Paging Dr. Blackmail, Dr. Blackmail

As a physician I have seen 2 different occasions where patients had some type of injury (sciatic nerve injury with hip replacement) related to a surgery where the performing doctor instituted chronic pain meds. However in both cases they got chronic pain consults and as a primary care doctor, the management of both pts. were above board. To be quite honest, the type of prescribing in your first example should be reported to your state medical board. If a previously normal prescriber is now doing this, he either owes this guy something or in (as in our state) is in 'cahoots' with him.

Yeah, I have one of those. I have a Father/Mother/Son/Grandmother AND an "aunt who occasionally visits from Florida, sho all get Hydro/Apap 10/660. They come in the exact day it is due and never quibble about the price. I call the MD's office (same MD for all members of the family) and get verification each and every time and document on the back of the RX that I called to verify. One day I actually had the chance to speak to the Doc and I questioned him on why every member of the family is on the same medication. He politely told me to mind my own busines and just fill whatever he wrote for. And yes the daily limit for APAP is surpassed on each prescription.

Waiting with bated breath on this one....

TAP, did you know that the APAP dose limit doesn't exist when the physician says it's OK?

...at least that's what I've gathered...

I am a tech, who was "raised" by Pharms that were *very* conservative. I would appreciate how you check your scripts and document everything. My current Pharm is very liberal. "If it is legal, fill it." I try to say what you say about the tylenol content, not to mention the narcotic part. But it's his Pharmacy so I type it. It bothers me, though.

that kinda stuff happens way too much...
I have 1 doc that will write percocet for pain first before trying darvocet or lortab/vicodin. We have about 7-10 pts that get 100 percocet every month and they all are associated with a shady guy that i know is selling them. I've talked to the doc, called the cops to watch out for them....what else can you do?
the scripts are never early...but i know the pt's aren't taking them all. i wish the doc would give them all piss tests to see but sometimes i wonder if he even gives a shit.

A couple years ago I had a dentist who paid a little too much attention to a couple of his "patients". The Vicodin ES rxs kept the women quiet.

He has since moved out of town, divorced.

Clearly you see the same situation that I see all the time, husbands and wives/sons/daughters/dogs all have the same exact magical illness that causes pain. My favorite husband and wife are both on the fantastic combo of Oxycontin 20mg bid, Oxycontin 40mg bid, oxycodone 30mg QID, and alprazolam 0.5mg tid, all prescribed by the same physician they both see regularly.

The best excuse for wanting their vicodin filled early was "I went fishing and had my meds in my fanny pack and I dropped my fanny pack in the river so I lost my meds". Even the cop laughed at that one. We ended up getting rid of that patient, now she's at Walgreens.

I have the same eery feeling whenever a husband and wife with NO CHILDREN come into our pharmacy and by the full limit of Sudafed once a week (in Illinois they can by it weekly) on the dime. And when we report it to the police like we are supposed to we are told to continue selling it to them. Not to mention that neither of them are diabetic yet still by the legal limit of syringes, also on the dime!!

My money is on diversion, with kickbacks to the docs (selling scripts.) If it walks like a duck and quacks like a duck, why do you ask if it could be a zebra?

As for the ones who "never come in early": I bet they're going to multiple pharmacies, and are smart/organized enough to keep the all straight. Do you call other pharmacies and share lists?

a few quick comments from Canada:

first, try working methadone for a week. you will not believe what you see and hear. games beyond games.
second, it KILLS me to own an independent pharmacy and to have to play the Good Pharmacist role and turf patients...while the dr is getting paid to be shady and another pharmacy will dispense the Rx without batting an eyelash.

Oh I suppose every pharmacy has these patients. We have a guy on soma, xanax, and ativan. He tends to buy his drugs, leave the store only to return moments later and claim we shorted him three. That's why we have to double count all his meds. He also tries to get early refills constantly. I don't even know why we fill for that doctor anymore...

In Ohio responsibility is 50% with the doctor and 50% with the pharmacist. I don't care what the doctor says because my 50% says it's not getting filled.

I have been out of retail many years. However, if I did return to it, and had a doctor, regarding suspicious controlled-substances, tell me, "Mind your own business," my answer would be, "Doctor, this IS my business! It is illegal for me to look the other way and fill these prescriptions."

Can you say, "corresponding responsibility?"

