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 36) (Top voted first)

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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Spyz, a lot has been learned about opiates and how they affect someone since the 70's. The drs are responsible if the patient dies due to him over prescribing, not if the patient isn't treated adequately for their pain.

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Posters,

As a professional nurse and published researcher with over 400 intractable pain disorders, and who will die without a new physician in days it is FDA a regulation they are ADVISING and all physicians due to the DEA witch hunts are compliant. I had the top specialist in America let's call him Dr. Famous in California and he let go 30 out of state patients over 10 months ago. I am seeking a physician in Texas, Louisiana or Alabama. Any good ideas? I have ultra rapid opioiod metabolization and was on $25,000 a month of Duragesic and Oxy liquid (pills do not work for this DNA).

Unfortunately we are all being thrown under the bus. I suggest if you like most pain patients start putting away medication start working downward.

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I am in Florida. I go to a doctor who writes for pain management and for recovery. He had to pay an extra fee as he is a multiple opiate prescription writer. He gets monitored but does not have to change anything. He just has the pain patients fill out a form ahead of time and they receive their medication after a visit. Nothing is changing in the upcoming future as Florida has already rearranged everything to stop all the pill mills. Since 2012 98% of the pill mills that were giving Florida the title of "most opiates prescribed" have all been shut down.

Some things have changed like the pharmacies can only have a certain percentage of their sales narcotics. This makes for a lot of patients having to find a place to fill their prescriptions. The pharmacists are becoming more strict and interfering with patient care. People have had their scripts refused because they live more than 5 miles from the pharmacies. I have been on subutex for years and I can not afford the whole month at once. So I split it up and get what I can when I can. If you go over 6 times getting your medication, you lose all the rest of your prescription. Which usually just means you have to track your doctor done and he calls in and then its usually a few days without meds to get you back on track. Anyone on schedule 2 medication is treated with contempt and judged by the pharmacist. Its not impossible to get prescribed your medication in florida, its just very difficult.

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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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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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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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Joey,

Odumma did this and it is rampant in opioids.

Look at Florida limiting people from out of neighborhoods on purchase.

Doc looks like you and I and my life is ending shortly still no physician and on the amount of hypercortisolemia that occurs with my pain I'll go to adrenal failure and code hopefully without a CVA means you should now get a pharm to go with MD.

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Ladytg50, it is not law, but a FDA Guideline 120 mg Morphine/120 mg Morphine Equivalent Daily and almost all drs are going by it. I can't believe dr actually thought it was 200 mg. The CDC has proposed lowering it to 90 mg instead of 120. We should know if that will be applied later on this year.

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Exactly WEHERE is this permitted? Not in NYS with a few "dying exceptions" — that's right; for me to write for 90 days of MS-Contin, Dilaudid, etc., I have to certify that pt's Dx is TERMINAL. And I'm bound by that document. I never heard of any doc whose patient just kept living regardless of the stated DDx (and that happens in real life). I suppose the docs get a "grace period," but I don't treat terminal patients and am not familiar with this part of the regulations. But it is unequivocally NOT true that all doc can writes script for C-II drugs in a 90-day supply throughout the US.

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Chris, it does not makes sense that you're going to have pain meds from a three year old rx. Did you take the actual bottle in to the dr ? This is used often and it tells drs that you got pain meds from some place that was not prescribed to you. Pain drs do not tell you to save pain meds for disasters. One of the problems now is that patients save up their pain meds and that is why drs are prescribing just enough for 30 days. I have seen one person say that their drs did say that here and that was Dr Tennent in California.

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Spyz, when a patient need pain management 24/7, extended release pain meds are the best way to go for several reasons. For one, the pain medication being released in you system is at more if a constant level than it is with immediate release pain meds. Immediate release meds are easier to abuse than extended release ones. When a dr writes a prescription for immediate release meds that are to be taken every 4-6 hours, there are many more tablets that when it is for a med that is only taken twice a day. That means that there aren't as many pills that can be diverted. Extended release pain meds are not to be prescribed for acute pain.

