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Dr won't authorize early refill for fentanyl patches

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Posted 3/15/2014 4:11 PM (GMT 0)
Hi, I'm having a big problem that I'm hoping someone can help me with. I'm on 50mcg fentanyl patches every 3 days. Over the past month I lost two patches due to adhesive problems, and another was removed during an ER visit on the first day of the patch. I will run out 6 days (2 patches) before my next refill. I see my dr every 4 weeks, but because she will be out of town during my regular appt time, I was allowed to pick up my scrips early this month. My husband took the scrip for my fentanyl to CVS to fill, since I'm short patches, but was told they could not fill early without dr authorization (last refill date was in their system). The pharmacist called my dr, who refused to allow the early refill because she does not want to get red flagged for this. I personally called her to explain and ask how I was supposed to make it without the patches, and she got very angry and told me she gives me a scrip for the correct dosage, and beyond that its my problem. I have been seeing my dr for 3 1/2 years and never once asked for an early refill. She is usually very kind and compassionate. I'm on day 5 of my last patch and already having horrible pain and withdrawal. Any suggestions on how to get through the next 4 days? I also take oxycodone 10mg 3xday. I have enough of those to double my dosage for a couple days, but conversion charts show it will take 7-12 oxycodone/day to equal the fentanyl patch.
Posted 3/15/2014 4:35 PM (GMT 0)
Sorry to hear what you are going through...sadly, docs have to be very careful....and they have become paranoid and worried when dealing with narcotics. Its a rough world for us CPers right now.

As far as tips...

Hot baths
Movies/TV series/ something to distract yourself when you can't get a single wink of sleep.
Immodium(it has an opiate in it...won't help with aunt but may help with W/D)
Hearing pad
Get active....as much as you possibly can...even if its just a 2 minute walk

Also...did you bring up w/d with your doc? There are medications your doc could Rx you(besides the fetanyl) that can help with w/d...like clonidine.

Hope this helps....I know WD can be rough. Had to face it a few times due to doc issues.
Posted 3/15/2014 5:54 PM (GMT 0)
Hello Pain, your dr is only following the rules & guidelines set out by the FDA in treating chronic pain patients. I know this does not help you get your script filled but that is how drs have to practice or run the risk of getting red flagged. If a dr gets ref flagged its nothing but bad news for the dr. Your dr is not singling you out, its this way for everyone. Apparently you do not know about how there are new rules & guidelines these drs must follow or lose their license.

You might try to see if your PCP will rx some Clonodine this can help with WD's. Make sure you keep yourself hydrated. I would be very careful self medicating with the Oxycodone too. You can contact the maker of your patches, a lot of them offer free adhesive covering to help keep them in place, Also, Tegaderm is another adhesive, I used it when I was on the patches. My pharmacist ordered it for me.

Take care....
Posted 3/15/2014 9:22 PM (GMT 0)
I'm sorry you're in this situation but it sounds like you're going to have to get through it with your oxocodone.

Now a days Pain Management Doctors are sticking to the 30 day rule.They know they're being watched.

Do what you have to do to get through til your script is due.That's my 2 cents.

God's Speed,
Rick
Posted 3/15/2014 9:39 PM (GMT 0)
I would be very cautious about "doubling up" on anything....you're already on her radar for the fentanyl. I honestly do not think it's worth risking an established relationship by taking an additional medication in any fashion other than how it was prescribed.

I agree with Susie. She isn't singling you out, she's playing by the rules. Every time our pain docs write a Rx for us, they're being monitored. It's not worth jeopardizing their Rx-ing license.

Hopefully when you next see her, you can speak with her, but I would choose my words carefully, and be even more mindful in the future. Letting her know, as it happens, if anything should happen, with your patches or your meds,....not after the fact. Early refills, regardless of reason,....well, you're treading in some dangerous waters.

I guess that's my $0.02, too.





M.
Posted 3/16/2014 12:00 AM (GMT 0)
Why would the ER remove your patch? How long have you been on fent and why now are they not sticking? Did you use lotion,get too hot,etc.? Did you try taping it back?

My guess is she is getting far too many requests for early refills so she is saying no to all. Safer for her since in the end she has the most to lose.

I would think having the oxy onboard you shouldnt have too many w/d problems. You could be a fent only patient with nothing to rely on now.
Posted 3/16/2014 1:19 AM (GMT 0)
Thanks, everyone. I absolutely understand that my dr is following the rules, and the last thing I want is for her to get into trouble. I do resent how angry she was about it, and how much she made me feel like i was abusing my meds. As I said, I've had a great relationship with her for years,have never needed an early refill, and have even been reluctant to add more meds when she's suggested it.

I've had unusable patches before due to lack of adhesion, but when you have a 30 day supply and get refills ever 4 weeks, I end up with an extra patch every month or two, so it's usually not an issue. I've been having a lot of hot flashes the last couple months, and the sweating seems to cause problems. I use surgical adhesive tape to keep them on, but that doesn't always work. They removed the one in the ER because they were giving me IV pain meds. I was told to put on a new patch 6 hours after I was discharged.

