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New laws on opiate pain medicine
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Hanzy56 posted:
Hi.I have been involved in the back pain discussions for years,but I am asking for help in a specific matter,I am hoping that one of the DR's,or anyone who is informed.I have been in Pain Mngt.for over 10 years,My back is wrecked,I have MS,etc.
My ?-What exactly are the new rules regarding the presrcibing of,& from the Pharmacy side,dispensing of opiate pain medicine.I have been told I can only get 90 pills,I can't get methadone,I can only get Ms-contin,can't presrcipe xanax w/ opiates,& on & on.I called the DEA,they said it had nothing to do w/them[??>,It was the FL board of Pharmacology,called them& was told it was up to the Dr's & Pharmacists.I am starting to get angry,I have always used my meds as directed,never any overdoses.I am tired of being treated like a criminal because I'm in severe chronic pain Any help out there?
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mpathia responded:
I wish I knew, myself, WHY they are becoming so "strict" with meds. I never abused anything, either... but my last trip (today) to a NEW phychistrist (a resident program) put me through hell. I can't afford my prescriptions and they want me out of program, for whatever reason, I don't know. The psychiatrist orders Valium, Ambien for sleep and an antidepressant, Remeron. I am on FentanyI 75 mg pain patch, and 1-2 tabs of oxycodone ever 4-6 hrs. I can't take doctors anymore. I hate them all. They make you more miserable than the diseases. No one can "find" the reason for my pain after colonoscopy, but they all want me off everything... I suffer enough, already. They wouldn't last 1 hour in my body if we "switched" places. Sick of being sick and sick of no one diagnosing me... My back's a mess, no one cares. I've got bone on bone in lower back. Disc gone... What the heck do they think we are? ALL drug addicts? Sorry... crying... it is all just too much.
 
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peskypain responded:
Each state has their own regulations and laws as well as the rules set by the DEA.

Florida has unfortunately become a hot bed of addiction and rogue Drs. and Pharmacists so there has been a lot more attention down there.

Now, this doesn't mean that there aren't really good and ethical Drs. and Pharmacies in Fl.

I know of at least 3 other patients that are able to get Methadone in Florida for their chronic pain issues and have been doing so for many years.

From whom did you hear about this 90 pill issue? Can you please find a link to these laws/regulations that you are speaking of as I don't find them...

Many Drs. do not want to prescribe a Benzo with an opiate so that is not a law but a smart choice by many Drs. as this can lead to a deadly combination of respiratory issues.

Have you been seeing a Pain Mgmt. Dr. and all of a sudden they do not want to see you there anymore? I'm not understanding what has happened in your situation as you mention quite a lot of different things.

And for MS, opiates are not the first choice of medications to help with the symptoms. Are you being treated by a good Rheumatologist for this?
 
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peskypain replied to mpathia's response:
I responded to you in your other post....

I am actually kind of shocked that Drs. have put you on the 75mcg patch as well as so much Oxycodone to manage pain after a colonoscopy.

I asked on the other thread...but what tests have been done to see what is going on and causing so much pain? What did the Gastroenterologist say?

What Dr. put you on all of these medications and why all of a sudden do they now want you off all of them? This is where I'm not clear what is going on with your journey here.

Sorry to ask so many questions but it seems strange to put you on such high dosages of opiates without any diagnosis and then now want you off everything...Did you have any issues with running out of meds early? Or taking more than prescribed?

I would be asking the Dr. these questions about where you go from here...
 
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77grace responded:
Hi,
I read your post and then the replies,I hope the one about Florida's rules helped a little!I know for me I would probally really be in a rough place if I could'nt get Methadone,so far its the only thing that will touch my pain!Like alot of us my tolerence to meds is shot(meaning opiates)I fought having to take it after my 1st surgery but because of pain gave in.I can understaand about the xanax or benzo's with opiates because of possible breathing problems ,but if your like me and have been on that combo I don't think its wrong!I'm just sorry for you that you are having such a hard time!I hope that at least some of your questions were answered!
I will keep you in my prayers!
77grace
 
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Anon_160307 replied to 77grace's response:
I am on 50 mcg/hr Fentanyl patch and I am allowed up to four 10 mg of oxycodone IR a day for breakthrough pain (thank goodness I haven't needed four yet!). I also am prescribed valium, and Remeron. I recently cold turkey'd my muscle relaxant, Flexeril because it was no longer helping.

I have been taking valium for 6 years and since then I have also taken some form of opioid medication. When I started Fentanyl, I had a pharmacy consult as I wanted to make sure the valium wouldn't cause issues. The pharmacist told me that "for some unknown reason" patients that have been taking a benzodiazepine with a opioid for a long time don't overdose because of tolerance. However, the mixture of the two can easily can someone not tolerant to overdose. That isn't to say that just because you take an opioid with a benzo you should "feel free" to bump up the dose of the benzo. But as long as you are on a "predicable opioid", unlike methadone, continuing to take a benzo rarely causes issues in those opioid and benzo tolerant. It is; however, recommended that the benzo be reduced either long term or temporarily whenever the opioid dose is being increased to minimize the risk of issues but once adapted to the larger opioid dose, the benzo dose can be slowly titrated if needed. All under doctor supervision, of course.

On the contrary to popular belief, benzos are good medicines. They offer many medicinal benefits that are all within one pill: Benzos are an effective sleep aid, a powerful muscle relaxant, reduces anxiety/panic and some types have anti-depressant properties (e.g., Xanax).

