how much narcotics can a dr. prescribe in a month?
Question:
heres the deal…my doctor gave me my script for the month…its approx.90 tabs..at 3 times a day ..anyway.. he tells me increase my meds again up to 4 tabs, but he stated when this old sript runs out he is not going to renew it until the old order is due…is this ethnical?…im going to be without pain meds for a week..and he knows it..he also knows i have withdrawl when i dont take the meds (hydrochodone)…is this a common thing that pain mangement dr. do?….im starting to think or feel this dr. thinks im a junky or something…should i be looking for some other dr.?… another thing that there is no guesting game with why im in pain..i had surgery and been to several doctors who concluded with the same diagnoisis… all have told me that i have perm nerve damage…sorry for rambling.. im confused about this as well in severe pain all the time…
Response:
`Hello, I would get a new doc. You should not be with out pain meds at all. My doc asks me how many I need(my break through meds) and I tell him. When I ran short before he called in another script. When you run out, I would call him and tell him he told you to take 4 and you are out. Or maybe make your meds last by taking 3 day until you get a new script stating 4 a day. Before I went on MS Contin I was getting 120 vidocin a month. Good luck, Stacey
Response:
To increase a narcotic then refuse that the increase was made (i.e. no Rx) is unethical. Anytime a physician changes directions on ANY prescription, get another Rx with those direction change, in writing. Example-you are on an antibiotic, with 2 refills, and your Dr increases the dose. When you go in for a refill, it takes HOURS because your insurance or medicaid card will not approve the early fill. Pharmacists don’t have any other direct phone line to a human at your insurance carrier than you do….we have to call and plead your case "after" calling your Dr-another hour or two of "run-around" You can save hours of waiting by asking for another prescription for what (s)he just told you. Takes less than a minute. Pharmacists, by the way, are NOT paid one cent for these calls-we usually have to pay for the call, and are contractually forbidden to ask the patient to pay for a telephone call. Place yourself in that position, and you can see why some pharmacists are ready to quit after an hour at work. If you have an insurance card, and have had the fortune to never to call them, give it a try. The average time from dial to getting a human is 20 minutes, and the human you get usually gives you another number to call, starting all over. They WANT you to give up. These people increase their profits by denying services. And, while we are in this run-around, other patients get "short" service if any, because we are stuck on the damn phone. We don’t have enough support staff to handle these problems-we have to do it, and most carriers require the Pharmacist to call, not a high school kid-never mind that they could do it better!!! Complaints to the Medical Board will fall of deaf ears, unless you are on *long term* pain management (MS Contin or Oxycontin) and are suddenly stopped because the Dr wants you to "tough it out", Most patients wind up in the hospital from such stupidity as that. Medical Boards DO look into those issues. It is malpractice. If a Physician wants you off of an addictive drug, it is his/her professional responsibility to provide you the means to stop the drug with minimal to no withdrawal. TELL THEM THAT, and mean it. If they refuse, have your lawyer remind them of their professional responsibility to their patients. (including his client) They started the drug-they must correctly stop it. My advice-stay at 3 per day. If you are dependant, withdrawal syndrome will occur when you run out of medication… and don’t blame the pharmacist if you are turned down for early refills. Physicians issue written complaints to Boards of Pharmacy on a daily basis, and the Physician usually wins-pharmacist looses his license and livelihood. I have been in this battle before, and it isn’t pleasant. I provided a drug under the 72 hour statute allowed in my state, and I filed a complaint to the medical board against a physician . Needless to say, not a popular move. I would also find another Physician. Hope this is helpful/ Dave/
Response:
First of all, in my opinion, 3 vicodin hardly constitutes a "junky". Second, it IS unethical for your doc to verbally tell you what he is going to prescribe and then refuse to actually do it. Either he is the most manipulative, lying jerk that ever lived or he is incompetent. Either way, run for your life. Get a new doc who DOES know how to treat pain and turn this one in to the state medical board. I know it sounds drastic, but this guy is clearly incompetent. Just my opinion. Shell — My personal web page: http://www.mindspring.com/~shellianne/index.htm
