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Attacking opiod crisis or attacking patients?

RobertU

RobertU

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Vacaville, CA
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In the early morning of March 14, I went to the Kaiser Permanente ER with severe and crippling side and back pain. I was diagnosed with a kidney stone and sent home with a prescription for hydrocone 5mg/acetaminophen 325 mg. Dosage direction: one tablet every six hours, as needed.

When the IV pain killer from the ER wore off, I took the tablet, but it lasted for only 1.5 hours. I called to see if I could increase the number or frequency that I took the pill. I was told no because excess acetaminophen use could damage the liver. That didn’t really make sense because my over the counter version of acetaminophen had 500 mg and a recommended dosage of 2 tablets. I assume the hydrocone is the more potent part of the formula.

After persisting, I got a call back from the office of my general practitioner, which stated I could double the dosage. I did so and was satisfied with the result. However, I then discovered that the tablets would likely run out before I could request a refill on Tuesday. I requested a refill, the pharmacy looked into it, but no renewal information appeared on my pharmacy web page.

In the next call to the pharmacy, I was informed that Kaiser was restricting pain killers because of the opiod crisis, even though my doctor had given me explicit permission to increase the dosage. They suggested I simply rely on the OTC version of acetaminophen when my supply ran out.

After another call, I was referred to a Vallejo physician who, after reviewing my case, said she would write a new prescription with a higher dosage. It was not filled and my website entry for that medicine no longer states it can be reordered after Monday: now, it cannot be refilled at all.

As of Sunday evening, I have 3 tablets left and a phone consult with a urologist scheduled for Tuesday afternoon.
 
Last night, after getting a hospital grade enema in the ER, my original low dosage pain meds were refilled, with the advice not to take more because that would aggravate constipation. OK. That now makes a lot of sense. They could have told me that the first time. I apologize if this is TMI.
 
RobertU said:
Last night, after getting a hospital grade enema in the ER, my original low dosage pain meds were refilled, with the advice not to take more because that would aggravate constipation. OK. That now makes a lot of sense. They could have told me that the first time. I apologize if this is TMI.
Click to expand...

Just so you know.. based on your history it was probably not "opiod abuse" which was the reason for the delay in prescription.. it was not wanting to prescribe without the actual doctor seeing you because there are potential complications with the medication you are taking.. (constipation being one)..

The flim flam was from folks that just didn't want to say "we don't want to make the call".
 
jaeger19 said:
Just so you know.. based on your history it was probably not "opiod abuse" which was the reason for the delay in prescription.. it was not wanting to prescribe without the actual doctor seeing you because there are potential complications with the medication you are taking.. (constipation being one)..

The flim flam was from folks that just didn't want to say "we don't want to make the call".
Click to expand...

This is actually a real issue though. There are a lot of doctors who want prescribe opioids. Because they fear being arrested by DTF. Now don’t get me wrong I deal with doctor who don’t know me. So getting the meds I need is almost impossible. I work a job where I’m in a area for 3 to 6 months. So I don’t have a general physician that I see all the time. I have been told by doctors that even though it appears that I need these meds. Because they don’t have an extend medical history they want prescribe them. May case my be unique. But it’s not that uncommon. Many countries do not interfere with doctors prescribing medications. And in my travels I have heard of and seen news reports on doctors getting arrested for prescribing medication. Although I’m not proud of it I get my meds on the street most of the time. I don’t take them to get high. I take 5mg in the morning and 5mg at lunch. Just enough that my pain isn’t overwhelming. I have tried many times to get the medication I need legally. But once I get to the point where they are prescribing the meds my current project ends and I move to a new area with a new doctor. Who wants to do all the same test and starts drug testing to make sure I’m not already taking meds. Which means another 3 months without the meds I need. It has been a real pain for me.


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RobertU said:
In the early morning of March 14, I went to the Kaiser Permanente ER with severe and crippling side and back pain. I was diagnosed with a kidney stone and sent home with a prescription for hydrocone 5mg/acetaminophen 325 mg. Dosage direction: one tablet every six hours, as needed.

When the IV pain killer from the ER wore off, I took the tablet, but it lasted for only 1.5 hours. I called to see if I could increase the number or frequency that I took the pill. I was told no because excess acetaminophen use could damage the liver. That didn’t really make sense because my over the counter version of acetaminophen had 500 mg and a recommended dosage of 2 tablets. I assume the hydrocone is the more potent part of the formula.

