THE DEA IS NOW YOUR DOC!

so had my monthly pain appt today. i thought last month we cut to what the pain practice was arbitrarily cutting every patient to- bad back or terminal cancer it was 4 oxy 15's a day and some er pills...went in today and doc looked at me and said sorry...i was like what...she said dea is creaming docs around the country- going after pain docs...so now it's 4 ir pills max AND 150 mg morphine equiv...!!!!!! so for reference...4 oxycodone 15's and 3 oxycontin 30's a day equals 225 mg morphine equiv!!! so you do the math...it's going to SUCK...and if your pain doc hasn't started cutting back yet they will very soon! we really need to stand up for ourselves as chronic pain patients! does anyone know any patient advocacy groups? we all need to join and make sure our voices are heard or we're the ones who are going to pay the price!!!!

according to the DEA it soesn't matter why you need meds- hang nail, terminal cancer, crohn's disease...or how you react to meds, how much you weigh, what your metabolism is...your maxed out at 150 mg of morphine equivalent!  this is insane!  docs everywhere are going to start cutting you back sooner than later...

my docs operate a high risk clinic also- people who are on such rediculous levels of narcotics from pill mills, addicts etc...we're talking about HUNDREDS and HUNDREDS of mg a day...THEY ARE CLOSING THIS PRACTICE!!!  These people will be forced into rehab very soon because there is no where else to go- no doc will prescribe anywhere near the levels they are on...

my doc was cool.  i convinced her to let me stay at level from last month so i can stow some away (HOPEFULLY)...i'm terrified!

Hi mtgman! I scoured the d.e.a. website and I can't find anything about this. Do you have any other details on where we might be able to find information on this? Maybe it is a misunderstanding on the Drs. part? I only say that because I once had a doctor tell me that "the d.e.a said so and so" and I ended up discovering that what he was referring to was actually a medicaid directive, not the d.e.a. If you get any more details, please let me (us) know! Of course any way you look at it, we legitimate c.p. patients will be made to suffer.

I'm so sorry that you encountered this today.

Yes, there's a huge DEA crackdown everywhere. But as Splashdancer said - there are no federal limits to dictate a "max" amount of meds. I'm not sure what's going on w/ the clinic you are going to.... :( But I hear your frustration and worry....

But I agree wholeheartedly in that we need to make sure we make our voices heard.

--Tina

I was wondering if you could "cite" some specific link or site to substantiate this claim or report?
Not saying you are wrong, but I have not come across anything that would show that happening to that drastic extent.

Yes, the DEA has been cracking down on specific areas where there are bad doctors and pain med mills, where scripts are being handed out like candy. And so they should.

My oncologist, who is my PM, and I talked about restrictions in general, and he said that as a bonified cancer patient, I would never have to worry about cut back or restrictions in my meds, especially as my cancer and cancer pain progresses as it will.

I can only speak for living here in SC, and there is no evidence at the local level of any kind of crackdown or restriction.

The lesson I see in general, and I think I am preaching to the choir on this, is this is more reason for we with CP to never, ever abuse our meds. Never take more than presribed, so self-dosings, no "losing my presription", no accidently losing our meds, etc. Think you get my point

We have to continue to be responsible patients, and be up front and honest with our PM doctors.
Some of this, and I don't mean the intent of the original poster, sounds like scare tactics or rumours. And it works, because it puts fear into the minds and hearts of all the legitmate CP folks that truly need their controlled meds.

Just my take, but if there is some legitimate article that says different, let's get it cited so we can all read and be aware.

David in SC

Here's a link to the DEA website, which specifically addresses oxycontin regulation. I found nothing that says they are going to restrict doctors to any specific amount at this time. But I only scanned over it.

http://www.deadiversion.usdoj.gov/drugs_concern/oxycodone/oxycontin_faq.htm

I really hate it that this has happened with you. But, you know the more I think about your situation and others on here that are having difficulty with their drs and medications. I think a lot of these drs are using the DEA as an excuse with the patients. Rather than be honest with the patient and say I am going to reduce your meds, they are copping out and using the DEA as the scape goat. They could be doing this with everyone in the clinic in an effort to get their numbers down on writing scripts for narcotics so the DEA does not take a hard look at them. They know the DEA monitors this. There is so much variance from state to state and how drs script the narcotics is another reason I am not buying into this one.

This way the drs do not have a bunch of patients getting mad at them and walking and looking for another PM dr. These are my thoughts on this. Have you considered looking for another PM dr?

Take care....Susie

The DEA is a federal agency and doesn't work with specific PMs in setting any rules. Laws are either a federal law, state law, or choices made by particular PMs.

The rules about Pharmacies and having certain amounts on hand at one time really don't have anything to do with prescribing choices by Drs.

Those particular laws were set forth because of the pill mills and rogue Pharmacies supporting them as well as for safety issues for Pharmacies as well for robberies. If a Pharmacy doesn't have enough for a prescription, they will usually be ok with ordering for you. That is what mine has done.

As Susie mentions....I also feel this is more the case that this PM is using the DEA as an excuse for their prescribing practices. It could be they are doing this just for you if they are concerned about your prescriptions...or for all their patients.

But it really has nothing to do with federal laws or the DEA as a whole or even your state as there are just not any laws in place stating that someone is limited to x amount of medication as a whole.

As I wrote earlier...there is concern with patients who are only on short acting meds for long periods in larger doses..so I think I had responded to you in past posts that if they were trying to transition you over to more ER meds and lessen your breakthrough meds...this is perfectly logical.

The whole concept of "breakthrough" medications....which are the short acting meds given when a patient is also on ER meds...is that they are only meant to be used once in awhile. So if you were given 4, 15mg Oxycodones a day max for breakthrough....then they aren't expecting you to use all 4, every day. Then it is just part of your maintenance med so they try to lessen this and get you on a steady ER med.

