quote:

Originally posted by jdmb03:

quote:

Originally posted by jimmy123x:
The reason for this is government pressure. During the Pain Pill mill days, CVS was THE largest pusher of Opiates- Oxycontins and Oxycodones......by far.....it's a miracle they didn't get a VW sized fine.

Unless CVS was filling illegal prescriptions, I doubt they can be blamed.

http://articles.orlandosentine...acies-sanford-stores

https://consumerist.com/2014/0...in-pills-go-missing/

https://www.law360.com/article...-fla-oxycodone-probe

Neither CVS nor Walgreens would agree to be interviewed. Both mega chains were fined by the DEA and paid tens of millions of dollars for violating the Controlled Substances Act.

http://www.wbur.org/hereandnow.../pill-mill-crackdown

quote:

Originally posted by ZSMICHAEL:
Again addressing the problem of addiction with rules.
On the horizon no prescription for opiates along with benzos.

This sort of blanket edict will not address the ugly problem of opiate addiction which escalated rapidly in the mid 1990s with the introduction of Oxycodone. Heroin is cheaper than the pills, so now the heroin problem is no longer confined to the inner city.
Addicts will find a way around this pretty easily. Others will have a problem.

You're thinking of Oxycontin - - Oxycodone has been around for 100 years.

If the pharmacy wants to play Doctor, they can Fuck Off. Just fill the damn thing and if they think a Doc is over-prescribing or being the agent of a pill mill, there are ways to deal with that.

Cvs’s New policy is going to piss off a lot of doctors and patients. My wife had a surgery a couple of years ago, pain meds were a god send. She was in a lot of pain and if a pharmacist (i’m A retired one) told me that we could only have a limited days supply we would have come to blows. Sure some doctors abuse the amount of narcotic prescriptions that they write, but if the pharmacist feels that is the case then he\she should contact the state medical board, not limit the meds to the patient. And yea some patients also doctor shop to get an excess of narcotics, the pharmacist should then contact the doctors involved and make them aware of the situation.

wanted to address a few issues that have come up in the thread

1. strong pain killers used too much for minor pain

I am not talking about minor pain. I am talking about pain that is so intense you feel nauseous and feel like you will vomit. You can't think straight. Your decision process is very poor. The pain dominates you and normal living is impossible.

2. Why not just follow the prescription ?

For my wife the surgeon told us some recoveries are relatively easy, and some are long and hard. The doctor prescribed a 2 week supply of pain killer with an estimate of an average person daily dose. He said not to worry, if she needed more, he would prescribe additional pills.

The doctor said not to exceed 12 of these pills in 24 hours. But they were "use as needed". My wife was in a lot of pain (slowly getting better now). She couldn't sleep. She couldn't focus or concentrate. She couldn't do normal things at all.

3. I am not blaming CVS for any past history of filling prescriptions for addicts

I am upset with CVS that the doctors prescribe "as needed" (and then adjust to the pain the patient actually encounters), while CVS takes a hard line literal interpretation of each prescription and rolls that into subsequent refill instructions.

4. There are many cases where even the initial evaluation is known to involve pain killers for longer than 7 days.

5. We are a society that tries to fix problems by penalizing everyone while the criminals remain unfazed because they ignore laws anyhow. We keep "solving" problems with approaches that are not effective, but they put restrictions on honest individuals without any plus side benefit. "Feel good" solutions.

I think that as soon as a physician writes you a prescription for painkillers, CVS should dispatch a hit squad to murder you in your home. That'll teach you to try and get opioids, ya criminal bastard!



Better do the wife and kids, too. You know how it is. These drug addicts travel in packs. Better safe than sorry, right?

Few thoughts from a 14 year retail pharmacist at a large chain, not the topic of the article mentioned in the OP.