– Hide quoted text — Show quoted text -> heres the deal…my doctor gave me my script for the month…its > approx.90 tabs..at 3 times a day ..anyway.. he tells me increase my > meds again up to 4 tabs, but he stated when this old sript runs out > he is not going to renew it until the old order is due…is this > ethnical?…im going to be without pain meds for a week..and he knows > it..he also knows i have withdrawl when i dont take the meds > (hydrochodone)…is this a common thing that pain mangement dr. > do?….im starting to think or feel this dr. thinks im a junky or > something…should i be looking for some other dr.?… > another thing that there is no guesting game with why im in pain..i had > surgery and been to several doctors who concluded with the same > diagnoisis… all have told me that i have perm nerve damage…sorry for > rambling.. im confused about this as well in severe pain all the time…
Response:
Get a new pain management Dr. db
– Hide quoted text — Show quoted text -> heres the deal…my doctor gave me my script for the month…its > approx.90 tabs..at 3 times a day ..anyway.. he tells me increase my > meds again up to 4 tabs, but he stated when this old sript runs out > he is not going to renew it until the old order is due…is this > ethnical?…im going to be without pain meds for a week..and he knows > it..he also knows i have withdrawl when i dont take the meds > (hydrochodone)…is this a common thing that pain mangement dr. > do?….im starting to think or feel this dr. thinks im a junky or > something…should i be looking for some other dr.?… > another thing that there is no guesting game with why im in pain..i had > surgery and been to several doctors who concluded with the same > diagnoisis… all have told me that i have perm nerve damage…sorry for > rambling.. im confused about this as well in severe pain all the time…
Response:
Ken, The NC legislature provided Statutory Authority for Pharmacists to write and sign prescriptions for up to a 72 hour supply for anything (except a CII) when the physician cannot be found, with the requirement that the patient’s physician be notified of the prescription. (I fax them) Prior authority is not required from anyone, but we have to justify (medically) our decision to write these orders if the prescription is questioned. The C2 limitation is due to the fact that DEA regs supercede State law. Most pharmacists in North Carolina do not use this statute because they do not have access to medical records, or are simply uncomfortable in actually prescribing a drug for a patient that they do not have prior knowledge of their condition. That is their privilege. I keep charts on many patients as well as computer records, and all patients requiring chronic medications (including controls) have a diagnosis and prognosis on file. In fact, over 60% of my clients have their medical Hx in my database, as well as medical charts in such a manner that I can make these decisions for the benefit of the patient, based on sound medical reason. I know of no other ambulatory care pharmacy (what is commonly called a "drug store") that maintains clinical charts; however I cannot justify these decisions without records. We should not initiate therapy-only continue it, and it can be from any physician, and from any pharmacy. With this authority comes a very large responsibility, and I do not exercise this privilege lightly, nor very often..-and NEVER if a patient outrighty lies to me about their medications. An example-if a patient is routinely exceeding doses prescribed (of anything) and *always* showing up on Sat., I know that it is intentional, and that is NOT within the spirit of the legislation. (One Rx if justified, is all that is issued, with the explanation -don’t run out of medication when the physician is not in the office) If risk of cessation places the patient at risk (due to abuse) I find a Physician. The legislation is to allow Pharmacist discretion for the benefit of the patient.and yes, analgesics are included.-but only if medically justified, and only for the benefit of the patient, and only for the limit-i.e. if the MD will be available in the morning, then only 18 hours is provided.,etc. Many pharmacists in North Carolina will not exercise this privilege at all. Some are "uncomfortable" with it, others just won’t do it. (lack of clinical experience is what I hear, and the fact that they are "employed"). As I stated earlier, the responsibility is huge, and one has to be willing to accept that responsibility and defend their decisions, even if they later prove to be not wise. (I fortunately have not had that problem) Hope this answers your inquiry. Dave/
Response:
- Hide quoted text — Show quoted text -> My advice-stay at 3 per day. If you are dependant, withdrawal syndrome will > occur when you run out of medication… and don’t blame the pharmacist if > you are turned down for early refills. Physicians issue written complaints > to Boards of Pharmacy on a daily basis, and the Physician usually > wins-pharmacist looses his license and livelihood. I have been in this > battle before, and it isn’t pleasant. > I provided a drug under the 72 hour statute allowed in my state, and I filed > a complaint to the medical board against a physician . Needless to say, not > a popular move. > I would also find another Physician. > Hope this is helpful/ > Dave/
Hi Dave, My name is Kendal Little Wolf from Washington State,I’ve read many of your replies and they come in handy. Mostly I am a lurker. I have a question for you. What do you mean by providing a drug under the 72 hr statute in your state? Thank you. KLW Before you buy.
