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 5)

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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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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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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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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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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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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Technically, RPhs even have to call if I write for Klonopin 2mg #90 and they don't have the brand or generic, but they have the 1mg generic. Then they call and ask if it's to dispense #180 with directions to take TWO tabs TID. They also always state that they will explain to the patient and that have approved.

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Spyz, when someone takes an extended release med, dr don't prescribe an immedicate release more than 4 tiems a day. If the four times a day of the immedicate release isn't helping like it should, your extended release may need to be increased. You also need to adjust your life style. You can't continue doing things now like you did before you had chronic pain.

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Under what statutory authority can they do this? Some pharmacy regs may fall under the realm of Administrative Law. but the law is the law. Period. ASNY regulation requires Statutory Authority — and I've seen a bunch of "Ad,in Laws
" crumble under State Supreme Court and Federal District Court scrutiny. The Courts really DO have law enforcement authority.

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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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Dr Joey, the one thing(to my knowledge)the Pharmacist doesn't have the any legal right to do is change the written prescriptions Mg amount. Your example of a written script for Klonopin 2mg TID #90 and the pharmacy only has Klonopin 1mg so they want to change the mg and dosage to 1mg take two tabs TID #180. I've not seen any new legislation stating that they can just, use their own discretion to change without getting permission from the Dr.

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I mentioned the R.Ph would require my verbal authorization. Unless I overlooked something, you're spot on.

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BL I understand adjusting lifestyle- six per day had me up bright and early and off to school, only two classes per semester mind you but it beat being a couch potato. Six per day enabled me to not only be able to climb in and out of my expedition, but the energy, motivation and leg strength to be able to go to grocery store. It also allowed me to be able to stand long enough to shower 2-3 times a week, peel, chop, dice fresh veggies and cook healthy meals. Six per day keeps me alert and inspired enough to be able to read the Word without falling asleep after the first sentence, and to keep up with practicing and developing my art. Six a day even helps me to do little things like answer phone, visit a friend, walk my dog, go to church, etc. four a day has me in bed till noon, crying in pain. Vertigo again everyday, Eating a microwave meal maybe twice a week, nothing the rest of the time. Four takes three trips back to bedroom to grab 1) pillow, 2)blanket and 3) change into sweats or more comfortable pj's to wear till my next shower which won't be for at least a week. Four a day has me explaining to my dog that she must wait for her daddy (my roommate)to get home before she is walked. Four a day has me crying, agoraphobic, despondent and just plain ill due to not only homeostasis out of whack but more symptoms flaring up and PAWS.

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THE VERY SAVVY POSTER WHO INFORMED US that pharmacists cannot change strengths on controlled substance scripts (my Klonopin example) — IS ABSOLUTELY RIGHT AND I THANK HER FOR THE STRAIGHT INFO ON THIS ISSUE. There are other doctor errors they can correct. Thinking back, I realize pharmacists LATELY only have done this with "Rx Only" (new name for "non-Controlled Substances, I guess) drugs. A recent example is a patient I have on Prozc 60mg qAM (I forget THAT brand name, but it is around and with the generic laws, it doesn't matter.") Phone rings? My local pharmacists and I are very relaxed. I never gave a damn about titles except in that they establish my legal right to prescribe treat and know what I'm talking about. Phone rings. "Joey, I have that script for 'Prozac Weekly 60mg' here, but I don't have the pills. I don't even have Prozac Weekly, [This guy considers his rep more important than bulls***ting patients in this situation because state law provides that if I write for a generic and only the brand is available, the brand must be dispensed at the generic price or copay. Kev did this for me PERSONALLY with Effexor-XR.] You ordered brand name Prozac 60mg. Can I sub with brand Prozac 20mg #90 and directions of 3 tabs po qAM. This girl's a smart kid; I"ll explain if you like. Or I can call and put you on the phone; can I use your private cell." I said that this patient was sophisticated, but because Prozac is an "Rx Only" drug and not a CS, the pharmacist made the revision.

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P450, a Pharmacist Cannot change a prescription like you're stating. Some prescriptions a Pharmacist can make changes to Only WIth A Physicians Permission And Indications. Other prescriptions like Schedule II's a pharmacist Cannot make changes to. A Pharmacist or Drug Store that chooses to limit certain prescriptions to only patients that live in the immediate area of that store is up to each Pharmacist, Drug Store/Chain Store. It Is Not Law and the President has Nothing to do with it.

Spyz, you need to talk to your dr about increasing the mg of your patch. You aren't going to find a dr that will give you 6 tablets a day as a breakthrough med.

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Thank you for this forum. I empathize with the individuals who contribute, being a chronic pain sufferer with Piriformas Syndrome. Everytime I move to FL for the winter I have to find a new primary care physician and/or Pain Management Dr. In the hopes that s/he will prescribe Hydrocodone. The OTC drugs don't work and led to a bleeding ulcer that landed me in the hospital for 3 days.

Until I establish myself with someone in the Crystal River area does anyone have any suggestions for getting the equivalent of Hydrocodone without using a NAISD?
I can't remember the dose but I took one to two a day to get relief. I have been out of it for a few days and with the new regulations my Dr. in Michigan can't prescribe it while I am in FL because I have to be seen and be given a script in person after showing ID.

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Sylvie, have you heard of CWE Cold Water Extraction? It is a simple process to separating the hydro one from the aspirin or acetaminophen--the method is on YouTube or you can google it. Or just ask your doc for roxicidone

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I should have mentioned that benzos are considered and treated as Schedule II (or C-II) Controlled Substances in New York State.

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Sylvie, drs can write 3-30 prescriptions for hydrocodone meds at one visit, although most dr chose to see patients every 30 days. There is no law stating that your dr must see you face to face each time they write a prescription for s Schedule II med. The law only states that a dr that prescribes pain meds to chronic pain patients must see the patient at least once every 90 days. There is also no law stating that you must present a legal form of ID when receiving these prescriptions from a dr. When you pick these meds up at a pharmacy, they ask for your legal ID.

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Dr.Joey- Question-I have apt with new pm dr. so will be taking u/a - now since I lost my 12 yr. pm dr. in March I was w/o meds til May when my temporary primary took pity writing me a month worth of meds which I have tapered dose so it would last til find new pm. However it has been 5 & half months so when I found old script from lost dr. I took one 40mg oxycontin about a week ago (it was expired over 3 yrs but need relief so hoped it would help). Will that show in u/a & if so there is nothing illegal or wrong now with new laws is there since it prescribed for me & I have records? So scared to jeopardize finding pm dr. am paranoid in horrid 24/7 pain now...
Thanks
Oh-am in central FL if someone knows of a pm dr!!!

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I doubt this U/A will be of sufficient sophistication to pick up metabolites of OXY from now more than a week ago. I'd say being the bottle if you have it, but that bottle is three years old (even if you DO have it). I'm thinking only a full EXPENSIVE too scan (blood required) could pick this up, so I'm making an educated guess you'll be OK. OXY metabolites rather quickly — OXYCONTIN a little less so, but you'll note that the OXYCONTIN dose is q12h. That's in your favor. You didn't do anything wrong. God luck, my friend!

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