HealingWell
Search Close Search
☰

New Laws on Opiod Prescriptions

Support Forums
>
Chronic Pain
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 7/23/2018 10:58 AM (GMT -5)
Hello all! I hope you are living well.

Florida has a new law (Begun July 1) that limits prescriptions to a 3 or 7 day limit. Does anyone know how this works with Chronic pain patients who are usually on 30 days and sometimes multiple opioids?

Thank you
Posted 7/23/2018 12:55 PM (GMT -5)
Shaw, my guess is this is for treatment of acute pain, not chronic. I don't live in Florida, so I imagine you can look this up online in your state.
Posted 7/23/2018 1:52 PM (GMT -5)
Susie stole my answer! lol

I just came home from my pain management appointment where I had no trouble getting my prescription written for a months worth of medication.

I also told her about the dermatology nightmare...that the office told me to bring my P.M.s info with me on the day of surgery...then refused to call her! So, although the surgeon wanted to give me a prescription for percocet...I said 'No Thank You'. I'm not screwing up my contract for anything!

I 'suffered' through the first 4 days post op and the pain did lessen after that. My P.M. told me to just call them if I need another skin cancer surgery and they will make sure I am covered next time.
Posted 7/23/2018 4:35 PM (GMT -5)
Shaw:
As others have noted, the law applies to new prescriptions for acute pain conditions.

The rationale behind limiting new-onset acute pain opiate prescriptions is to prevent overly generous prescriptions (ex. 60 tablets) where the full prescription is not needed and then idly sits in a bathroom cabinet where a friend or family member later takes access to the medication, possibly introducing that person to addiction.
Karen
Posted 7/23/2018 8:39 PM (GMT -5)
As we've been discussing: /www.healingwell.com/community/default.aspx?f=16&m=4032541
It's not just state laws, it's insurance companies also making restrictions. They are demanding prior authorizations for new or renewed prescriptions for opioids.

Pitmom, I refused a pain med for my carpal tunnel op, but the stuff I take for chronic pain was enough. But for real operations I consult my PM, and he writes the surgeon what he wants me to have, or I can get a new script after the surgery. It's always smartbest to ask the PM if you will need a different drug or higher dose. With the new insurance rules you might be refused when you go to the pharmacy, if you show up with a script from a different doctor.
Posted 7/24/2018 12:07 PM (GMT -5)
Was wondering the same with a painful surgical procedure. I had a pretty tough one several years ago and my regular meds covered it but now I'm facing rotator cuff surgery and am scared that they'll just assume what I'm on is enough. Already have new horrible breakthrough pain that is tough to get control over.
Posted 7/24/2018 12:49 PM (GMT -5)
1 day at a time, if I were in your situation I would be concerned too. This has been an ongoing problem before the opioid crisis started. Chronic pain patients on daily pain meds, drs & nurses assume these medication will cover post op pain. Depending on the medication & dosage there is a very good chance additional pain medication will be required at least while in the hospital. We just had a member have a 4 level cervical fusion, her pain mgt dr did not allow her anything extra for post op pain

I am guessing you are under the care of a PM dr. If so I encourage you to talk to him/her before the surgery & ask for a few days of extra meds. The dr can either say yes or no. Do not depend on the surgeon to send you home with anything extra & you would still need your pain mgt drs approval anyway.

Take care.
Posted 7/24/2018 3:28 PM (GMT -5)
1 day at a time:
Susie gives you sound advice in discussing post-operative medication with your pain management physician before your upcoming rotator cuff surgery.

A likely scenario would find your pharmacy unwilling to fill an opiate prescription from any MD other then your established pain management physician of record.

I was in the ER last month and the ER physician wrote me a prescription for additional dilaudid (which I am already on through Palliative Care). I know that my pharmacy would have questioned the prescription had I elected to have it filled. At a minimum, the pharmacy would have called my Palliative Care MD to ask, “What’s up with this additional prescription by the emergency room?”

It is best not to have any unexpected surprises in the first few days after your rotator cuff surgery. Ask ahead about post-op medication by having a conversation with your regular pain management physician.