I don't deal with a lot of narc scripts since I mainly work at a hospital and only do occasional staffing at a walk-in where I refuse to give out narc scripts because I can't follow up. Anyway - I wonder which is worse..the blackmail for the narc scripts or the blackmail for the antibiotics. I kid you not - there is a lady at the walk in clinic that, in the last 3 months (yeah, I literally added them up one day) had received 47 rocephin injections, 160 mg of decadron, and like 400 mg of depomedrol injections...

I was stunned. Oh, and I didn't mention that she was on cipro at the time she saw because she "failed" treatment on the other 4 courses of levaquin she'd been on during that SAME time frame!?!?!?!?

As a doc, I would never wish lawsuit upon another physician - but I wholeheartedly disagree with the narc practices and the abx practices. I'm surprised my tires haven't been slashed because of all the abx and narcs I've refused to give at the walk-in.

Anyway - just wanted to point out equal-opportunity blackmail exists out there!!

I work in a private pharmacy that stocks a very large number of narcs. We had one customer, who for years, has been on massive amounts of Oxycontin 80mg and Actiq 1600mcg on top of that! She had a running storyline with her Dr. that she would "lose" the rx's and have to get new ones written every week....Hmmm.....she also paid these huge hundred dollar co-pays all in $20 bills, everytime.....The Dr. is notorious in town for being the narc writer. She is now moving her practice :)

Don't worry, I'm not going to get 'uppity' about the doctor thing....

But this is what's always made me laugh about the utter stupidity of having COMBO products with APAP in them (and somehow the 'government' considers this to 'less addictive' than the non-combo products and as such get the C-III designation).... The government really thinks that the addicts CARE about the flippin' tylenol part of it!? Prior to being a pharmacist, I used to always be under the impression that taking too many opiates caused liver failure (notice, I didn't mention opioids).... But it was ALWAYS the tylenol.... So now, we have a bunch of people getting hooked on the same damn oxycodone in percocet that's in oxycontin....but getting so much damn APAP they put themselves at extreme risk for liver failure (I'm always surprised to hear the stories about addicts taking 30 tablets of darvocet a day and NOT going into immediate liver failure....makes you wonder just how 'variable' the stated 'toxic doses' really are)....

Now...so what you ask, another no-good junkie offs himself....except this junkie...who's been living off your tax dollars for years, sticks it to ALL of one last time by rackin' up a massive 'final exit' medical bill for all of the management the healthcare profession will give this person just prior to their death.... RETARDED! I'm not condoning the abuse of opiates, but it's laughable for people to think that APAP is really going to STOP someone from doing so!!!! Oh, and anyone who thinks the APAP in those tablets is really effective for pain management of the type that supposedly necessitates the need for those drugs...is smokin' the pipe too...

Maybe its because Im a new Pharmacist (licensed just over a year) but I dont ever fill the narcs early regardless of what the doc says. I have a license to protect.

If the magic 4g of APAP exceeded, I dont care if Dr. God walked in and said to its okay to fill early, I wont. Ive had a few Docs get into it with me, but ultimately they come to understand that I am only protecting myself. They are welcome to send their patients elsewhere for early fills, they arent getting them from me.

I will refill narcs 2 days early with our chronic pain patients (meaning if its a 30 day supply they can get it on day 28), they are all now well trained at this. Of course we do have those who try to push the rules, but it only makes me crack down harder. Typically they go elsewhere, and tell me they are going elsewhere like I am affected by this!

No matter what the doctor says when I call to verify anything (drug interactions etc) if its seems fishy or wrong to me, I will refuse to fill it. I have to protect myself.

i understand the shitty position it puts you in and don't disagree, but just wanted to add what ran thru my head as i read this:

it was implied that he was selling them AND high as a kite. i think it's unlikely he was doing *both* if he was still getting high on day 15...
...and called 20 times in an hour, which suggests he was in or anticipating withdrawal symptoms, which wouldn't happen unless he'd been taking them himself for at least a few weeks straight.

7.5mg of vicodin doesn't have a "huge" black-market value. it's at the bottom of the opiate totem-pole as far as value goes, unless you're selling them to middle schoolers. i've seen tramadol sell for more on the street (not the norm. but it happens).

I once did relief work at a pharmacy where this woman was always claiming that her dog ate her Ultram. Never her Synthroid or lisinopril, but always her Ultram.

The regular pharmacist asked how the dog got them and that shut her up, for a while anyway.

