Scary Letter from PM

Yikes...that is a close call and thankfully they are still keeping you on!...

I think when the PM ok'd the prescription it was for last year and they weren't anticipating you still taking it as most prescriptions are meant to be "current" and not used for a year.

Valium is looked at differently than actual muscle relaxers because it's a Benzodiazepine. Many people who are recovering from addiction have issues with Benzos as well as opiates. So this is why many Drs. will take issue with you being on this from another Dr. (NOT saying you are recovering or have trouble with addiction...just stating this as a reason why they red flag this medication) So the nurse may have been "testing" you when she said the Dr. doesn't care about them...Or, it could just be that because of the mounting pressure from the changing state regulations and DEA that Drs. are having to be accountable for more.

Don't they ask you specifically on the day of your urine test what you have taken in the last 24-72 hours? Mine does this so they know what they are looking for on the test and that it matches exactly what I say.

It would have been much better (obviously hindsight), if you had brought in the prescription the day of the urine test and told them that you had taken one so they had a head's up but now it "seems" as if you were hiding it which obviously you weren't.


At this point I would mail the letter certified but also bring in a copy with you to your appt. along with the bottle/prescription to show them it was filled last year and has lasted so long.

And then have your PM write down specifically if he will allow you to still take this or switch to another actual muscle relaxer.

I hope it goes well for you...

Post Edited (Snowbunny21) : 11/9/2012 2:56:25 PM (GMT-7)

Hi Cogito, that must be a scary letter to read, I know you did everything by the book, so you should be fine. Just to continue to be on the safe side, I would contact the PCP, and ask if he can draft up a quick letter stating what you wrote, and reminding the PM that the script was written with his blessing. A letter from you will be good, a letter from another doctor would carry more weight. My understanding is that you've been with this PM for some time now, so there should be some level of trust there. It's probably just a simple inquiry, wondering where it came from. I'm sure if your PM was fine with it then, he'll be fine with it now. I would also go as far as to bring the bottle with you, and offer to turn it in, in exchange for a script from the PM, especially since I'm sure the old one will be expiring soon.

Just some other suggestions. I hope this works out OK for you and doesn't turn into a big mess, maybe pop a few rounds off tomorrow to ease some tension lol. Good luck. And keep us posted.

Rediculous what patients have to go through .....thank god I have the pcp that I do .....she is trusting, compassionate and healing and treats me as an adult with respect !!!

I take many "red flag" meds I believe

Oxycodone / morphine / Valium

I have a chronic progressive bi lateral hip problem ........ So what happens if I ever go to another doc like a PM and I still have meds from my past scripts ??? I let then know everything and hope they don't treat me like criminal ???

That sux ......the pain is bad enough

Snow bunny - actually I have been under a contract for over a year now and have taken a urine test .....no problem for me .
My pcp is willing to be my pain manager but I have discussed PM's with my surgeon and he said " if you have a good relationship with your pcp and she is willing to treat your pain then stick with her"

I understand regulation / DEA / federal guidelines etc

I think a reminder note from your PCP would be an excellent thing to have with you at the time of your appt., along with a brief explanation from you too. I hope someone did not drop the ball and forgot to note this in your chart.

Good luck,

Susie

Cognito,

While I am glad that it doesn't appear that this valium script from long ago is going to be a problem right now, I do want to caution anyone that taking an old prescription, when you are being treated for pain, can and probably will get you dismissed if it is not written for and provided by your current treating pain management doctor. In most cases, if the prescription is over 30 days ago, and it is not written by your PM doctor, taking old meds for any reason, even ones prescribed by your PM doctor but no longer being used in your current treatment plan can get you dismissed. Just as having taken meds from another doctor, using up old meds in lieu of or in addition to your current med regimine can cause big problems.

The best advice is not to take any old meds, no matter who wrote them without the express permission of your PM doctor, and after making sure that it is included in your file....

I know of too many patients who have run out of meds or taken old meds in addition to their current ones when they have taken too many of their old ones to supplement their current meds and gotten dismissed because they did....and when the doctor asks why they are using old meds , even ones that were previously prescribed by their treating doctor, they were told that if it is older than 30 days from the ER or is not a part of their current medication plan not to take it......period.

 

I have had several prescriptions that have lasted many months. For example, when I first began taking xanax it was for severe panic attacks and it said on the bottle, "Take one tablet as needed, for anxiety". With my phenergan it was labeled, "Take one to two tabs as needed, for nausea". Other examples would be a certain bp med that I would take as a 'booster' when my maintenance med wasn't enough and even a pain medication that I was to take only when I had a severe spike in pain. Until my condition(s) worsened and I was needing the medications on a regular/maintenance basis, some of my prescriptions did last up to a year. I understand the other issues that have been discussed, I only mentioned this to show that there are legitimate reasons for a prescribed medication to last a long time.