Express Scrupts has taken a recent stance that they will only cover 7 days or 2 fills in a 30 day time frame of any short acting narcotic analgesic. There is also a quantity limit in there as well, but I can't remember that number at the moment. IMO, this is the route that needs to be taken. Put the onus on the prescriber to get a prior authorization if more is needed. CVS/Caremark is following the lead of Express Scripts. If it is set up the same way, all that would be needed for a longer days supply is a call from he prescribed to the insurance with supporting documentation.

I think this is a step in the right direction. Many in this thread have complained about pharmacists not filling their prescriptions, and I will address that in a bit. I have also read posts stating to contact the prescriber or medical board if we had issues. That is precisely the problem. The medical boards are a joke when it comes to any type of discipline for a physician. An example I will give is a prescriber I (and many others) dealt with early in my career. He would write anything for anyone. Cash only. When we took our concerns to supervision and higher, that got authorities involved, both regulatory and law enforcement. He had multiple patients die due to overdosing and that is what got him before the Board of Healing Arts. He had a friend, another physician, testify that his prescribing was in line with normal standards of practice. It wasn't, but that's all they wanted to hear. This happened twice and after the second time, the DEA got involved. Once they started investigating and filed charges, he fled the country.

That is why going to the medical boards doesn't always work. We as pharmacists have to take an approach to protect the patient and our license. If we aren't comfortable filling a prescription, we are under no obligation to do so. It's called professional judgement.

Let's talk about early fills. If I fill a control early, it has to be documented why. If my files get audited by DEA, BNDD or the Board of Pharmacy, I have to be able to explain why. I took more than prescribed doesn't cut it. sdy, you said that the prescriber said to take as needed, but weren't exactly clear as to how the rx was written. If, for example, a prescription says to take 1 tablet every 4-6 hours as needed, I fill with the assumption the patient will take it every 4 hours. That doesn't mean they can take it every 3 hours, the max at that point is 6 per day. If the prescriber wants them to take more, then it has to be written that way. If the doctor verbalizes to the patient they can take more, I require the doctor to write a script with directions to that effect. As needed does not mean whenever I want, it means if I need to I can take it at the prescribed intervals.

sdy, I hope that last paragraph makes sense. I'm typing this on my phone in a waiting room while my oil gets changed. I read over your post about the pharmacists interpretation of as needed and addressed it how I interpreted it. If I misread that, I apologize. I completely understand that there are some pharmacists that are on a power trip and like telling people no.

Good! I deal with 10-15 drug seekers a day. Everything from outright junkies to upper class house wives who are constantly being “thrown from their horse”

This won’t effect my prescriptive habits as I refuse to write narcotics for anyone longer than 3 days.

quote:

Originally posted by KMitch200:

quote:

Originally posted by ZSMICHAEL:
Again addressing the problem of addiction with rules.
On the horizon no prescription for opiates along with benzos.

This sort of blanket edict will not address the ugly problem of opiate addiction which escalated rapidly in the mid 1990s with the introduction of Oxycodone. Heroin is cheaper than the pills, so now the heroin problem is no longer confined to the inner city.
Addicts will find a way around this pretty easily. Others will have a problem.

You're thinking of Oxycontin - - Oxycodone has been around for 100 years.

If the pharmacy wants to play Doctor, they can Fuck Off. Just fill the damn thing and if they think a Doc is over-prescribing or being the agent of a pill mill, there are ways to deal with that.

I love when a pharmacist does their job. I wrote some mope 3 days worth of Norco in the ER and the pharmacist calls me and tells me “well he’s refusing to fill the antibiotic” or “I looked him up in South Carolina and he has filled 4 other narcotic prescriptions this week.” That step of gong above and beyond makes my job easier. Especially since it was a pharmacyst who caught a guy writing fake prescriptions using my credentials. Anything that looks out of the norm should be questioned. People in America are simply pussies when it comes to pain. Anywhere else in the world after surgery you get a prescription for ibuprofen 800 and a boot in the ass at the door.

There’s a lot of changes coming from state governments in regards to the prescription of narcotic pain medications. Mark my words in the next 5-10 years your PCP will no longer be allowed to write narcotics for any sort of chronic pain. ER providers will be severely limited. Pain management contracts will be the norm for anyone with any sort of chronic pain.