Unrelated to the article, just wanted to vent; had a guy tonight refuse to get his $3.10 plavix post discharge bc he "only has 22$" as he points to his basket with peanut butter, a 24 pack of coke and some teddy grahams. (The rest of his post MI drugs were covered.) I bite the co-pay bc the geezer is deaf and unable to comprehend the ridiculous situation, but still feel i deserve some of the teddy grahams.

Dr. XXXXX's Pain Clinic, Scene 1.

MD leaves VM on Doctor line as follows:

"She's up to it again!!" (pertaining to patient repeatedly harrasing said MD @ home, @ office, and etc for a refill of her beloved Vicodin ES)
"Go ahead and give her 100 of them, TUD, she knows how to take it. Now, whether she takes it like she is supposed to is unclear. No refills, ah hell, give her 3 to keep her off my back for a bit."

Sorry.. forgot to mention this, I'm sure you will enjoy.

Pt. Babycakes (total pun, have to be there) has been on Vicodin 5/500 for a while now, and obviously, he is addicted to it.

So he gets a script for them, 20 qty, standard sig (12T;Q46..etc), and he, ah, takes all 20.. in one day.

The Pharmacist informed the Doctor, being concerned for his liver and mental stability, and MD wisely gave him ANOTHER script, same as before.

He took all 20 in one day. And he was given another chance.. to do it again.

This was shocking, since before this, I actually had faith in the medical profession. This MD seemed like he had a good head on his shoulders.

But, I guess, you can never tell, huh?

I would contact the state medical board/DPS on this doctor. We have had several docs in the area lose their license for these sort of things. On another note..just started a new job this week at an independent..have never filled so much Hydro/Xanax/Soma in 3 days as I have here!!

I have run into cases when the office was called the prescriber just didn't realize he was seeing this Vicodin patient so often. Also have run into cases where the Dr is seeing the patient for the 1st time and writes for 100 Vicodin ES and 3 refills. On calling the office they have no rational reason for this other than the patient is allergic to just about everything else. Imagine that. Usually upon learning that the patient has had past complience issues and 3 other Dr.s they cancel the refills. My best was the Dexadrine patient who just increased her own dose as she felt like and the Dr just continued to cover her with new increased directions. Upon speaking to the Dr he stated he was using Dexadrine for depression. Problem is in our state there are only 2 approved usages for Dexadrine without approval from the state board of medicine. When I asked the office if they had such approval they called the patient and instructed them to go to another pharmacy. Cause we all know be now these Drs have special legal exemptions for any law or rule that irritates them. As mentioned-I wrote it you fill it, I AM GOD.

We are desperately trying to educate our residents regarding diversion issues. it is hard, they learn the path of least resistance pretty quickly.

BTW we are a lorcet kind of town. Patients will refuse a vicodin prescription. and they absolutely hate vicoprofen. which is the only post surgical pain med I will use. I assume it is because there is no street value for vicoprofen.

I guess its good that they dont know how to actually look up a med. then they might realize that hydrocodone is the same regardless if it is coupled with tylenol, IB or has the WATSON label on it or what.

It's the doctors' passive-aggressive way of helping natural selection along. ;)

Somehow I never deal with the doctors described here.

Everyone I see has a big sign that says they will not even prescribe diet drugs.

At our pharmacy, its brand name lortab. Personally I think that they remind me of certs. I think the speckles might be just what makes them popular. For example, we rarely sale the brand Lortab 10's because they arent any different looking that the qualitest generic we have except for the markings.

I've been in practice for 22 years and this post really makes me angry. Once you see a Dr. Feelgood and he/she won't respond to your calls or suggestions about over prescribing (The same family all on Oxycontin? whew!)it is your duty to report to the medical board. Medicine has enough problems without these shady characters continuing to practice dangerous and greedy medicine.

To RXPower- yes you deserved the teddys!

I think it does cathc up to them eventually b/c we had a NOTORIOUS control-writing MD here just revoked of his prescriptive authority by DHEC. Sad thing was, they only took his C-II and C-III authority so he's still able to write C-IV and C-V. (Guess his patients will have to settle for good old Lomotil or Robitussin AC highs instead of their beloved Lortabs...) This was a welcome memo from DHEC by so many pharmacists b/c we'd call to verify large quantities, early refills, overlapping strengths and a variety of other things to be met with "It's fine" on the other end of the telephone line.

Documentation on Rx's of these very calls are probably what saved the RPh's butt and put the focus on the MD once there WAS an investigation. This prescribing went on for YEARS and involved many patients and pharmacies, so it proves investigations don't happen over just one "hard to treat" patient!

