primitives whine about reduced narcotics; cbayer primitive, Ugly, spat

[franksolich]

http://www.democraticunderground.com/11429249

Oh my.

Beartracks (3,195 posts)   Thu Jul 25, 2013, 11:47 PM

Are there new limits on the amount of daily narcotics doses?

My spouse has been seeing the same pain management specialist for a few years. In addition to performing occasional radiofrequency ablations and/or epidural blocks, they prescribe a regimen of several medications for "long-term" pain management (taken daily) and "short-term" pain management (for acute "break-through" pain events). With a variety of physiological conditions (including fibromyalgia, compressed disks, and worn down cartilage), the overall treatment plan has been rather successful, and the docs always assured us that the doses of these meds, including the narcotics (like oxycontin and morphine) were nowhere NEAR what many of their patients take on a regular basis.
 
So it was quite a surprise when the doc said at last week's appointment that new drug regulations from the DEA were limiting patients to a total dosage of 120mg of narcotics a day. Total, cumulative among all prescriptions. Immediately.
 
Shit, the as-needed valium prescription alone was more than that.

So, he seemed to say, that's that, just take the short-acting stuff when you need it and quit the rest, see you next time -- as if my spouse was supposed to quit all this other stuff COLD TURKEY!! He acquiesced and suggested taking the remainder of the existing prescriptions at half doses daily until they were all gone, and that was it. Like benzo withdrawal is just a walk in the park.
 
He did at least write a scrip for Lyrica for the fibromyalgia. Like that's gonna help lift the load. I guess we'll see. I wonder what they're supposed to give the really heavy-hitting patients? Tylenol 3?
 
Anyhow, what I'm wondering is -- has anyone ever heard of such a "new regulation"? I mean, sure, over the last few years the narcotic drugs have been closely monitored and my spouse had to undergo periodic testing to make sure the blood levels were correct, and that seemed like sufficient regulation to ensure no one was abusing or selling. But to just cut narcotics willy-nilly to a total daily limit that is apparently way LOWER than ANY pain management patient ever takes?? That seems absurd.
 
Oh -- By the way, we know one other patient at this doctor and she had an appointment last week also, yet is still being allowed her narcotics prescriptions, which, to my understanding, exceed this supposed 120mg/day threshold. So we're upset AND confused.

You know, I'm sure there's people legitimate in great pain who need this stuff, but I suspect the number of people who get these drugs "free" from the taxpayers and sell them, is much larger.

silverweb (13,212 posts)    Fri Jul 26, 2013, 01:24 AM

2. Haven't heard anything at all about it.

As a medical transcriptionist, I do a fair number of pain clinic and palliative care reports, and this is the first I've heard about it. While new regulations aren't something a doctor would necessarily mention in a dictation, I also can't find anything in a computer search.
 
The closest thing I found was an article from 2009 limiting prescription dosages for "24 popular narcotics" in an effort to curtail accidental overdosing. Acetaminophen (Tylenol) limits were also changed in 2009 because of its potential for liver damage at higher doses and the fact that it's an ingredient in so many over-the-counter medications.

Ugly, she with the face like Hindenberg's, butts in; free and unlimited narcotics is a cause celebre for her, for reasons one might well expect:

Warpy (70,440 posts)    Fri Jul 26, 2013, 01:48 AM

4. That's insane, but so are the DEA and the drug war it's fighting.

There is no upper limit known for human tolerance to morphine. Yes, people can overdose on it, but if the dosage is raised slowly, what would kill me and thee would barely touch a cancer patient's pain. Putting any sort of arbitrary limit on milligrams is both cruel and nuts.
 
Second, Valium is not a narcotic drug, it's in a separate classification.

Having the DEA lean on doctors who are treating pain is unconscionable. We need to limit their mission severely or, better yet, defund the agency and tell them to go get real jobs, preferably jobs where they never see other people.
 
ETA: it's for opiods only, the happy, peppy sunshiny publication is here:

http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf
 
That idiotic guideline is soon reached by people on oral morphine since it's poorly absorbed by the gut. Strategies would be swapping drugs, swapping delivery systems of morphine, and using non opioids to potentiate the drug.
 