Response:
I’ve wondered too, why the pain doc’s seem to mess with our heads sometimes. Of all people you would think they would understand that we are especially sensitive to being jerked around about our meds. Don’t know what to say to you, except to say that I understand. It hurts. Hope you can find some help. Hope I can find some too. My doc was writing my prescription for 30 days. For a month with 31 days, when I asked, he told me that was my problem. Go figure. Good luck. Bonnie PS He has since reconsidered…
Response:
Hi Dave, I live in North Carolina too and I don’t understand some of the things I have to do to get my medicine.I leave my doctors office and drive the 45 min home, then I go to Eckerds to get my medication. The prescription was for hydrocodone and oxycontin. I give them to the lady and she won’t fill the oxycontin. There is no mg written on it. I told her I had my old bottle in my purse and could she just look at that and fill it like the old one says.She says no.I ask her if she can call my doctor and ask him. She says no, I have to go back to my doctors office and get him to write it in, and that I can’t do it myself.Was she just being snotty or having a bad day? I did like she said. Next month I call my doc and tell him all the medicine is almost gone. Before he would call in the ultram I was on, now its the hydro and oxycontin. He says he will call it in and I go there and there is no medicine waiting for me. The receptionist said it was ready to be picked up when I called his office. The eckerd pharmicist said there was nothing there. Come to find out it was ready at his office to be picked up, and now he can’t call it in.Why do I have to drive all the way there to pick up the paper prescriptions when use to he would call the pharmicist and have it ready for me.Its very hard for me to drive because the vibrations of the car make me hurt, not to mention the medication I’m on.I’m always nice to the lady pharmicist but I think she doesn’t like me for some reason. Should I go somewhere else? When I go to get my medicine she asks me if I drove.She has has asked me questions about my medical condition and I explained it to her as best I can. I think she thinks I’m writing my own prescriptions or something. I’ve never heard her ask anyone else all these questions. What do you think I should do? Thanks Mechelle * Sent from RemarQ http://www.remarq.com The Internet’s Discussion Network * The fastest and easiest way to search and participate in Usenet – Free!
Response:
Hi Mechelle, I think she is being rude and nosy. I would find another pharmacy. I have a little mom and pop pharmacy that I just love. They always ask how I am doing and sometimes I end up chatting with them for a half and hour! You do not need to be treated that way, Take care Stacey
Response:
i just like to say thank you all for the respondence to this post….the only problem is finding a new pain mangement dr….the guy i use now is an D.O. …. i live in new york and its weird that i cant find another pain specialist in my area..its not like i live in an remote section… anyway thanks again….james
Response:
Mechelle she is crude and rude in my opinion however here in Florida you have to hand carry the scripts if they are a narcotic any thing else can be called in to the drug store. maybe it is that way where you are too? — deb/fl
– Hide quoted text — Show quoted text -> Hi Dave, I live in North Carolina too and I don’t understand some of > the things I have to do to get my medicine.I leave my doctors office > and drive the 45 min home, then I go to Eckerds to get my medication. > The prescription was for hydrocodone and oxycontin. I give them to the > lady and she won’t fill the oxycontin. There is no mg written on it. I > told her I had my old bottle in my purse and could she just look at > that and fill it like the old one says.She says no.I ask her if she can > call my doctor and ask him. She says no, I have to go back to my > doctors office and get him to write it in, and that I can’t do it > myself.Was she just being snotty or having a bad day? I did like she > said. Next month I call my doc and tell him all the medicine is almost > gone. Before he would call in the ultram I was on, now its the hydro > and oxycontin. He says he will call it in and I go there and there is > no medicine waiting for me. The receptionist said it was ready to be > picked up when I called his office. The eckerd pharmicist said there > was nothing there. Come to find out it was ready at his office to be > picked up, and now he can’t call it in.Why do I have to drive all the > way there to pick up the paper prescriptions when use to he would call > the pharmicist and have it ready for me.Its very hard for me to drive > because the vibrations of the car make me hurt, not to mention the > medication I’m on.I’m always nice to the lady pharmicist but I think > she doesn’t like me for some reason. Should I go somewhere else? When I > go to get my medicine she asks me if I drove.She has has asked me > questions about my medical condition and I explained it to her as best > I can. I think she thinks I’m writing my own prescriptions or > something. I’ve never heard her ask anyone else all these questions. > What do you think I should do? Thanks Mechelle > * Sent from RemarQ http://www.remarq.com The Internet’s Discussion Network * > The fastest and easiest way to search and participate in Usenet – Free!