Best wishes for a successful shoulder repair,
Karen
Posted 7/25/2018 9:51 AM (GMT -5)
Yeah my doc office is getting more strict with scripts which is ok with me (although it takes longer to get refills now & planning is a nightmare without looking like I'm asking for early refills) but this breakthrough pain is really hard to stay ahead of without taking more than directed. I've been taking a lot of Tylenol. Can't take any NSAIDS due to allergies but I'm almost at the point where I would risk an allergic reaction just to take an Aleve.
I see a sports medicine doc tomorrow but PT told me I need surgery just based off of his first exam. I have an HMO that makes you jump through hoops to get referrals. Four months and just getting worse and weaker. Not very happy about it but I'm stuck with what I have. I just want my old life back with the bearable pain not this.
Posted 7/26/2018 10:41 AM (GMT -5)
Interesting aside on the topic of opiate prescriptions . . .

I have a sweet 7 month old Maltese-poodle mix, named Abby - 6 pounds of love and snuggle cuddles. Abby had surgery yesterday for her spay procedure, excision of 4 desiduous baby teeth that were crowding her jaw, placement of an ID microchip and flushing of her eye/lacrimal tear ducts.

On picking her up, the veterinarian suggested a canine NSAID and gabapentin for home post-op pain control.

I was gobsmacked.

I advocated, politely but forcefully, for liquid buphenorphine.

Abby was discharged to home with 12 single syringe doses of liquid buphenorphine.

Sadly, even our 4-legged companions are being adversely affected by the opioid delimena.
Karen
Posted 7/30/2018 11:03 AM (GMT -5)
Didn't even know they gave that to dogs. So far my vet has been ok with giving my 12 year old dog tramadol although I have to bring my dog in for each refill. Extra cost. Also have to sign a document stating my birthday and that I realize the med is scheduled. Maybe it was bc your dog is younger? My little Havanese mix was only given metacam after her spay. She's a diva so I spent several days literally holding her like a baby and walking around. She cried so much.
Back in the days when I was younger (70s) they didn't give anything for pain control after a spay. Seems barbaric. My boys (dogs) weren't given anything and this was in this century.
Posted 7/30/2018 12:04 PM (GMT -5)
My vet said that many of the drugs we take are first used by the vet on their patients. Poor little ones are sort of a guinea pig. But, I can see how it would get harder for her as well. She keeps meds at her office so I don't really have to deal with paperwork or didn't as it's been awhile since my fur babies have needed that type of med.

I was talking to my PCP about a med that my sleep Dr. wants him (my PCP) to handle now. My PCP said he couldn't because he didn't write the script in the first place. So, I'm in the middle of nowhere. I'm now changing sleep Dr. (with my PCP's blessing) to one who might handle the medical part of my issues. It does seem like we can't win one way or the other.

1 day at a time I feel for you. I can't take insaids or narcotics and there are times when I'd give about anything even for one little ibuprophen. I have digestive issues and they could cause trouble with it. Also chronic pain from fibro etc. Tylenol just doesn't do much.
Posted 7/30/2018 1:19 PM (GMT -5)
Abby is improving gradually day-to-day from her recent surgery.

Thank You to one and all who offered quiet words of prayer, well-being, and positive karma for Abby.

The canine-human bond is a unique and life-affirming relationship.

Love and gratitude to each of the companion pets in our lives.
- Karen -
Posted 8/6/2018 10:06 AM (GMT -5)
Hi Everyone,
I am a member who lives in FL and what I have found so far is that the changes in the laws send everybody working with pain patients into a bit of a mess. The Pain Mgmt office was somehow completely unprepared for the changes even though I am sure they had advance notice for quite a while. I would guess at least 6 months. I do not understand a cookie-cutter approach to treating patients and laws that insist on that are wrong in my opinion. A qualified Doctor and patient have a relationship hopefully where appropriate prescriptions are written. Pharmacies provide a check on this as well.
Posted 8/6/2018 10:41 AM (GMT -5)
I cannot remember the exact date it's been over a year ago or so that the guidelines came out for treatment of chronic pain. It could have been longer than that matter, lol. Drs had plenty of notice to prepare. Once the feds stepped in & started shutting down the pill mill drs & the ones that were over prescribing several years ago, now that was pure chaos. Drs had plenty of notice to start weaning patients down. People found themselves being told no more medication or being tapered down. The drs receive monthly letters from the CDC like clock work.