I guess I was just looking for ideas of how to get through the withdrawal. I've been feeling like I'm crawling out of my skin, but Xanax seems to help with that. I'm wondering, too, what the patch manufactures expect you to do when their literature tells you to discard a patch that doesn't stick, and to never go off the patches cold turkey, but then we are not given a way to get through the days that we are short due to lost patches. Seems like a no-win situation. Anyway, thanks for the help.
Posted 3/16/2014 3:25 AM (GMT 0)
I don't want you to do anything your doc is not OK with, but I have been on the patches over 10 years. There were times where I put on a patch and it fell off. I would then put it back on by holding it flat against my skin with the heat of hand trying to engage the adhesive again long enough to then put a Tegaderm or bioclusive patch over it. The fent patch worked fine after doing that, I never had a problem with less pain control. I have done that at least a half dozen times. I finally went back to the Duragesic Brand and it stays on without needing a Tegaderm or bioclusive over it.

If you have a patch remaining I would leave that one on. There may still be a tiny bit of medication in the patch and it's better than nothing.

I am sure having her get upset with you after being a long term patient was upsetting. You could talk to her about that at your next appointment. You did what you thought you were supposed to do.
Posted 3/16/2014 3:25 AM (GMT 0)
Next time something like that happens in the ER make them write those orders and take it to your Dr as soon as possible.
Posted 3/16/2014 8:23 AM (GMT 0)
My Pain Management gives me 2 months of written prescriptions but it says Do Not Fill til ------.It's always 30 dys after the other.

I never get an extra days meds like I do with my Xanax,which is nice.

Your next appointment just have am honest,frank discussion with your Doctor about what happened.

Posted 3/16/2014 2:57 PM (GMT 0)
@Boxerlover -- I've actually tried to get mine to stick by putting a hot water bottle on it (just for a minute or two to soften the adhesive) or give it a quick zap with a blow dryer. I wonder if the extreme cold weather we've had in IL has had anything to do with the adhesion problems. I'm now on day 7 of my last patch. I also kept the one that had fallen off and have been trying to get as much contact on my skin as possible. Even though I have it taped on, it just won't make much skin contact, and since the medicine is in the adhesive, I don't think it's doing much.

@Vickie -- I do still have my ER orders, so I will definitely take them along to my next appointment. I would have asked them to put on a replacement there, but they wanted me to wait 6 hours, and they won't give a med like that to just take home unopened.

Thanks again, for all your help. I'm so glad I found this forum.
Posted 3/16/2014 6:52 PM (GMT 0)
I don't condone heating patches, BUT, I had one that didn't stick and it was going to screw my month's supply too. What I did was get the waterproof tagederm, and stuck it on anyway, and applied *light* heat for 30 minutes to reset the adhesive. Worked like a charm. Did you happen to hold onto the patch that unstuck?
Posted 3/17/2014 2:55 PM (GMT 0)
The only thing I can suggest is that the next time you end up in the ER and they remove your patch ask them for it and then reapply it once discharged.
Posted 3/17/2014 4:32 PM (GMT 0)
Im glad you have the ER papers and make sure they make a copy and put it in your chart. The reason being if someone wrote something about you requesting an early refill and did so in a not so nice way those records will inevitably follow you wherever you go should you need PM elsewhere. Then your side of the story is there to show why you had made the request. Ive also been known to take my order form,reciept,etc for tegaderm,tape,whatever I tried and used to help prevent losing anymore patches.

They have the opportunity to write whatever they wish about me and I am going to make sure I cover every base possible. I had an ex who stold some meds long ago,was arrested with them on him,charged,served jail time. Now here is the thing,they would not give them back because he had torn the label off? They knew I filed a report and they went and found him with exactly what I said was missing but with no label no way was I getting them.

I had copies of police report,court record and disposition,copied his inmate info with pics,chaarges,arresting info,what he had on him. All were placed in my chart since my Dr then wrote a partial replacement. I did the same for pharmacy and Insurance co. Covered all basis since it was technically a violation of my contract to ask and or obtain early refill.

I moved from Ky to OK then eventually to fl 5 years ago and those records are in my PM chart here. 11 years 3 states 4 PM docs but my rear was covered and they just dont open my record and see i requested early fill for lost or stolen narcotics.
Posted 3/18/2014 1:55 AM (GMT 0)
Using tape won't usually work, you need to get the Tegaderm or Bioclusive covers because those will keep the patch tight to the skin. Personally I would never apply any kind of heat to or around the patch. I would lay down and hold my hand over it for 3-5 minutes and the heat from my body was enough for the adhesive to stay down.
Posted 3/22/2014 12:04 PM (GMT 0)
Pain_is_running_my_life,

Hello and sorry you're having problems with the patch. I know this a few days out, but when I was on the patch, sometimes, I'd put kitchen plastic wrap over a patch that wouldn't stay on and then used scotch tape to hold it on.

Hoping you're feeling much better.

Dave in Bartlett, TN
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