Somebody needs to sue those morons out of practicing medicine without a license.

nenagh (1,384 posts)    Fri Jul 26, 2013, 04:30 AM

5. I can tell you from an Ontario perspective that there are new guidelines regarding narcotics developed in part because it was determined that the number of fatalities due to narcotic ingestion (often combined with alcohol) had significantly increased in the province of Ontario to an unacceptable total loss of life.
 
Here in this small Ontario city, after new guidelines were in place...apparently many physicians suddenly severely cut back the amount of narcotics they were willing to prescribe on a daily basis.
 
Frankly, there was an inquest in this area due to the death of a teenager who had ingested narcotics which were legally prescribed to an older woman but she had given/sold? some of her meds to this young man.
 
I was not in Ontario when the new guidelines were finalized and implemented, but I have been told that as physicians altered their prescribing of narcotics to be in line with the new guidelines, that the dosages were greatly reduced or stopped.
 
I do not know about USA narcotic guidelines...

Hopefully your husband can taper off the meds...I would think it would be important for the sake of continuity to write down the times he takes each dose, so that you can remember these changes day to day and keep a record so that you have ready information for the physician and yourselves.

Hmmmm.

Here comes the cbayer primitive; one wonders why she's not hanging with the cooking and baking primitives, teaching them French, German, and Italian:

cbayer (121,731 posts)    Fri Jul 26, 2013, 01:17 PM

6. This doesn't make sense.

Different narcotics have different strengths. A vicodin may have 500 my of the active ingredient while an oxycontin may have 10 mg. There is no way that narcotics could be regulated by mg's.
 
Also Valium is not a narcotic. Tylenol3 does contain a narcotic.

There are physicians that basically sell narcotic prescriptions for a living and I would love to see the hammer come down on them, but what you are describing here just makes no sense at all.

Warpy (70,440 posts)    Fri Jul 26, 2013, 02:41 PM

7. I disagree about docs who sell prescriptions

I used to go to a GP in Boston who had a reputation as a Dr. Feelgood. If he knew an addict well, that addict could go to him if his connection had gotten busted or the town was dry for a few pills to tide him over. It was a very kind thing to do and I remember him as a very kind and caring doctor. I just went to him because I was sick and his was a drop in office.
 
Strangers couldn't get anything out of him, but he was extremely compassionate to his patients. He was elderly and probably out of practice before the DEA cowboys took over.
 
The bottom line is the drug war is a miserable failure. We're still awash in drugs, gangs are violent and prosperous, and the whole world has been poisoned by this "war." If some addicts are able to get pharmaceutical grade drugs, good for them, they'll live longer than people using street drugs. They'll certainly be healthier.
 
And that's really the point. Laws written by moralists always have unintended consequences that plunge a lot of people into hell instead of creating the sinless heaven the moralists intended.

cbayer (121,731 posts)    Fri Jul 26, 2013, 03:36 PM

8. Well, you would be wrong, and I know this from the inside.

While I think the DEA sometimes goes after some good guys, there are some very bad guys out there.
 
This isn't about the drug war, this is about unscrupulous physicians. If you can get your hands on any state board of medical examiners regular publications, you can see it in black and white.
 
Detoxing patients who are getting Rx's for 180 Vicodin ES, 180 Soma and 180 Xanbars from multiple physicians is a nightmare. And they will tell you exactly who is doing what out there. To say nothing of the accidental overdoses.
 
I'm with you about the war on drugs having been a failure, but this is not about that at all.

Warpy (70,440 posts)    Fri Jul 26, 2013, 06:26 PM

9. I personally know legit docs who have been leaned on heavily and others who say there is a climate of fear among prescribers who never know when they've gone over some arbitrary and unpublished number of pain prescriptions the DEA doesn't find suspicious.
 