I have had more than one dr tell me, I would rather deal with the medical board than have to put up with the DEA for an audit. Not that the dr had anything to hide, it disrupts business of the day.

As an example, over a year ago my PM dr's NP was telling me they had to go over every patient's file & look at the diagnosis as well as proper testing to warrant continuing medication. There was an angry patient leaving the office. Some patient were dismissed from care & some had their dosages reduced to comply with the guidelines.
Posted 8/6/2018 11:15 AM (GMT -5)
I have seen a similar thing Susie. My situation was complicated by my PM dr selling his practice (due to his divorce not the laws) and then my latest surgery. The original PM decided I should stay on my regular dose...Not that much for the conditions I have. The new PM did not know me as I just started there in June. I do understand these Drs have a tough time. I don't think the gov't should be involved at that level. But, ultimately I don't feel too sorry for the PM places because they chose this area of practice and the ones in my area schedule about 5 patients for every time slot. I don't feel happy or good going in to a pain dr. I wish it could at least be similar to a medical appt for any other situation. You have a lot of insight!
Posted 8/6/2018 11:37 AM (GMT -5)
I have been reading for years about treatment of chronic pain once the government stepped in. I have been in pain mgt a very long time & have watched it evolve to where it is today. I was not surprised by the guidelines.

I do not blame the drs for heeding the guidelines because I am aware of what can happen to them. The prospect of having their license revoked or reprimanded or even a temporary suspension from writing a script is a real possibility. I understand their theory on not wanting to be under the microscope from that stand point. I have seen all 3 of these things happen.

As it stands now with our regular drs they are controlled by insurance on how to practice medicine. From what testing they recommend to treatment they propose. That is the insurance calling the shots. Drs fees has been reduced so much by insurance they have to stack appts to balance out. My PCP gets paid more per visit than my cardiologist or pulmonary dr!! I was floored when I saw this on my EOB's.

None of it is right & this is another reason we no longer have an abundance of drs all over.
Posted 8/6/2018 11:59 AM (GMT -5)
The United States has the highest per capita use of narcotic pain medication of any country, developed and underdeveloped.

As a society, people use a broad means to find solace and comfort in a world that is increasingly upside down. People have fewer close relationships and support networks. Excess consumption of alcohol, food, tobacco are symbolic of how people cope.

Long term use of opiates actually increases the brain’s perception of pain. Centralized pain. Long-term use of opiates is also correlated with secondary adrenal insufficiency. I can attest that no one wants to develop adrenal inadequacy. Low cortisol and low aldosterone is permanently life-altering.

Although I am on prescription opiates, I have no illusion that long-term use also has detrimental effects to my brain chemistry, lends to physiological dependency, and acrtually heightens pain sensitivity.

Opiates are powerful medications.

While the pendulum of opiate oversight has likely swing too far in direction, an interception of some sort was inevitable given the abuse and over prescriptioning that became evident. Pain patients, unfortunately, are collateral damage. I hope the pendulum will swing back to a more moderate place.

The CDC, in conjunction with the NIH and DEA, released the recommendations revising opiate prescribing in April, 2016.

I never take my opiate prescriptions for granted. I also am committed to using a “tool box” of techniques to ease my experience of pain. Relaxation/guided imagery; yoga; soft tissue mobilization and strengthening; warmth and cold modalities; TNS; diversion (gardening, snuggles with my puppy,
crossword puzzles).

Pain is a uniquely personal experience that, ultimately, depends on personal resolve and an ability to tolerate the intolerable.

Blessings to all affected by pain,
Karen
✚ New Topic ✚ Reply