New here Q's about Pain Clinic/Contract

Hi there...welcome to the boards.

Sorry to hear of your pain issues:(...

Pain contracts are becoming more standard these days with all the unfortunate abuse of controlled substances.

I've been going to my current PM for over 6 years now and had to sign a contract a few years ago. For me, they do one yearly random urine test. But it's really not that random as they always ask me if I want to take my test that day...LOL

And they do ask that everyone bring in their pill bottles at each appt. (I go every 3 months), but again, they never count mine, just ask if I brought them.

The using one Pharmacy is pretty standard, although they are fine if there was a problem that someone was having and had to switch, you just call and let them know.

I don't have any experience with mail order Pharmacies....I have been going to the same Pharmacy for 11 years now and I like being able to talk with them and get to know them over the years. Because this way, when there has been a glitch which has happened twice where it was their error, we can solve things quickly. They know me and trust me.

I would make sure that you were supposed to get this new prescription if you had plenty of meds already. As in, just making sure it wasn't a mistake by the staff/Dr. so that you don't get into trouble for filling meds early if it was their error...

How many more days did you have left? What happens at my 3 month appt. is that I leave there with two sets of prescriptions in hand. One to fill that month when I am out, and then one dated to fill the next month. And then the following I just call and go pick up those prescriptions and then back to the appt. again.

Feel free to ask any questions and if you feel like sharing more about your journey with chronic pain and how you got here.

This is a wonderful board where we all have different types of health issues, but we all empathize and help each other live the best lives we can with chronic pain!

Post Edited (Snowbunny21) : 5/9/2013 1:10:19 PM (GMT-6)

Thank you so much!!!

Snowbunny21--- My doc is the one who was doing the math at my appt for my increase in medicine. So there was no mistake is just that in the contract the prescription is supposed to go from her to their pharmacy and then within a couple of days, delivered to my house. She wasnt following it.

I didnt need the new script right then cus I still had some left. However, because of the increase she needed to give me more. The clinic also has me on this schedule as to where I go into ( what will be monthly but is currently 2 weeks cus Im new on it ) for my appt I should have enough meds for 7 days. They do this in case of holidays or weekends or shes out or whatever.

I leave with no scripts in hand its just auto given to their pharmacy.

JD333--Im not worried about any of it I just dont really understand why all the requirements I had to initial to and be thinking about for them to not follow. Like I said, its nice but was worrying also that its not normal.

Does anyone have their med just delivered at home? Its convient but I also never heard of it.

I personally would never want any of my pain medications delivered by mail to my home. I feel much safer and I feel that its just easier to pick them up in person. I would hate it if by some chance my meds were lost or stolen in the mail and I had to wait for a new script if I ran out.

If you are fine with meds being delivered, by all means go for it. But I remember my dad had Vicodin shipped directly to him from Express scripts from the VA hospital, and he always got them on time until about 6 months ago, when they never arrived and he ran out w/o anything and started going through W/D's. I had to take him to his VA doctor who is 2 hours away from his house to get the script going again, since its the VA and he usually only has to see his doctor every 6 months for a check up. Watching him suffer was terrible.

Yes - not sure how I feel about the home delivery thing as well. I had an exp in theist 3 months where the pharm had my med (proper dosage ) but with the wrong label ??
I would think that it would be harder to fix any possible mistakes, although rare, by mail.
I have a lot of family in the med world here in boston and I am a forme Boxer / runner who developed severe hip problems in the past few years. In boxing, extreme athletics, you are used to fighting through pain and pushing your body. Unfortunately that was a habit that made me force my hips too far. But it is also a spirit that makes me my own best advocate in the doc office.
I for one, am not going to suffer needlessly. We must remember that doctors work for us!! Not the other way around. I grew up with a mother w a severe heart condition and I watched her beng her own advocate. I learned lessons frm her that I use in my own care.
Plus I'm a stubborn Irish / Italian boy from Boston ......lol

But really, I agree w/ Snow bunny on the rotating meds as a combatant against constant increase in dodges and as much alternative therapies as you can use to improve your condition.

Above all - stay positive and keep the fighting spirit !!!!

Josh

This seems very strange to me and something I would investigate further.

A few questions...

Are you in the US? And do you have insurance?

I would ask the Dr. why you have to use this Pharmacy. I have actually never heard of a Dr. telling someone which Pharmacy they "have" to use.

As I mentioned, most all contracts just state that you should only use 1 Pharmacy for all your controlled substances prescribed by them but WE get to choose which Pharmacy we want to use and if he need to change, we just let them know the new name.

This puts a bit of a red flag to me and makes me wonder about a monetary kickback for this Dr. for everyone he sends to this Pharmacy.

Yes I am in the US. Yes I have insurance.

Im not sure about the kickbacks if any but she is a great doc. I dont think I would feel comfortable asking her if she did or not. But she also did waive the delivery fee.

Also, if I take my med 4 times a day and then stop for a day or so, how long does it take for it to get out of my system?

Quincy--this was my 2nd appt with her since the contract...I didnt accept the script I left it with the doc and she told me she would have it delivered. I like her and feel very comfortable with her and will keep her as she spends alot of time at each appt with me.