The reality is that if someone needs pain management, they can go by the rules that the dr has and have it to some extent or not go by the rules and not have it at all. Life isn't fair and we all have to adjust to things.

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jamie, Methadone Clinics do not treat chronic pain patients for their pain. They treat patients for their drug addiction. If someone has gone to a Methadone Clinic, they aren't going to be able to find a dr that will manage their pain with opiates.

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Not probation. Jail. It's Draconian, but please lets think straight here and not politicize this because President Obama isn't doing anything but bringing the issue to further scrutiny because let's face it, people are dying out there more than motor vehicle accidents. We are collateral damage and remind your prescribers of this. He's only put his name out there and endorsing guidelines of the FDA/CDC/DEA. let's leave the poor guys at DEA out of this because all they do is say, huh? What have I got to do now? These are clear headed reasonable men and woman and my healthcare collegues -well I've never seen such cowards-I've talked to them on the phone and I pictued him (DEA) with his feet up on his desk. They enforce laws and do not make them. I think everyone needs to take a deep breath and relax and look at this for what it is. It's a huge over response to these drug overdoses. The statistics do not include chronic pain patients that take their regular doses. However, they've turned a blind eye to the statistic of suicide. We aren't hearing suicide in these overdoses. Don't you think that is strange? I do. Think of how on the ground the scenario plays out. The largest growing segment of people suiciding are the upper middle age and elderly white males. Most are on opiates and antidepressants and sedatives. The coronor arrives and the family is all distraught that Grandpa or Grandma slipped out of the craziness and uncontrollable pain the easy way. The coronor is going to ease families distress and write: Cause of Death-Opioid and Benzodiazepene overdose-Accidental. This way it's all tidy and good and they didn't commit suicide. The stigma of suicide is very real and causes huge guilt among everyone involved let alone an accident. So we don't hear suicides anywhere and that is why we, the fringe taking our pain meds appropriately are targeted...we might OD just like the stats say we will. So that is the big Elephant invisible in the room that nobody addresses because you know a large percent are purposeful overdoses. If they aren't on purpose then they are done by people not knowledgeable about the dangers of not being tolerant enough to take the prescribed persons pills and they stop breathing. Here's more of my two cents if you can stand it. People prescribed opiates also need to have available the antidote drug narcan. Narcan reverses the opiate effects immediately and it can be given like an allergy pen subcutaneous. This will save lives. The limit on the dosage of 120 mg equivalents I tend to agree that is reasonable. Now before you get crazy about this hear me out. There are only so many opioid receptors in the brain. 120 mg Morphine saturates all of these receptors quite well for as long as 12 hours. Any more is placebo. Placebo is very important to patients with chronic pain simply because it works. Studies show that placebo gives 40% more pain relief. Pain occurs within the brain. All the action is there. You may have had an injury to your back 30 years ago and it's really your brain that is remembering the location of the inititial stimulus when there may not be any nerves or bone left after surgeries to cause the pain in the area that we say it's coming from. We know this from limb amputation pain and phantom pain. The brain itself can think it has pain (oh it's very real, don't get me wrong), but the more you know about this the more you'll find that huge megadoses of pain meds may placate the patient in the MD's office to make the patient be quite.. but it is placebo that is working not the more medication. The opioid receptors are saturated already and no amount of increase in narcotics will help other than via placebo effect.

