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 7)

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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The DEA and State boards of Pharmacy do NOT issue guidelines in these matters. When it comes to what you call guidelines I and every MD , DO and district attorney in the country calls "Regulation with the Force of Law". There's are underlying enabling statute(s) and the penalties are the same as for criminal offenses and ethical violations. (The basic difference: a judge can't suspend a doc's license except as part of plea deal. The DEA or state board? They suspend or revoke in a New York Minute upon the presentation of valid, substantiated charges.)

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Once again....I said that the DEA uses local guidelines, which they invent at will because each regional office makes up their own rules - not laws, but guidelines of practice. There is no FEDERAL regulation regarding maximum amount of controlled substances of ANY type and ANY agency using that as an excuse for investigation is lying...that said, it does not mean that they will not investigate, nor that the physician or pharmacist will refuse the prescription, patient or otherwise. The point being, it is not a "LAW" but a guideline which are unpublished, subject to interpretation and in all cases non-binding. Unless it is part of the CFR, or part of the pharmacy regulations, it is not a LAW - it is a practice that you still will not be able to get around.

EVEN when the FDA makes labeling requirements and warnings - it does NOT prevent a physician from doing otherwise and ALL "guidelines" are just that, guidelines - not laws.

Arguing otherwise simply shows that you have not had a course in DEA and pharmacy law - and are confused about rules, regulations, guidelines and laws - and the state and federal agencies which make such - different from individual DEA offices, FDA inspectors, pharmacies, physicians and insurance companies.

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Joey,

Anywhere in the country works. I'm in dire need due to my complexity and P450 even with my credentials I am at the point of having to end my life soon as it stands I had almost enough medication saved for this physician had us keep a percentage probably due to this type crap to taper me to a state where I am housebound. I cannot function and continue living at this rate.

If I cut again my renals will shut down, you would think my peers in Texas would care but the FDA suggestion has too much outcome.

For the pharmacist perhaps you know someone in Texas who can help me if you've kept up on my posts. I had Dr. Famous in California after my Houston doc of 10 years died. I am complex. He dropped 30 of us out of state due to new California regulations.

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Pharmacist,

They have shut down most of Houston, and the list grows daily of physicians who try to do chronic pain in Texas without pain clinic certification.

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Joey,

Under Odumma established pain patients after the first year when once monthly visits are required must be seen every 3 months and are to take 3 months of scripts with them and write "not to be filled until" they are not post dated.

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I worked a Chief of Psychiatry in Sullivan Co's (NY)'s major hospital. I've contacted a friend of my brothers who was MY doc whenI was living and working there. He was a classmate of my bolder brother. I remember being surprised (but not upset) that prescribing say #180 Percocet-10/660s my usual and customary. People lived far apart. I can't ayall the shrinks in the area loved me, but, basically,nI was well-respected. It's just that, I have my have my Mom's genes [primarily], and she was a naturally practice supervisor who took no shot from nobody at no time. Abe is going to ask around. He's one of the senior physicians in the area now and I did treat his wife and son.

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I spoke with Dr. Abe last night. Abe's a diligent guy ad he appreciated my having his back on his DDxs and Rxs for kids in the school district. I billed them, or the hospital did, with the note PROFESSIONAL COURTESY TO DR. ABE...andthe $580 balance "zeroed out". He should have something from soon.

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P450- your post on pumps & ball(less) drs. is correct- I have now been to enough actual appts. gone thru BP, U/A then paid in full only to be told "Oh we cant do this prescription- you must see a specialist or go to Mayo Clinic or....your case is too complex for this office. WTF??! Either you are not sick enough for pain meds or youre too sick for them to handle... I need a dr. with guts enough to see my stable meds for almost 15yrs saving my life & now am dying on 1/10th of my stable functional dosage. I will be dead soon too nurse lady wonderful- lets pray for all of us extreme cases that are being sacrificed in name of drug abuse, which is not being affected, only us. I wish there was a dr. SOMEWHERE with true grit. Chris-FL dying of intractable, debilitating uncontrolled agony