Snowbunny--Yes I am taking a strong med. Ocxycondone 5 mg. I can take 1 1/2 pills four times a day. I am not tapering I was just wondering if my pain was not so bad that I had to take it, would I really be pain free or would the med still be in my system and make me think I was ok. Thats all.

Sorry for the confusion I was saying that I would be comfortable asking her if she was getting kickbacks wtih the pharmacy not why she uses them. I am sure she would not be upset if I questioned her about the pharmacy she just is to nice of a doc.

Snowbunny-- I just read the posts with you and another member and understand your wanting to ask questions. I have no problem with that from you or anyone. I know you guys trying to help me and I will be doing alot of asking back at you all ;))

Poweredbylove---thats not cool what happened with him. That is terrible. I have taken vicidin before and when I stopped I didnt have any problems. But that is a reminder of I could miss a delivery somehow...but its fine for me. I have tylenol on hand 24/7

Thanks CNS:) Glad that you see they are good intentions behind any questions I ask,  even if I don't spit it out correctly sometimes..LOL


With regards to having a contract and possible pill counts or urine tests....It's never good to take more than prescribed (Just saying this in general. NOT that this is what you are doing)....but if you need less some days than others, the short acting medication of Oxycodone leaves the system fairly quickly.

But it also depends on what type of lab they send the urine test to. The one my PM uses..he sends all the way cross country to this lab that uses gas chromatography mass spectrometry which is extremely sensitive and can find the minute details of meds in one's system as well as the last time they were taken.

So, not sure if you were asking in reference to that part of things.

As far as feeling the effects of a med for pain relief...a short acting one is usually 4-6 hours....and most long acting ones are 8-12...Some are 24 hours. Then there are patches which are a few days.

Many of us keep a journal to write in every day about our pain levels, what we can and can't do, where the pain is coming from at that time, and what times through the day to we take our meds. This way you can show and discuss with your Dr. so that you are on the same page of your medication needs.

Like if someone was needing 4 pills one day, but then none the next two, then back up to 4...is this working for someone or are they making it worse for themselves with such a swing in pain levels. Would it be better to take 2, every day instead to be consistent...

It really is all trial and error about finding the perfect combo. I am on a long acting med, one every 8 hours and I need this one every single day. Then I have a short acting med for "breakthrough" pain that I can add anywhere from 1-8 if I needed for a really hard day. They are 5mg Oxycodones...so there is a lot of leeway set up depending on my activity level.

I'll stop blabbering...LOL.....Hope that I am answering some of the questions for you:)

Ok..thanks for expanding on what you were referencing, that all makes sense.

Hi, just to chime in here...pain contracts like yours are very standard where I live. I have only had to do a pill count once and that was an over zealous nurse who overstepped her bounds after my SCS implant surgery had a glitch and I had to stay in the hospital on extremely high doses of meds for a few days and was released with additional meds. Yes, being released with additional meds would break the contract, however, my NS made a call directly to the PM's office to explain the situation and all was fine.

The drug tests are also very common, so please do expect the and be happy if it is not your turn when you go in. It's not that big of a deal unless you have some type of genetic situation (like I do) that causes some tests to show more or less of a certain drug in your system due to metabolism of the medication. I have had two false negative tests and all my tests show improper use of Xanax, which I take every day (a 3mg cr form) at exactly the same time. The test always show I haven't taken my Xanax for 3-5 days, but my psych has no issue with this and knows how proper drug metabolism works. Some places use in office dip stick tests and others use out of office in depth testing. Some use both (like mine) because dip sticks can produce false negatives on occasion and sometimes false positives. You can ask for an immediate retest if you feel the dip stick test was wrong (usually). I have also done this and the second test was fine.

Often people do not realize that all drug tests are not equal. There is a cut off point on many tests where they may show negative when there is a slight amount of a certain drug in the system. For example, an agency I used to work for had us do drug testing on our clients. We also had to undergo random testing. The cutoff for staff was much higher than for clients as a fail safe set to keep from having staff questioned for trace amounts of illegal drugs (because we often came into contact with them). The agency was well aware that there would be trace amounts of drugs in our systems by nature of our jobs, so they did not want to penalize us for doing the job we were hired to do. The clients did not have that luxury because they were not allowed to be associating with or using illegal substances.

***Please do not ask questions regarding this agency or what I did before. It is personal information I do not wish to share online :)

On the pharmacy issue, I had to give them the name of my pharmacy and agree only to use that pharmacy for everything (except my HGH that must be mailed monthly). Even that had to be documented. It is a safety measure for the doctor to make sure nobody is doctor or pharmacy shopping....say filling one copy with insurance and self paying the other with a different pharmacy. It's really no big deal as long as you have a good relationship with the pharmacist.

Best of luck to you!

Thank you for all the great info.

Sounds like you guys are doing mostly the same thing. Except the pharmacy. I will bring up that issue when I see her next. Like I said it is only for narcoticmeds.

Straydog--I am aware of the rules, Did I break any?

Seems like I threw a big ? into this thread, CNS,sorry to worry you but it is a true issue that should be asked about. I have posted over 1400 times on a CP site similar to this one and saw the issue come up perhaps 10 times. usually it was some minor prob like too far from home or their hours were too short. It's really been no biggie in my experience. As for breaking rules here, I know of none that you have messed with, maybe stray dog will fill us in. best of luck . . . Q