After persisting, I got a call back from the office of my general practitioner, which stated I could double the dosage. I did so and was satisfied with the result. However, I then discovered that the tablets would likely run out before I could request a refill on Tuesday. I requested a refill, the pharmacy looked into it, but no renewal information appeared on my pharmacy web page.

In the next call to the pharmacy, I was informed that Kaiser was restricting pain killers because of the opiod crisis, even though my doctor had given me explicit permission to increase the dosage. They suggested I simply rely on the OTC version of acetaminophen when my supply ran out.

After another call, I was referred to a Vallejo physician who, after reviewing my case, said she would write a new prescription with a higher dosage. It was not filled and my website entry for that medicine no longer states it can be reordered after Monday: now, it cannot be refilled at all.

As of Sunday evening, I have 3 tablets left and a phone consult with a urologist scheduled for Tuesday afternoon.
Click to expand...

You are asking for an increase in a medication that is being horribly abused right now. Everyone is suspicious and paranoid. I've been dealing with back pain since 2008 and I've had a big monthly script for percocet since then. I know all about this kind of thing.

The laws and restrictions on this drug right now are crazy. Here in Florida, you must see the doctor every time you are refilled an opiate. There's no getting the pharmacy to refill, or requesting from the office manager. I must go in there and look him in the face every month. It's the law. Then pharmacies have their own laws. Can't refill until 28 days since the first day of your last script. No getting around that either. And there's a difference between "chronic" pain and "acute" pain and that will determine how many pills you are prescribed and how often. And in Florida we have a database that shows all our prescription activity. Any pharmacy tech can look into our recent prescription past. If they see I've been prescribed an opiate and went to a different doctor for more before I was supposed to run out of pills and they will send the law to my home. Do this too many times and you'll be arrested. Serious biz.

Get to know the laws in your state. Try a walk-in clinic if you're in so much pain you can't stand it. Of course the ER must help you. Last resort, you can try a legit pain management place. But they are expensive and they do pill counts (call you in and count your pills to make sure you're not abusing).

My best advice for long term chronic pain is an inversion table. Saved my life, I think. Good luck. I hope your pain eases. I know what you're going through, and it's awful.
 
There should probably be a different opiod policy for those with short-term acute pain, as with kidney stones, and long-term chronic pain. Given that my kind of pain was going away in a few days, the chances that I would become addicted were minimal.
 
Babykat said:
This is actually a real issue though. There are a lot of doctors who want prescribe opioids. Because they fear being arrested by DTF. Now don’t get me wrong I deal with doctor who don’t know me. So getting the meds I need is almost impossible. I work a job where I’m in a area for 3 to 6 months. So I don’t have a general physician that I see all the time. I have been told by doctors that even though it appears that I need these meds. Because they don’t have an extend medical history they want prescribe them. May case my be unique. But it’s not that uncommon. Many countries do not interfere with doctors prescribing medications. And in my travels I have heard of and seen news reports on doctors getting arrested for prescribing medication. Although I’m not proud of it I get my meds on the street most of the time. I don’t take them to get high. I take 5mg in the morning and 5mg at lunch. Just enough that my pain isn’t overwhelming. I have tried many times to get the medication I need legally. But once I get to the point where they are prescribing the meds my current project ends and I move to a new area with a new doctor. Who wants to do all the same test and starts drug testing to make sure I’m not already taking meds. Which means another 3 months without the meds I need. It has been a real pain for me.


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Click to expand...

Yeah no. Doctors are still prescribing opiods.. when patients need them. they just have to be a lot more careful.. so do pharmacies. and that's because patients that ARE drug seeking.. go to multiple doctors for the same thing and get multiple prescriptions and then go to different pharmacies to fill them...

We started catching this in our outpatient therapy clinics. Our doctors would prescribe an opiod.. but also refer the patient to physical therapy for their back pain or shoulder pain. (Research shows that PT can decrease the need for opioids and decrease pain and dysfunction in patients with back pain).

the patients that were drug seeking.. would agree to therapy.... get an appointment.. and then never show.. or continually cancel..

then in 3 months or so.. the clinic would get another referral for therapy... from a DIFFERENT provider in a different office outside our networks.

With your case and you are only in an area for 3 months to 6 months.. it probably looks like you are falling into the pattern of drug seeking...