And I know all about detoxing patients. With no damned drug war, we could simply medicate them.

cbayer (121,731 posts)    Fri Jul 26, 2013, 06:31 PM

10. I do too and I blame the physicians who are abusing their licenses for that.

What do you mean we could medicate them? These aren't pain patients, they are addicts.

[Skul]

Am I reading these two comments correctly?

Warpy (70,440 posts)    Fri Jul 26, 2013, 02:41 PM
7. I disagree about docs who sell prescriptions

I used to go to a GP in Boston who had a reputation as a Dr. Feelgood. If he knew an addict well, that addict could go to him if his connection had gotten busted or the town was dry for a few pills to tide him over. It was a very kind thing to do and I remember him as a very kind and caring doctor. I just went to him because I was sick and his was a drop in office.

Warpy (70,440 posts)    Fri Jul 26, 2013, 06:26 PM

9. I personally know legit docs who have been leaned on heavily and others who say there is a climate of fear among prescribers who never know when they've gone over some arbitrary and unpublished number of pain prescriptions the DEA doesn't find suspicious.
 
And I know all about detoxing patients. With no damned drug war, we could simply medicate them.

I'm a little tired right now, but, something there just makes this 'ol dog cock its head.

[Big Dog]

Am I reading these two comments correctly?I'm a little tired right now, but, something there just makes this 'ol dog cock its head.

Yes, you read it correctly.

The hopeless junky Warpy is well-known up and down the Eastern seaboard for her drug-seeking behavior.

Otto von Hindenberg was also known to have a taste for the poppy's juice, so she comes by it naturally.

[Doc Savage]

I do not believe there is any DEA regulation concerning daily useage of schedule drugs.  While state have instituted a data base that tracks the dispensing of controlled substances, it is used for finding forges scripts and scripts from a drug mill.  I guess everyone will have to use injectable Fentanyl, that is measured in mcg, so 500mg will just kill you. 


I am guessing that when the primitive showed up at CVS with a couple of scripts, one for oxycodone, one for morphine SR, the pharmacist said, you know taking this much will kill you, I am not going to fill it till I talk to the doc.  Therefore, because someone used their professional training there is a new "regulation" in place.   The DEA does not usually get down in the weeds to determine total daily dose of a narcotic cocktail, because as people do use them over a long period of time, their tolerance goes up.  We have hospice patients on Fentanyl IV, at such a high dose, it would put a normal person down for days, these folks can communicate, eat and walk.  It is friggin amazing.

[GOBUCKS]

Well of course the OP homo talking about his "spouse" is pure bouncy fiction, but that's not the best thing about the thread.

The funniest thing is DUmmy Warpy bitching about the DEA, the organization behind her hospital drug theft charges and her subsequent banishment from nursing.

In that case, the war on drugs did good work, because sick people should never be exposed to anyone as god-awful ugly as Warpy.

[RobJohnson]

cbayer (121,731 posts)    Fri Jul 26, 2013, 03:36 PM

8. Well, you would be wrong, and I know this from the inside.

While I think the DEA sometimes goes after some good guys, there are some very bad guys out there.
 
This isn't about the drug war, this is about unscrupulous physicians. If you can get your hands on any state board of medical examiners regular publications, you can see it in black and white.
 
Detoxing patients who are getting Rx's for 180 Vicodin ES, 180 Soma and 180 Xanbars from multiple physicians is a nightmare. And they will tell you exactly who is doing what out there. To say nothing of the accidental overdoses.
 
I'm with you about the war on drugs having been a failure, but this is not about that at all.

cbyaer trying to use the street name for Xanax due to one generic brand comes in a yellow "bar shape" that is scored. Most just ask for "zannybars" 

Doctors are being very careful as to what prescriptions are sent out the door.

There is a crackdown on some cocktails and doctors are being asked for verification and documentation before a pharmacy fills certain prescriptions.  The verification process requires additional work for the staff of the doctor's office and those offices are already facing lower reimbursement from Medicaid and other payers.

This does not seem to limit medication to those that really need it, just to the ones that are able to get by without it.

Doctors are telling paitents different stories. Pain management doctors now have to be very careful as they usually write more controls then non-controls.