We recently caught a guy here in Charlotte for doctor shopping. He was recognized by multiple ER and urgent care providers (we have a big secure group messaging system and kept tabs.) he was here today using this name, there last week with this name. Finally he checked into an urgent care and the police were called. He had a notebook full of aliases and every place he had been up and down the eastern US with X’s through the ones who had not prescribed him anything. There were 100’s of them. This was his job. Running around getting pills was his career.

quote:

People in America are simply pussies when it comes to pain. Anywhere else in the world after surgery you get a prescription for ibuprofen 800 and a boot in the ass at the door

Perhaps one of the dumbest comments I have read on the forum.

Why would one not relieve incapacitating severe pain during recovery from surgery ?

quote:

Originally posted by sdy:

quote:

People in America are simply pussies when it comes to pain. Anywhere else in the world after surgery you get a prescription for ibuprofen 800 and a boot in the ass at the door

Perhaps one of the dumbest comments I have read on the forum.

Why would one not relieve incapacitating severe pain during recovery from surgery ?

Because a large percentage of these people are still taking narcotics a year later without missing a beat. Back surgery is a perfect example. More often then not people who undergo invasive back surgery remain on narcotics indefinitely afterwards. As stated above, pain is a part of life. I have had multiple surgeries and never even filled any of my narcotic prescriptions. It can be done. Americans simply chose not to. This is evidenced by the difference in rates of narcotic prescriptions between the US and other developed countries. 80% of the worlds opiate prescriptions are written in the the US. Western Europe and Canada make up for another 15% while the rest of the entire world makes up for the remaining 5%. What does that tell you?

Americans are so adverse to pain that needless surgeries have become a cottage industry. For example Gallbladder removal is necessary in about 40% of cases in which they were removed. Americans simply refuse to change their diets so they opt for be easy way out...surgery. People here are so adverse to pain that we actually had to come up with fake medical ailments like fibromyalgia and chronic pain syndrome to be able to justify norcotic prescriptions for no real reason.

None of what I’m saying is an indictment on anyone here it’s simply the way things are in this country.

quote:

Originally posted by sdy:Why would one not relieve incapacitating severe pain during recovery from surgery ?

Because we are now learning that the risk of becoming addicted to those drugs is MUCH greater than we once believed and that recovery from opioid addiction may be more difficult than dealing with the pain.

BTW: I'm not passing judgement on your wife in particular since I have no idea what kind of surgery she had.

Down here in Florida, people that are prescriped opiates long term have to get blood tested I think it's monthly (but might even be more often) to make sure the opiate they're prescribed is in their system at a certain concentration before the prescription can be prescribed again.

If you truly "need" any drug you will jump through the hoops to get them...and it's medically necessary for you. Other than that tough luck...

quote:

Originally posted by jimmy123x:
Down here in Florida, people that are prescriped opiates long term have to get blood tested I think it's monthly (but might even be more often) to make sure the opiate they're prescribed is in their system at a certain concentration before the prescription can be prescribed again.

Hmm Live in Florida ....Have been on Oxycodone for the past 4-5 years at the same initial dosage for chronic Osteoarthritis pain. Never been drug tested. And I hope I'll be able to continue my usage. As it does relieve my pain, and allow sleep. And a somewhat normal mobility for my age. I don't abuse it, I don't get high from it and it defiantly works for me! Plus a monthly dose cost me just $5.43 at my local Publix pharmacy. People that are addicts will always find a way to get high even if it's with common objects like sniffing gasoline. Why take away what works for those of us that need it for a normal life without crippling pain??

quote:

Originally posted by Dusty78:

quote:

Originally posted by sdy:

quote:

People in America are simply pussies when it comes to pain. Anywhere else in the world after surgery you get a prescription for ibuprofen 800 and a boot in the ass at the door

Perhaps one of the dumbest comments I have read on the forum.

Why would one not relieve incapacitating severe pain during recovery from surgery ?