Have a peaceful day......

The real issue here is that the prescription is a year old....As well as he didn't tell the nurse the day of the test that he had taken the Valium and showed her the bottle to write it down and when the PM Dr. had said it was ok that he take this when needed. It now makes it "seem" as if he was hiding it to them.

I'm not trying to blame Cogito at all here...I'm truly just trying to explain why this is such a big deal to lots of Drs. out there.

As I mentioned, Valium (Benzos) are abused as much as opiates are so they are on the radar of the state and DEA when it comes to urine tests. So now Cog's PM has to account as to why this showed up in his urine test when the PM has not prescribed it to him.

If it was just a month or so old...3 months max...I think it would be an easier time...

I still think that if Cogito brings in the prescription bottle to his appt. and gives the PM the date when they discussed this and he ok'd the usage...he will be ok.

The other part that makes this a bit more difficult is that Cogito's PM is already doing something a bit more unusual than most Drs. as he prescribes two short acting meds along with a long acting one. So he may be getting the state or DEA asking questions lately so he is under the gun of having to have everything in perfect order.

So, his PM is not trying to be a jerk here....it's just having to have a good explanation in his file that matches with the test results.

That is why it's very important for those who may have a prescription from another Dr. for ANY type of controlled substance like Benzos (Valium, Xanax), Ambien, Adderall, Ritalin...etc. To keep reminding your Dr. and getting permission if you are still taking this medication month after month.....These are meds that will come up red flagged if they are not prescribed by your current PM. A year is just not in the normal time frame of someone continuing to take the same medication so it's best to always make sure your Dr. knows as it unfortunately is always going to fall on the patient to prove that the OK was given.

regarding notifying the doc about all of your medicines, my wife and i are not in any of these pm programs, but we do make drug lists and keep them current. any time we add, subtract or change doses, we change the lists. every time we go to see any doctor for any reason, we print out the current list and give it to the doctor for their info and our records. that way every doc knows every medicine we are taking every time.

Hey Cogito -

Sorry you had this scare.... but I'm on the side that says not to worry about it. I think all will work out for you.

Everyone -

I usually agree w/ most things.... but I don't agree w/ this being an "old" script issue... Or that a prescription has a time limit kind of thing. Well - there are a few exceptions I can think of.... but, as a generalization, I've never had this be an issue.

If Cogito was given Valium last year for muscle spams - w/ his PM's consent.... I know my own doctor would not have a problem w/ me using it down the road (for the reason intended, etc).

I've done the exact same thing as Cogito did w/ an older script of Ativan..... had it awhile (scripted w/ PM's consent, by another doc); anxiety got better and didn't take for several months.... and then started using it again w/ a flare in anxiety. I *probably* wouldn't think to mention it at my PM appointment. Not that it would be a problem or I was keeping the info.... but I just wouldn't mention it probably unless asked, for some reason. When I am given urine tests - I'm not asked about what meds I've taken either.

Anyway, so I think things are done differently w/ all doctors - and all have a different slant on things. I'm a HUGE advocate of being completely honest and upfront w/ ALL doctors, especially a PM doctor. I have a great relationship w/ my own PM office for this very reason.

Just wanted to give a different viewpoint.... again, just my own thoughts - not telling anyone to do things this way, lol.... just my own two cents :)

Cogito - let us know what happens. I know that was a scare.... but I think w/ your explanation, etc.... I really don't think it will be an issue.

Take care, Tina

I think this will blow over too, I would still pick up a note from my pcp & take it to the appt. Cogito has the bottle with the original date and that alone shows the valium is not being taken all the time. Knowing Cogita there is a lot of valium left in the bottle. I don't think this is an old script either, as I have medication right now that is over a year old and is take prn.

I know it shook Cogito up getting this letter, but the good news is not one word was mentioned saying to get a new dr either. It would scare any of us to get a letter such as this. Let us know how this all pans out....Susie

Hi All,

I just got back from the PM. No problems -- a total non-event!

No one even mentioned it until I asked, and was told that somehow the Valium script never got recorded so they had to have something for my file.

I wasn't even urine tested this time!

Also, the nurse handed me a script for 180 oxycodone for BT, even though the PM wrote the same for me just a month ago. This kinda makes me wonder if they were doing a refill so soon as a unspoken apology, or if their record keeping is messed up. I refused the script since I (hopefully) won't need any more oxycodone for 3-4 months.