Response:
Try here–they have a states list and state reps–maybe you can find one? "ADEQUATE and Ongoing Pain Medication, for ALL who suffer" http://www.widomaker.com/~skipb/skiphome.htm.html "To Get Help for Pain": http://www.widomaker.com/~skipb/panic.html
– Hide quoted text — Show quoted text -> i just like to say thank you all for the respondence to this post….the > only problem is finding a new pain mangement dr….the guy i use now is > an D.O. …. i live in new york and its weird that i cant find another > pain specialist in my area..its not like i live in an remote section… > anyway thanks again….james
Response:
Mechelle, I missed your original post. I have experienced the same lack of strength problem on prescription documents. I personally request by phone the strength, then take the Rx by the MDs office myself if necessary. Some Physicians will drop by the shop on their way home and finish out the Rx, as they are the ones who did not complete the prescription. In the long distance Physician problem, I request a Fax of another prescription with the missing info filled in, and the hard copy mailed to me. With the initial Rx and the Fax document, I will fill the prescription. All narcotic Rxs in the CII class have to be handwritten and picked up by the patient or his/her representative; and in some situations can be mailed. This is federal statute and HAS to be followed. Incomplete Rxs also cause problems, as we cannot "complete them" for the physician. The pharmacist at Eckerds cannot complete the Rx, or use your previous bottle. (DEA regulation again) It is not allowed. |An aside- In the case where the Rx is on a Hospital Blank and cannot be read (usually written |by a resident) you have to return to the Hospital. I personally feel that Hospital Blanks should |be done away with-and be pre-printed for each MD who has prescribing authority. Chain store pharmacists often do not have the time to do any of this for you. The pharmacist does need to know your condition and why you are taking these medications. I try to get the Dx from the MD office when patients are placed on long-term pain control, and not bother the patient unless I can sit down with them and discuss their problem. Time (or the lack thereof) is becoming a real problem here. Board inspectors (Medical and Pharmacy) examine CII prescriptions, and the pharmacist needs to know why the drug(s) are in use…hence the questions. They also look for alterations-these are not allowable. There are many instances where physicians simply dislike pharmacists, and in that case the patient has to return to the office. When your Dr’s office tells you that "prescriptions are ready" ask if they are ready at the office, or at the pharmacy. Hope this is helpful Dave/
Response:
Hi Dave: Your response to Ken wa a good one and very informative. I learned a few things with this one, as usual. Thanks, Bonnie
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> Hope this answers your inquiry. > Dave/
It does,wopila(thankyou) Kendal(not Ken,I am a women (;) Before you buy.
Response:
Thanks everyone for your replies. Lately I seem alot more sensitive, maybe its the medications or my mental outlook.The lady is probably just doing her job and I’m reading too much into it.Maybe she mistook my disappointment at having to drive back to the doctor as a negative feelings toward her.I was so exhausted that day. She’s a foreigner and maybe their customs are differant. What I took as being nosey could have been concern when she was inquisitive about my condition.This month I’ll go back and see if things are better.If not I’ll start getting my prescriptions filled elsewhere. As far as the doctor goes I now do ask him where.Maybe I need to try to be a little more tolerant of others and not jump to conclusions that they are out to "get’ me, when in reality they were only following the law.Lesson learned, Mechelle * Sent from RemarQ http://www.remarq.com The Internet’s Discussion Network * The fastest and easiest way to search and participate in Usenet – Free!
Response:
I’ve had many problems with pain medications in the past, so I do understand how you feel. I take MS Contin and Oramorph at the moment, and although I have never had any addiction problems, every time I went to the doctors I had to sit through a half hour lecture on the danger of addiction before I got my script. About a year ago, I went to the doctors for my normal refill, and he refused to prescribe me any more meds, and didn’t give me anything else in their place. Thankfully I didn’t have withdrawal problems, but I did have such acute pain that I ended up in hospital after taking an overdose as I could no longer cope with the pain. Although they knew what had happened, nothing was ever done. All I do now is avoid most of the doctors at the practice, and will only ever see 3 of them, even in an emergancy. I finally got my meds increased to the needed dosage, and thankfully do not seem to be having any problems at present, but I just wonder how long it will take until it all starts again. I live in a rural area and the chemist tells me I am the only one being treated by the practice with opiates for chronic pain, and the doctors there do not seem to have much experience, and seem to be frightened of prescribing – even though we do not have the strict triplicate prescriptions, or pharmacy limitations etc here in England. I just wish there was more that could be done, as each time I go to the doctors I am scared that they will stop my meds again. I also never go to the doctors alone anymore, and always insist that my husband goes with me, which I think is the main reason for the change of heart. Here, I don’t have any choice about who my doctor is. If you do, you already know what you need to do. Yours Em
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