Because a large percentage of these people are still taking narcotics a year later without missing a beat. Back surgery is a perfect example. More often then not people who undergo invasive back surgery remain on narcotics indefinitely afterwards. As stated above, pain is a part of life. I have had multiple surgeries and never even filled any of my narcotic prescriptions. It can be done. Americans simply chose not to. This is evidenced by the difference in rates of narcotic prescriptions between the US and other developed countries. 80% of the worlds opiate prescriptions are written in the the US. Western Europe and Canada make up for another 15% while the rest of the entire world makes up for the remaining 5%. What does that tell you?

Americans are so adverse to pain that needless surgeries have become a cottage industry. For example Gallbladder removal is necessary in about 40% of cases in which they were removed. Americans simply refuse to change their diets so they opt for be easy way out...surgery. People here are so adverse to pain that we actually had to come up with fake medical ailments like fibromyalgia and chronic pain syndrome to be able to justify norcotic prescriptions for no real reason.

None of what I’m saying is an indictment on anyone here it’s simply the way things are in this country.

Dusty is absolutely correct. Quick fixes are a huge part of our current culture. Whether it is pain management, anti-depressants, sleep aids, or fast-food, people want it done and want it done now. I deal with this in the PACU and in my pain management dealings every day. I tell everyone that I'll do my best to keep them comfortable post-op, but they are having surgery...it's supposed to hurt. Yet, still, despite nerve blocks and narcotics I still frequently get those who demand more. They want and expect to walk out after surgery feeling better than when they came in and can't seem to deal with even minor discomfort.

I had three major surgeries on my ankle over the span of a year after nearly tearing my foot off of my leg, the last being a total joint replacement. I was written for 60 Percocets after each of the first two and 90 Percocets for the third (all with refills available). I managed my post-op pain with Tylenol, Motrin, ice, and elevation after each one. Did it hurt? Fuck yes it did. It was supposed to. But, it got better. (I admit though, that I did fill those to keep in my bug out bags should the need arise)

The vast majority of time, pain is normal and acute. It is your body's way of telling you you fucked up and what you should or shouldn't do to get better. Listen to it, and deal with it. Don't expect to take a pill and feel perfect.

An interesting observation is that I find most patients who have trouble dealing with pain are under 50 y/o. This seems to correlate culturally with the advent of "fast" everything and the "feel good" generations. The older folks can hurt, but more often than not, they just deal with it and drive on. It's a part of life. Of course, these are mostly folks who grew and cooked their own meals rather than eating fast food, looked up words in the dictionary rather than Googling them, and wrote letters rather than texting.

"I want it and I want it NOW". Sadly, it is what we have evolved into and what we now demand.

Is there abuse? No doubt.

But who the fuck do you (the universal) think you are telling someone else - especially someone you don't know - that they should just suck up xyz pain, that x-days are too many, or the like? You (even some physicians and pharmacists) need to get a fucking grip. Like most laws, these intended to stop abuse are hurting just as many if not more good people, and your (the universal) righteous indignation and intolerance for "addicts" and addicts alike doesn't mean shit, isn't helping anyone, and is a giant pointless distraction.

Any physician like Dusty who simply, as a blanket policy, doesn't prescribe more than x-days worth, just because of their own personal bias, isn't providing adequate care, and clearly isn't the best physician to see if you actually need help. They aren't listening, they're letting personal agendas get in the way, and they deserve to lose your business. It's lazy, overly cautious to the point of detriment, but hey, their life is easier, so fuck you... right? The abuse by some is no excuse for this or the government's or CVS' behavior.

Making things harder for regular people because others have issues is always, always, always a colossally poor choice, a dumb and over simplified approach, a sledge hammer when you need to thread a needle, and much more of a pain in the ass than it's worth, and for what benefit - usually? So that some other busy bodies and know it alls and those with other agendas can feel like they're DOING SOMETHING, or some other useless bullshit. We'd be much better off with more ODs and laxed rules, in almost every single regard.