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New York is still good ! Sorry u had to leave Oregon and uproot your entire life but what life is it if you're in pain constantly ! So I understand! There is a Dr Bhatia in Staten island which is right off the garden state parkway, Richmond Interventional pain management at 2066 Richmond Ave Staten Island ! He is sympathetic and caring and was prescribing 400mg of Morphine daily for chronic pain, not cancer and I had no problems getting it once I got set with one drug store ! Good luck and I think all these doctors are a**holes as I went to one again after I first saw him two wks ago and he said my case was too complicated for him and said I'd have to see a pain psychologist before he could treat me and talks on his tale recorder and not to u which is rude right off the bat and doesn't even say goodbye, good luck, nothing. His name is Ted Freeman in Bricktown, NJ and he shares an office in Ocean NJ so put out the word he is rude, treats u like an addict and doesn't care about anyone but himself and gets his girls to speak for him which is so wrong ! Everything's wrong with him ! Sorry to get off subject to my Oregon friend but the doctor in Staten island is good and Dr Jorden Fersel in Cranford NJ and Jersey City also definitely prescribes oxy 30s and other things ! He takes insurance and cash ! Good luck to u my friend who had to move from Oregon and I wish u all the best, Love Valerie xoxoxo

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Chris,

I'm heading there to try to make an appointment without giving information. Can you get to Baton Rouge? Feldman is a Harvard grad has a huge clinic going on over there, been there for years. I am also trying some group in Houston but they are all afraid of what this FDA deal is not DEA regulation but it's Odummacare. I saw this coming years ago and did not think Dr. Famous would drop his out of state patients but you know he has no bedside manner. He's loony as they crawl if you get my message.

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I have found that yes, doctors can still prescribe as they see fit. Most investigations or revoked liscenses stem from technical errors such as: wrong diagnostic code, forgetting signature, incorrect date, little things like that but yes you are correct, even with minor discrepancies docs can lose their liscenses in a New York minute!

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P450, established pain patients are Not required by Law to be seen every month for the first year. It is up to each dr how often they see a patient. The only requirement is that they be seen At Least Once Every 90 days if they are receiving a Schedule II prescription for chronic pain that is not terminal. Most drs do chose to see their chronic pain patients every 30 days. Some see their patients every 90 days and give them 3-30 day prescriptions at those visits, some require their patients to come in and pick up a prescription without a office visit for those 3 months. It is up to each dr how they decide to see their patients and how they write the prescriptions. As long as they see the patient at least once every 90 days they are obeying the law.

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That type of professional discipline doesn't happen with the speed of light. My Residents make errors on scripts for Controlled Drugs and if they're fully licensed, (NYS and Fed. DEA Regis. #) I don't HAVE TO to approve-them. Newer docs are usually so scrupulous that they'll come to me to date and co-sign a CII script. (At my hospital, they use the Service Chief's [Psychiatry, Neurology, etc.] DEA No. + a 5-digit hospital assigned ID number. In this way, I can turn them on and off as circumstances dictate) This is unusual, but we've had like ZERO forgeries of stolen hospital Rx blanks. Who would be able to get my DEA No? It's only on my script blanks for private practice and my practice is in NYC and my hospital position on LI. And, no, I can't put different addresses on scripts for different purposes. I CAN use the Hospital Dept of Psychiatry blanks and fill in my DEA No, which is what I do. I leave the five-digit identifier blank. This caused some confusion until I realized that CHIEF has five digits and I ordered some personalized Rx blanks from NYS, via our print shop.) And how would the thief know that I'm only Chief of Psychiatry, not Psychiatry and Neurology. What happens when a Chief is on vacation or out sick? We SWITCH the DEA # to mine or that of my friends, No law prevents my authorizing six Rxs in the same minute anyway. Now, this doesn't apply to anyone "cooking the books" and that includes my peers who know various ways to do so and about 99% of the ways to determine this. Nobody likes to hear that Dr. Joey is investigating their Controlled Substances scripts. I was the one only administration and staff could agree on (probably because I've told both a few residents and a few higher-ranking administrators to "Leave me [or my Residents] the f*** alone. Is there's a problem, I'll find it and I'll listen to the doctor in question first." I usually question authority; my Mom brought me up that way! My Dad wasn't crazy about it, but despite her working full-time since I was about 4 or 5 [Grandma Anna took care of us; Sicilians don't like "strangers" tending their kids], my Mom argued better than my Dad cut. (He is a retired Cardiothoracic Surgeon; the didn't do any of my length, complicated heart surgery in 1995, but he scrubbed and was asked to e available if a problem arises; the man has INCREDIBLE hands.)