And as you say.. you are already taking medication outside a doctors advice. And you are taking the medication illegally. Frankly its not surprising that the physicians don;t want to prescribe to you.. you are a malpractice patient waiting to happen.

You must have some area that's your "home base".. where you "reside".. a state and area that you are a resident... I would suggest that when you are thinking of going back to that area.. contact a physician well before you get there and set up an appointment. explain before the appointment that you are looking for a general practitioner to follow your case and be a primary provider.

When you get seen... have him/her examine you.. without telling the doctor "what you need".. and see what they say.. You may find that there are better options for you than opioids.. in fact.. the opioids may be masking a bigger problem.

then if opioids are necessary.. explain to your doctor your situation.. and they may be able to facilitate your prescriptions by sending notes, etc.. to any physicians you see on the road.. or they may be able to do a video visit.. etc..

Good luck.
 
jaeger19 said:
Yeah no. Doctors are still prescribing opiods.. when patients need them. they just have to be a lot more careful.. so do pharmacies. and that's because patients that ARE drug seeking.. go to multiple doctors for the same thing and get multiple prescriptions and then go to different pharmacies to fill them...

We started catching this in our outpatient therapy clinics. Our doctors would prescribe an opiod.. but also refer the patient to physical therapy for their back pain or shoulder pain. (Research shows that PT can decrease the need for opioids and decrease pain and dysfunction in patients with back pain).

the patients that were drug seeking.. would agree to therapy.... get an appointment.. and then never show.. or continually cancel..

then in 3 months or so.. the clinic would get another referral for therapy... from a DIFFERENT provider in a different office outside our networks.

With your case and you are only in an area for 3 months to 6 months.. it probably looks like you are falling into the pattern of drug seeking...

And as you say.. you are already taking medication outside a doctors advice. And you are taking the medication illegally. Frankly its not surprising that the physicians don;t want to prescribe to you.. you are a malpractice patient waiting to happen.

You must have some area that's your "home base".. where you "reside".. a state and area that you are a resident... I would suggest that when you are thinking of going back to that area.. contact a physician well before you get there and set up an appointment. explain before the appointment that you are looking for a general practitioner to follow your case and be a primary provider.

When you get seen... have him/her examine you.. without telling the doctor "what you need".. and see what they say.. You may find that there are better options for you than opioids.. in fact.. the opioids may be masking a bigger problem.

then if opioids are necessary.. explain to your doctor your situation.. and they may be able to facilitate your prescriptions by sending notes, etc.. to any physicians you see on the road.. or they may be able to do a video visit.. etc..

Good luck.
Click to expand...

I will give it try. Physical therapy does help I do the sun salutation stretches every morning. I do have a home where my wife and children live. But I’m only ever there for a couple of weeks at a time.


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Babykat said:
I will give it try. Physical therapy does help I do the sun salutation stretches every morning. I do have a home where my wife and children live. But I’m only ever there for a couple of weeks at a time.


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Click to expand...

You need to find a general practitioner in the area. Also physical therapy will help.. but also a referral to a pain specialist for injection may also help especially combined with physical therapy.

there are multiple injections for a variety of pain issues.. that offer long term relief again.. especially when combined with physical therapy.
 
jaeger19 said:
You need to find a general practitioner in the area. Also physical therapy will help.. but also a referral to a pain specialist for injection may also help especially combined with physical therapy.

there are multiple injections for a variety of pain issues.. that offer long term relief again.. especially when combined with physical therapy.
Click to expand...

I have a herniated disc that mess with that nerve that runs down my right leg it starts with an s but I can’t spell it


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Babykat said:
I have a herniated disc that mess with that nerve that runs down my right leg it starts with an s but I can’t spell it


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Click to expand...

Sciatica

Injection combined with therapy can help. non traditional medicine like acupuncture tends to help people.

And you may be a candidate for surgery.. though this should not be entered into lightly. The sciatica will likely be helped.. but.. you may experience more backpain.. and you may be predisposed to another surgery later..

Surgery for sciatica is generally a salvaging procedure. So you are doing a discectomy which removes disc material.. and then a laminectomy and foraminatomy which removes bone from around the nerve.

the upshot is that you are removing material that is support or the spine.. it takes pressure away from the nerve root.. but it probably weakens the structures leading to failure later down the road potentially.
 
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