you in the snotty way they do, decide that they will not give you the 300 Percocet written for you but change this to 300 Lortab ABOVE your physician's orders. That is correct.'

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70

BL that was very clear. The guy who insults the pres and calls him a murderer was very wrong in what pharmacists can and cannot do. You Dr determines the reason you take something. But as I have experienced many times is that if something is not clear on the script, your Dr will be involved before you get something. My dose of something was increased and that pharmacist made sure it was valid. No Pharmacists can change a script or substitute, they can not even give a dose of something in a less amount of they are out of your meds.

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69

Jenny,

Public suicides occurred when "Dr. Bill" was arrested in Virginia the first time; patients on high level opioids were viewed on the news begging for physician help. No one helped them, they took their lives. The second time "Dr. Bill" went down my physician of 10 years now deceased took the overload in Texas. It meant less time for us but he did the right thing. God bless his deceased soul, he was a good man.

There will be higher suicide rates for you cannot treat pain patients who are legitimate suddenly like dope fiends.

That is what your voted leader came in wanting to do rid America of chronic illness by non treatment to reduce the cost of health care. The wannabe socialist had this plan in progress when he was voted in.

Learn if you are a pain patient to do what I did (put 10% aside per month) for without a specialist for 10 months and an overjudicious and murderous workers comp group attempting to kill me for the lifetime medical award they could have settled years ago, they have effectively attempted to kill me literally, I will not share details here for clear purpose. I took them to court and won, they appealed holding off a panel of physicians of course that won't work but I have had this lifetime award for MANY MANY YEARS. It only became a problem when Odumma held up shortages of opioids to increase prices and then the little insurers thought they could take WC cases, old SSDI cases and make them Odummacare which they cannot.

IF Dr. Famous threw 30 out of state clients out cold without a solution and is sucking up to the vultures who are trying to kill me after 5 years well that's what the best did to me.

You don't need the statistics, you need to find the few physicians left who are courageous enough to practice proper medicine.

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68

A Pharmacist Cannot Change a Prescription Without A Physicians Authorization. A Pharmacist Can Refuse To Fill A Prescription. President Obama has nothing to do with this. It is a matter of liability.

"The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription."

Purpose of issue of prescription:
deadiversion.usdoj.gov/21cfr/cfr/1306/1306_04.htm

Role of Authorized Agents in Communicating Controlled Substance Prescriptions to Pharmacies:
deadiversion.usdoj.gov/fed_regs/rules/2010/fr1006.htm

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67

Jenny

Florida has the following a stats:

447 heroin deaths up 250%
538 fentanyl deaths up 200% and is mixed with heroin
1316 xanax deaths up 5%
978 oxy deaths down 7%

This is all for the year 2014. The increase in H use is because of the pill mills being shut down and Dr shopping being stopped. No increase in treatment at all. Thank god I have my subutex and that I am clean.

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66

Jenny,

You do know that the laws were changed so that pharmacists can WRITE above your physician?

What does this mean?

That a pharmacist can look at you in the snotty way they do, decide that they will not give you the 300 Percocet written for you but change this to 300 Lortab ABOVE your physician's orders. That is correct.

F the pharmacists. I am usually on such a high amount of medication and such a high bill ($25,000 monthly) if I have a physician which currently I do not that my medications are filled states away in a mail order setting and trust me it ain't Walgreen, CVS or the other opioidphobic pharmacies.

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