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My pain doc told me that 90mg's of methadone was the maximum the state of North Caro. allows?

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Posted 12/3/2012 11:11 AM (GMT 0)
I was talking with my pain doc about increasing my methadone and when he looked up my dose he told me 90mg's was the max that can be given.. I do know that for maintenance it's alot more.. Any info appreciated.. The reason for the increase is that my AVN in shoulder and right knee is in stage 3 and need surgery..

Thanks Randy

Posted 12/3/2012 2:24 PM (GMT 0)
It may be the most he can give you with your diagnosis. Or it may be the most he can give in his practice-hospital. Could be something insurance related. Who knows? All the regs that docs have to jump through these days.

Did he offer something else as an option? Or did he just say you were maxed out?
Posted 12/3/2012 4:05 PM (GMT 0)
I don't see any type of law that states this in North Carolina. You can easily ask your Dr. to please direct you to this particular law so you can read it.

90mg is a fairly high dosage....and as mentioned, it just may be the Drs. level of comfort is maxed out and because you need upcoming surgery...then it's not advisable to continue to raise the dosage.

Especially since Methadone can be associated with LongQT syndrome. This could potentially cause issues with someone going under general anethesia.

So....unless they can direct you to a specific "law"....then I think it's just their way of backing off on raising your dosage.

Post Edited (Snowbunny21) : 12/3/2012 6:26:37 PM (GMT-7)

Posted 12/3/2012 6:45 PM (GMT 0)
Hi Randy, to be honest, it wouldn't surprise me if such a law was in place regarding methadone. If there was such a law, I'm sure the interpretation of it is probably directed towards methadone clinics; but if the law isn't phrased properly, as most are not, it would make sense that a PM would have interpreted it to mean all patients, not just adicts. My suggestion is, when you want to know about laws, talk to someone who knows them. Aren't you receiving treatment at a university? You might be able to swing in by the law classes and find out more info there. Or check on your state's website, most of them have an 'e' version of the penal code tbat you can surf through, but it can take some time.
Posted 12/3/2012 8:31 PM (GMT 0)
You'd be hard-pressed to find an actual 'law' in the U.S. regarding how much of a medication can be prescribed. However, there are guidelines (from insurance cos., DOH, DEA, state pharmacy board, etc.) for various medications. For instance here in FL, Medicaid will only cover a max. of 8 oxycodone tabs per day. Also, the DEA is limiting the amount of certain controlled substances that a pharmacy can get each month. Of course many doctors have their own 'limits' of what they feel comfortable prescribing. Some of those doctors blame 'the law' when it is actually their own personal preference. I suppose they do that so the patient thinks it is out of the doctor's hands. I personally prefer honesty.

Post Edited (Splashdancer) : 12/3/2012 1:34:20 PM (GMT-7)

Posted 12/3/2012 8:59 PM (GMT 0)
Splash...the 8 a day is pretty much the daily max for everyone in the US, Medicaid of not...This has been a standard for quite a while for Doctors for most all short acting medications as it will even be labeled on the prescription bottle. So don't feel singled out on that one:) The reason is that if someone is needing more than this every single day, then they should be moved to a long acting medication.

And another reason that there are recommendations for limits that a Pharmacy has for opiates is for safety reasons as Pharmacy staff were getting robbed and even murdered for large amounts of pills!

Granted...Florida has unfortunately been a "hot bed" for abuse with so many pill mills and roque Pharmacies and Drs. that were in on it as well....But just wanted to share that a lot of these polices that you mentioned are in effect in most of the country.

My Pharmacy (Sam's club) gets shipments once a week for meds but always makes sure that I have what I need each month as I've been going there for 11 years now.
Posted 12/4/2012 12:11 AM (GMT 0)
My prescriptions for oxycodone 15 mg (and before that - Percocet) were prescribed at 8-10 per day. Long-acting meds do not work well for me - I have much better pain control with short-acting medications. It was never an issue with Medicaid until they changed their coverage earlier this year. The DEA began their volume limits as a direct result of 'over-prescribing' by physicians and the HUGE quantities that were being ordered by some pharmacies (Walgreens and CVS were 2 of the big ones). I remember reading about one pharmacy (Gulf Coast in Fort Myers) that had ordered almost 463,000 tabs of oxycodone in a 2 month period! I think they said it was like 7 times what the average pharmacy dispenses in a year.
Posted 12/4/2012 1:02 AM (GMT 0)
there are state by state regulations concerning these types of meds

i found this link for north carolina, see if this helps

http://www.medscape.com/resource/opioid/opioid-north-carolina

david
Posted 12/4/2012 1:27 AM (GMT 0)
Purgatory...I don't see anything that mentions the maximum dosage for Methadone on that website for NC as I read that one a lot in reference to many of the questions that come up on here.

Can you please point out specifically where you see this?
Posted 12/4/2012 2:16 AM (GMT 0)
"North Carolina has no quantity restrictions on dispensing controlled substances, including those in schedule II."

This is from the Guide to State Opiod Prescribing Policies - N.C.. I hope that answers your question. Like I said earlier, there are guidelines and policies but I don't think any state has actual 'laws' dictating how much of a medication a physician can prescribe.
Posted 12/4/2012 1:37 PM (GMT 0)
I also live in NC and know for a fact that some of the patients at my old PM doc (he retired) were on much more than that. I see my PM doc this week and will ask her.
Posted 12/4/2012 1:50 PM (GMT 0)
it's time to get a new doctor. it's pretty obvious he lied for whatever reason and you don't trust what he says. you need a doctor you can trust because your life is literally in his hands.
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