If a doc with my experience was making the kind of errors you mentioned, especially more than once or twice, the DEA or NYS CSB would want to have a talk with me; there's really no excuse unless someone else is writing my scripts and thats now illegal. But the average Resident or new doc would be given some leeway, especially if his/her motives are pure. Compared to when I started, 25 years ago, writing a script for Xanax 2mg #120 is a real pain in the ass!

Based on my experience with a longtime dentist, whose Hygienist writes and signs ALL his scripts, unless he were to prescribe excessively or there were other indicators of violations, no one would look twice I sure didn't tell the DEA, but I warned Dr. Lou the Dentist about the new rules. (I can't imagine what excuse he could cook up, but he could validly claim that his office is very busy and reauthorizes each script in "shorthand" on the chart.)

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Posters;

Rereading this before the end of my life occurs. Many of you know my background and I want ya'll to realize this is not just 120 mg. it is a morphine equivalent. Do not think that adding up milligrams on various opioids will give you a total it will not. For example 50 mg. of Demerol IV is about the same as 3 to 5 mg. Morphine IV. A conversion chart is used for many of our long acting medications are released at a different rate.

For over five years I was seen by Dr. Famous in California the best there is alive at this time; my best died was with him 10 plus years and he was on top as well. Only rare cases are seen of suicidal level pain and mine has embedded in my memory or in my brain which shows on lab values moving me to Central Pain Syndrome. I am also an ultra rapid opioid metabolizer as shown on P450 testing. I was dumped along with 30 other out of state pain patients and now 10 months later only because I put aside a percentage monthly which he had us do am I alive barely and now am at the end.

Odumma is subsidizing incentives as it stands for physicians to stop treatment of chronic illness. Your state may have further limitations. This will pass but when it does many of us will be dead.

I hope the best for all of you. if you still have a doctor do not let go. stay with him right now. do not offend or drop the doctor. The reason the FDA recommendation occurred is due to high overdoses with death NOT by legitimate pain patients who need this medication. Due to those who sell their pain medication for extra income, who leave it around where people can take it in short TO PEOPLE IT IS NOT PRESCRIBED and again we are punished by the government operating under killer Odumma and too little will be too late.

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P450, what have the other 30 patients that you were told the dr also let go along with you done for pain management? Have they been able to find care, or do you not know who they are?

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I Just found a post and it is on the ACLU website. They did pick up and started a legal case in the state of Indiana. It shows that the case was filed in 2013/2014 and that it's still open. They will need common sense feedback to nail it home! It is about the constitutionality violating our 4th amendment rights on how they treat us i.e. u/a's, etc.. that is a big step and needs to be followed to every state. These are the loop holes the state of Tennessee is using to cut down medications.

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NO WORRIES. I wouldn't be much of a doc, let alone much of a shrink if I didn't understand that: "S*** happens." NO HARM - NO FOUL - I've had such a f****d up ultra-busy day that I almost envy the dead, bro.

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Ever hear of a "Regulation With the Force of Law"?

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Regulation with "force of law" can be overturned In court if found unconstitutional.. we don't live in dictator country just yet...

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Give me ONE Cite not based on attorney misconduct or corruption (i.e., Perjured Testimony.) JUST ONE!

One function of the judicial system is to INTERPRET the law and sometimes overturn laws. That's the job the Framers designed as part of the Separation of Powers. Read the Constitution occasionally.

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