Why, because you can't legislate away this sort of problem anyway, and never, ever, will.

quote:

Originally posted by 46and2: It's lazy, overly cautious to the point of detriment, but hey, their life is easier, so fuck you... right?

Quite the opposite. The easy way is to give the patient a big bottle of narcotics and send them home so they won't bother you on the weekend. Same with moms that bring their kid in with a cold and demanding antibiotics. It's way easier to write the prescription than educate/convince them otherwise.

quote:

Originally posted by 46and2:
Is there abuse? No doubt.

But who the fuck do you (the universal) think you are telling someone else - especially someone you don't know - that they should just suck up xyz pain, that x-days are too many, or the like? You (even some physicians and pharmacists) need to get a fucking grip. Like most laws, these intended to stop abuse are hurting just as many if not more good people, and your (the universal) righteous indignation and intolerance for "addicts" and addicts alike doesn't mean shit, isn't helping anyone, and is a giant pointless distraction.

Any physician like Dusty who simply, as a blanket policy, doesn't prescribe more than x-days worth, just because of their own personal bias, isn't providing adequate care, and clearly isn't the best physician to see if you actually need help. They aren't listening, they're letting personal agendas get in the way, and they deserve to lose your business. It's lazy, overly cautious to the point of detriment, but hey, their life is easier, so fuck you... right? The abuse by some is no excuse for this or the government's or CVS' behavior.

Making things harder for regular people because others have issues is always, always, always a colossally poor choice, a dumb and over simplified approach, a sledge hammer when you need to thread a needle, and much more of a pain in the ass than it's worth, and for what benefit - usually? So that some other busy bodies and know it alls and those with other agendas can feel like they're DOING SOMETHING, or some other useless bullshit. We'd be much better off with more ODs and laxed rules, in almost every single regard.

Why, because you can't legislate away this sort of problem anyway, and never, ever, will.

Ummmm no I only write for 3 days because I am in emergency medicine. If you need more than that go see your primary care physician or the referral physician I’m going to give you. I’m in the emergency buisiness as in saving you from life and limb situations. Pain never killed anyone.

I wish I had the numbers in front of me, but unfortunately I do not. The number of people who have moved on to heroin, but started with narcotic prescription pain relievers is astonishing. Many teenagers get hooked by digging through their parents medicine cabinet and taking whatever is left over. THAT is a big part of this push. Decrease the number of pills that are on the streets that have been prescribed excessively.

A personal example....I have had narcotic pain relievers prescribed to me 5 or 6 times over 9 years. Wisdom teeth extraction, 2 abdominal surgeries (the recovery hurt like hell, but I managed) and slicing my hand open are the ones I remember. Had I not gone through our olds meds about a year ago and trashed them, I would still have plenty left.

Prior to this push, docs would write 10-20 days worth without thinking twice. I can't tell you how many times I've called doctor offices with concerns and have been told....give them what they want. Ummm, no Doctor, that isn't how this is going to work.

(borrowed from NEJM, Sept 12, 2013)
Pharmacies have a role to play in the oversight of prescriptions for controlled substances, and opioid analgesics in particular. Under the Controlled Substances Act, pharmacists must evaluate patients to ensure the appropriateness of any controlled-substance prescription. In addition, state boards of pharmacy regulate the distribution of opioid analgesics and other controlled substances through the discretion of pharmacists.

Sorry 46and2, but I (I don't think you directed this at me) and other pharmacists don't need to get a fucking grip, we just need to be able to do our job as medical professionals, part of which is making sure controlled substances are not abused and are prescribed correctly.

quote:

Originally posted by Erick85:
Decrease the number of pills that are on the streets that have been prescribed excessively.

Even though I hate it when others do this, I'll do it to you.

Decrease the number of guns that are on the street and we'll decrease the crime.

Sure, that might help, but it won't solve the problem. What will, is changing the culture, and THAT is a much more difficult thing to do. There are no easy solutions to this problem. Stopping the means is not the most effective or even the best way, stopping the desire is. But how?