new rule: nothing over the equiv. of 100mg morphine; pm appt update

This new law started Sept 1/20014.
If you don't have cancer or are dying, no person in PM can take over the equivalent of 100mg of morphine. So 20 opana 2 times a day, already goes over that amount because its 1 1/2 times stronger. Meaning no breakthrough meds.
You can increase 15mg oxycontin to TID and add 2 10mg Hydrocodoe, and that equals to 103 so its okay.
She said she is having to cut people's does in half, a man with 6 spinal surgeries does better during the summer, so thats when they lower his meds as low as possible, lowering his tolerace, and in the winter they go back up. This new law started Sept 1/20014. is it just is TN?

I asked her about building a tolerance, and she say, taking the max at your age, when you get my age, there will be nothing for you. Plus, the dr of the clinic says they have to start reducing meds to the lowest possible to anyone in child bearing age, because of some new study saying, even if your off meds for a year, it can still effect the growth and development of the baby. She told me this when I asked about fentanyl, she said the DR himself has to approve that one, and unless your just really really bad off he always says no. He actually prefers only one BT med a day, and the lowest dose for most of his pts.

I am glad that my NP was very open, forgiving(i was short a little bit bc of dislocations and such), understanding, and honestly wished there was more she could do. She says "my hands are tied and wish the government would get out of healthcare. Even our Dr. who has practiced PM for over 20 years says he can't really be a good DR anymore because of the government and the crazy rules"

I asked about butrans patch but for some reason, you have to try EVERY other ER med for a certain amount of weeks before they consider a PA, and she says for my type of pain it probably won't help much.i really want to try the ZOhydro, but she said it has the stigma of Oxycontin, if not worse and Dr's are prescribing it or letting their LNP"s prescribe it,plus insurance won't pay, and pharm doesn't carry it,

so just this month, i will continue the oxycontin but TID rather than BID (only since i may have surgery, and my family is willing to help me pay), same BT of 2 hydrocodone, but surgeon can write a script after surgery with ok from PM, then next month I"ll go back to the Opana since its covered but can't do the 20mg twice a day as it exceeds new rule. Will have to do 20/24hrs with 1 BT. if I can't tolerate it, will try 30 morphine BID, with 1 BT med....

Really dreading this surgery and recovery (if i have it, depends on what 2nd Dr says and prayers)


wondering if this is just TN, because it seems most people on this site would go over that equivilant amount...
I know yall have it a lot worse than I, but would hate to see you end up in the same position.

I hope your feeling well today. sorry that was so much writing.

Nag

Fentynal is not break through medicine it's prevent time release medication (72 hours).

I doubt Medicaid will pay for Zohydro for non cancer pain. The new law isn't in every state. Although the FDA has changed the labeling on long acting meds than may affect those of child bearing years.

What is below might explain it, but I'm not sure. It is dated 2014. It is also possible that this restriction applies to Medicaid patients only. The is also a link to what goes into effect November 1, 2014 with TennCare and changes in these meds and PDL.

TENNESSEE CLINICAL PRACTICE GUIDELINES
FOR OUTPATIENT MANAGEMENT OF CHRONIC NON-MALIGNANT PAIN
health.state.tn.us/Downloads/ChronicPainGuidelines.pdf

TennCare Pharmacy Program-
/tenncare.magellanhealth.com/static/docs/Provider_Communications/TennCare_Provider_Notice_20140902b.pdf

Post Edited (Mercy&Grace) : 9/26/2014 9:20:44 AM (GMT-6)

Unfortunately, many drs use the word "law" for things they don't want patients to argue with them about. Policies/Guidelines aren't the same as laws. Opana ER will become a non preferrd drug Nov 1, 2014. That means that there will be a lot more paper work for the drs who prescribe it for Medicaid patients for non cancer pain.

AngMichelle, did you say in another thread that Medicaid in Tenn wouldn't pay for Oxycontin ?

Post Edited (Mercy&Grace) : 9/26/2014 11:28:22 AM (GMT-6)

After reading the TN guidelines for Rxing controlled substances I checked out my state's, NM, LAW on Rxing controlled substances. What an eye opener and what a wonderful law. It separates addiction from physical dependence and defines both behaviors. It does nor vilify dependence, rather it allows for it's inevitability in opioid treatment and provides for it in prescription dosing. There are no arbitrary rules for how much a person may be Rxed as some of the pharmacies have claimed. I would advise everyone to google there own states LAW on this important matter . . . Q

Here's the State of NM's definition of addiction: A neurobehavioral syndrome with genetic and environmental influences that results in psychological dependence on the use of substances for their psychic effects. It is characterized by behaviors that include one or more of the following: impaired control over drug use; compulsive use; continued use despite harm; and, craving.
Physical dependence and tolerance are defined as: normal physiological consequences of extended opioid therapy for pain and should not by themselves be considered addiction.
16.10.14.7 DEFINITIONS

To read the rest of this remarkably compassionate LAW search: NM Management of pain with controlled substances . . . There is a whole lot more to learn from this piece of legislation, definitions abound as well as regulations and Prescription management rules . . . Q