Bottom line we find ourselves here because it was easy for the doc just to make the pain patient placated and happy to get an increase. Do you know how the mind plays with this? Particularly if the doc changes the type of narcotic? Oh we're trying to find the equivelencies to make sure that we are getting more and maybe this is more powerful than that. I think when the hystaria dies down that from what I've read most chronic non cancer pain patients will be OK with these new guidelines. I'm sorry for those of you that had pills shoved at you to make you be quiet and pleased. But 120mg vs 240mg of morphine physiologically on pain receptors is no different. Oh the side effect profile is different. More constipation, dizziness,, lower blood pressure, and slowed breathing when we push the body to it's limits with these high doses. Take heart though. I don't want to be on methadone all my life for this peripheral neuroapthy. I want topical alternatives available to me and I want them now!. The pain MD I have has my case closed after finding that I don't abuse them the office never calls me anymore to come in so I'm warehoused on this stuff. And time goes bye doesn't it? 5 years on, it turns to 10. Well not for me. Take heed and heart too that it IS true if you take your narcotic pain meds exactly as ordered (although I take half of what is ordered for me because he won't go down on the dose-go figure) that tolerance will not be an issue. I know this first hand. I didn't believe it when I was told in nursing school this was the case. But for me it really is. If you are having pain while at or over 120mg equivalents of Morphine then you need alternatives that do not exist yet because everyone has taken the easy way out and placeboed your dosage up. Read up or watch the nova specials on the brain and pain. It's all happening in the brain not in the sprain or the back or the muscles. The periphery started it and the brain modifies itself and runs with this ball. When you understand the pathophysiology of pain and pain treatment you can see that 120gm Morphine equivalents per day really maximizes receptor saturation and more will only cause problems. But don't sit there hurting. Go to the ER, find out all the alternatives that are emerging right now because of this crisis. These alternatives were never developed because it was too easy too just placate the placebo brain. Oh and use the placebo too! Take that super duper all powerful 800 mg Ibuprofen and have a hot bath and you've hit this pain monster on the side of the head it wasn't expecting. Pain is very real. Pain is treatable. Ever take a relax pill instead of a pain pill and the pain goes away? I rest my case. But, fight!

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Erik, if you are taking more than 90 mg Morphine/90 mg Morphine Equivalent Daily Dose it is extremely doubtful you will find a dr that won't reduce it.

You can write anyone you wish, but it won't make any difference. What is happening now has been in the works for quite a while. There was a time for the public to make comments on proposed changes. Unfortunately, few comments were made against the proposed changes during those comment periods.

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Although I am interested in this subject for conversation about Pain Management, the dates corresponding with it are showing 2014, 2015 and this is July 2016. What is with that?

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Ty, the CDC recently came out with Guidelines that recommend not more than 90 mg of Morphine or Morphine Equivalent Daily Dose. You aren't going to find a dr that will keep you at the high dose you have been taking.

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tara, doctors rarely know when a patient calls and ask to speak to them unless the doctor or nurse call the patient back. What was the doctor suppose to bring up at the December appointment ? If the doctor did not write it in your mothers medical records and your mother did not being it up, the doctor has no way of knowing what it was.

Did your mother sign a Pain Contract with her current doctor ? If she did and another doctor prescribes her pain meds, she can be dismissed by both doctors with no more prescriptions. Most new doctors want a copy of patients medical records before treating them to verify they have a medical need for pain meds and that they have not been dismissed for risky behavior, breaking a pain contract. etc.If the new doctor writes her a prescription for pain meds and she goes back to her other doctor for another pain prescription, that is Doctor Shopping. She could also end up with no doctor and no pain meds and not be able to find another doctor that will treat her pain. Almost all doctors check the state Prescription Monitoring Program to see what Schedule II meds a patient has been prescribed recently and by what doctor. The phamacist sends this info in when a prescription is filled. It has nothing to do with insurance, the pharmacy you go to or if your pay cash or use insurance to pay for prescriptions.

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Jennifer, I thought you might be interested in this.

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) OPIOID MISUSE STRATEGY 2016-
cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/CMS-Opioid-Misuse-Strategy-2016.pdf

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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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Lisa, what do you mean you're "looking for a good pain clinic" ? Have you been dismissed for not following the rules ? Are you on a high dose of pain meds ? A good pain clinic is one where the drs prescribe the medications that they believe will help the patient. If a patient wants a specific med or dose, that may or may not be best for the patient. But the dr is the one that should decide. It is also in the patients best interest to do routine drug panels, sign pain contracts and obey the rules.

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