Hypnotics like Ambien also cause Central Nervous System (CNS) Depression so the belief that benzos should be replaced with hypnotics, holds very little weight as hypnotics depress the CNS in a similar fashion as benzos.

I am on only 2 mg of valium a day split up as a dose in the AM and one in the PM. Daily doses for valium are typically in the 5 mg to 10 mg range.
 
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peskypain replied to Anon_160307's response:
Just wanted to comment on the part about someone who has been on a Benzo and an Opiate for a long time can't overdose. That is completely false.

Anyone can overdose if they take more than prescribed, or mix their medication with alcohol, or with other medication that happens to have sedating effects.

Benzos used for sleeping, or as a muscle relaxant, or for depression are all off label uses. Most of them are made for anxiety and supposed to be taken for that once in awhile "as needed".

Your Dr. has chosen to give them to you in a different manner and I 'm glad they work for you.

So....I'm not trying to say that they are all evil in anyway shape or form...but to say that someone can't overdose just because they have taken them for x amount of days/weeks/months is not a true statement.
 
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Anon_160307 replied to Anon_160307's response:
Please see a correction of a statement in the 2nd paragraph of my post below (the 2nd "can" should have been "cause"). I am correcting it because it is a very important point I was trying to make:

The pharmacist told me that "for some unknown reason" patients that have been taking a benzodiazepine with a opioid for a long time don't overdose because of tolerance. However, the mixture of the two can easily cause someone not tolerant to overdose. That isn't to say that just because you take an opioid with a benzo you should "feel free" to bump up the dose of the benzo.
 
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Anon_160307 replied to peskypain's response:
Peskypain, you misread my post. I didn't say they wouldn't overdose if they took a larger amount. I am talking about when they on doses they are already tolerant to:

That isn't to say that just because you take an opioid with a benzo you should "feel free" to bump up the dose of the benzo. But as long as you are on a "predicable opioid", unlike methadone, continuing to take a benzo rarely causes issues in those opioid and benzo tolerant. It is; however, recommended that the benzo be reduced either long term or temporarily whenever the opioid dose is being increased to minimize the risk of issues but once adapted to the larger opioid dose, the benzo dose can be slowly titrated if needed. All under doctor supervision, of course.
 
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peskypain replied to Anon_160307's response:
Again...my point is that even those on doses they are tolerant to, if someone adds a cough syrup, or alcohol, or something else to the mix that they think is more benign..Or have a bad chest cold..it can possibly cause an overdose with a Benzo, strong opiate, and sleep medicine like Ambien all at the same time...

That was my point.
 
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Peter Abaci, MD responded:
Right now, many of the states, including Florida, are coming up with their own ways to try to better regulate the use of pain medications with the hopes of improving patient safety and treatment outcomes. There isn't really a national policy at this time even though this topic (and pain treatment in general) has been reviewed and discussed in Washington at many levels. Here is a link to a very interesting Senate committee hearing that was held 6 months ago: http://www.help.senate.gov/hearings/hearing/?id=5906d585-5056-9502-5dd1-1d549d0d88f7 .

Setting limits on how many pills of a certain medication a patient can receive per month can come from many different places. That could include the policy of your particular health plan, your prescribing doctor, or possibly the particular pharmacy that you use. There doesn't seem to be one set of rules for everyone at this time. Your own personal physician may help clarify this for you.
 
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feelT2 replied to Peter Abaci, MD's response:
Setting a limit on the number of pills that you receive when you fill your monthly prescription makes a lot of sense.If your prescription is for pain meds..narcotics..lets say----a great many people have a tendency to not follow the RX or read about the side effects of the drug that they are given.They are in pain So before they even get home they are,already popping pills in their mouth!!THE DOCTOR gives you a prescription saying take 2pills (with food) 3Xs per day...To me that seems explicit enough.Therefore,you would have only 180 pills in the bottle -if this is for 1 month.You cannot take more pills than you are given.If you decide 2 pills are not doing the job- properly- YOU have a choice. YOU can try an over the counter(after talking to a pharmacist) pain medication to try and help with any breakthrough pain AND continue taking the prescribed meds,as instructed! OR YOU can do a foolish thing AND take more of you pills----Then ,of course,everything goes to hell in a handbasket!!!!! You do not have any pills left to make it to the end of the month!!!So,you are in a fine fix!!Your doctorshould not give you any more till next month even when you tell him that you ,accidently,dropped them and they fell in the toilet!!SO,One is given a finite number of pills/month so that you do not abuse the help that you are getting for the problem that you're having.
 
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feelT2 replied to mpathia's response:
Got a bit confused reading through your problems.Are you taki ng 5 meds --1 of these a heavy dose of Fentanyl delivered right into your system via a patch --- for your disc problem or did they find something wrong in your colon???If you do'nt mind my asking,what was the result of your colonoscopy & was this a routine 1st time exploration??Also(like PESKYPAIN asked)have you run out of your meds,too often?Why do they want you out of their program?Did you not ask them?What does your GP have to say about all this???Can I ask you how old you are?There might be some other resources that you could check out?!
 
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Anon_160307 responded:
Here is a link to her other post. It has a little bit more description of what is going on. I read the post linked below and another post which made it appear like the only treatment Mpathia was offered was cortisone shots but then in this thread it is revealed that she is on a high dose of Fentanyl with oxycodone for breakthrough pain.

I'm confused.

http://forums.webmd.com/3/pain-management-support-group/forum/154


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