Prescription drug abuse is truly an epidemic out there and we as true pain patients have to know and realize this what our Drs., the states, and the DEA are up against.

It is only in the last 20 years that so many people who aren't cancer patients are being prescribed such large doses of opiates. And yes, deaths and overdoses due to prescription meds is rising every year. So there has to be regulations/laws set in to place but I haven't seen anything that states what you are claiming.

So, my point is that we do have to recognize there are many rules set in place like the Prescription Monitoring Program, urine tests, pill counts, pain contracts, etc. are just part of the picture now.

As well as I know I say it a lot....but the opiates we are prescribed should just be one small piece of the puzzle in treating our pain.

So...it boils down to either trying this new regimine that they want you to be on and using other modalities to help with your pain...although I'm thinking you are already set against it mentally so it won't have a fair shot.

Or find another PM. I do wish you luck..

 

      here is another good artical of how the DEA is controling the pharmacys.

   http://articles.orlandosentinel.com/2012-09-29/news/os-oxycodone-shortage-dea-florida-20120929_1_oxycodone-cvs-prescriptions

 SE

I do suspect that PMs develop relationships with their local DEA offices and the latter likely make recommendations to the former.

Again, in the case of my PM, in July he sent around a letter stating that due to increased DEA demands, all patients must make appts for refills. That's neither a state or federal requirement.

Of course, he could just be claiming this for his own interests, but I wouldn't be surprised. Two local PMs retired in the past year, my PM took up a fair number of his patients and he may very well have met with the DEA to discuss the expansion of his practice and what their concerns might me.

I don't know if this is so, but I do know that federal and state officials do, at least in some case, make recommendations and local policies get set, at least informally, based upon them. This is not at all uncommon in other aspects of Govt as well. There are "technical explanations" and other less than absolute policy statements that are not law, but are interpreted in various ways region by region.

Cogito...I don't know of any PM that would take a "recommendation" from a local DEA office about their prescribing. It is either going to be law or a regulation they have to follow, or not. It's one thing as I mentioned if a Pharmacy is worried about recent robberies and they decide to carry less meds on hand but will order as needed...then that is a recommendation based on law enforcement...

Refills for opiates only with an appt. is becoming very common around the US but it's still not a DEA law...It may be law in certain states which is different. But it also just may be a certain requirement that a PM chooses to have.

I have been friends with my PM for years now outside of our appts. and have discussed these things at length with him. And as I already mentioned...our state passed a law two years ago requiring all patients on long term opiates (more than 3 months) have yearly urine tests. But that does not affect his choice in what he prescribes to people and it's actually helpful to weed out those who are not doing the right thing.

I just don't know many Drs. or anyone for that matter that would change their practice having years and years of education based on an "informal" recommendation. All the PMs that my PM meets with each year at annual conferences will only do what is absolutely required by law.

I'm not trying to argue with you...I just don't want new people reading these boards or new to PM to see the thread title and think that the DEA has set a federal law on how much a PM can prescribe.

Post Edited (Snowbunny21) : 10/3/2012 11:43:22 AM (GMT-6)

Please look over the Guide to State Opiod Prescribing Policies as they differ by State...The refill laws are specific to each state.

http://www.medscape.com/resource/opioid/opioid-policies#VA

And then there is the Model Policy for the Use of Controlled Substances for Treatment of Pain (under the Federation of State Medical Boards) that if you read...talks specifically about working with each state and their choices with regards to laws/regulations..It's also about making sure the patient is treated well for their pain...but also being mindful of abuse potential.

http://www.fsmb.org/pdf/2004_grpol_controlled_substances.pdf

So..I'm not sure why your Dr. used the DEA as the reason for the refill change...because it is not mandated federally.

And I'm sorry but I disagree...each state can choose about urine testing laws...Kentucky is another one that just passed it statewide as the law HB 1.

Without a law...it is up to each Dr. about urine testing...

The other law that is growing nationwide state by state is the Prescription Monitoring Program...There are now 42 states that use this now...

**I highly recommend that people read both documents to see your state laws but keep up with pending legislation...

As well as read the FSMB.org document that is listed second as it really does talk about trying to help the Physician treat patients with chronic pain and has a lot of good information:)

 

Post Edited (Snowbunny21) : 10/3/2012 1:49:54 PM (GMT-6)

The other program that has not been mentioned is the TERF-REM program. Currently it is only required for BT Fentanyl meds but their goal is to have all schedule II meds on this program. This is a federal program and they started with (at the time) the two new BT fentanyl meds Onsolis(a thin sheet that dissolves in the mouth) and Lazanda(a nasal spray). Then I think they added Abstral(a dissolving pill). In March of 2012, all versions of BT fetanyl went on the program so Actiq and Fentora were added.

What the TERF-REM program basically is that doctors, pharmacies and patients get education of the medications. In addition, the doctors, pharmacies and patients have to be registered into the program. So in order to prescribe it the doc has to be registered. You the patient has to be registered to get the prescription. Then you must take it to a pharmacy that has been registered.

Everyone made a huge issue at first with this, but most pharmacies got registered for it and if the docs already have to get extra education for pain management anyway it's a moot point. I cannot remember the year but it's still years away, they want to have all schedule II's on this program. Personally except for the big brother thing, I like this program. I had some issues with it the day it went into affect and they had an 800 number where I gave her my name and she said yep, here you are and was able to answer my questions as well as give me a list of all the pharmacies in my area. My normal pharmacy was having internal issues getting the program to run.

To be honest once it is all done, it will make things a lot easier because if you are not registered, you will not get the meds so this will help with diversion.

But other than the one Snowbunny mentioned, those are the only two things coming down the pike and as I mentioned this is years away for CII's.