It was interesting to see the responses from pharmacists...not ONE that I spoke to after this memo HADN'T heard of Doctor X. (Most were more suprised he had actually been reprimanded than shocked at his prescribig habits!)

I see this stuff happen all the time. And we call and check on things. We just had a dr's license taken away because he was doing things like charging medicaid & medicare for procedures that patients didn't need and shutting them up by giving them any narcotics that they wanted. Also threatened to fire any staff member who talked. Yeah the FBI took him. I'm not a pharmacist just one of those lovely techs. But like I said I see both scenarios every freaking day. I see a lot of people younger than me and I'm only 27 getting all these pain meds from their dr's or going to the ER people who are clearly a couple going to the ER and both getting vicodin yeah whatever they aren't in any pain! But legal scripts can't do anything but fill them and hope that one day they get caught for their shit. Karma is a bitch and it will catch up to you one day!

We had one guy filling dilaudid, oxycontin and percocet (all name brand) from our walgreens, from doctor A, through workers' comp. He also filled the same things at CVS across the street, from doctor B, using medicaid.

I caught him when I "accidently" billed his stuff through medicaid...I think I did him a favor, he was kinda looking very yellow. Yum, Jaundice.

We also had a guy who paid cash for his vicodinES, and after seeing him six days in a row, I looked at his profile. 6 months of pills in 2 weeks. Eventually, we found out that his doctor was the one to blame...the DEA nabbed him five days before he was supposed to retire. Job well done, Feds. ^_^

"Say you are a doctor, and you fuck up on a patient bad. Not like "to error is human forgive me" error, but "sue me for lots of money" error; and the patient is fully aware that he/she has you by the balls. Is it practiced to just bribe the patient with lots of narcotics so they won't turn you in/sue you?"

Err - Verb
Error - Noun

They say fear leads to anger. Blue Oyster Cult said "Don't fear the grammar..."

What a 'pun-ish' statement: To error is human, forgive me. Heh! Pardon the pun.

MO

I work at a retail pharmacy and there is an MD in my small town in FL that operates out of a mall. This office will not accept insurance of any kind. They will only take cash payments for office visits and everything. They only write RXs for pain meds. All I have ever seen him write for is oxy, perc., vicodin, soma, methadone, etc. Every friday we get a slew of prescriptions written by this doctor and all of the druggie patients come in and want their narcotics. How is this legal? Also the doctor does not stay in one place very long. He was operating out of Tampa before coming over to my neck of the woods.

Here's my thing.

Where i work, which i'm sure is inappropriate to tell you exactly where that is, but will describe it as a federal department that tends to patients, a majority of whom have perhaps seen combat.... (clarification: i am not making a sweeping generalization about the patient population that i serve, except to say, that this population, like any other population in other settings, has a growing number of individuals with drug-seeking characteristics who feel ENTITLED to whatever they want because they "fought for this country." I have nothing but respect for those who have done more for the country than i ever have, but that does not entitle you to all-you-can-eat narcotics.)

vicodin/morphine/oxycodone/metadone/soma/clonazepam abuse runs rampant... and when we try to call the doctor's on it, they say, oh, just give it to them early because [insert lame excuse here]. We document the early refills always. After the 2nd or 3rd "fill it early" command, we stick it to the doctor: "YOUR DIRECTIONS MUST REFLECT HOW THE PATIENT IS TAKING IT OR WE WILL NOT FILL IT." That is, you are allowing them to take 12 vicodin a day, so write that in your sig, or your patient ain't gettin' nuthin. That tends to shock them into reality... and they either adjust their dosage upwards, go to a more potent drug or not give it early anymore. I do not pretend to know how much pain a person is in, but i do know that if a doctor is writing a prescription for a medication for that pain, the patient must follow it to the letter. if that rx isn't treating the pain, then they must get another rx that does. Luckily, we are able to eventually get the dr's to implement (after endless begging) a "Controlled substance contract" whereby early refills are not allowed under any circumstances (unless the dr adjusts the rx), lost/stolen/my dog ate my meds (by the way, dog owners know that dogs NEVER swallow pills -- not even hidden in a glob of peanut butter)/ my bottle fell in the lake when i went fishing/fell in the toilet/i totalled my car and my pills were inside the car/i left them at a restaurant excuses do not fly. You can't keep up with them? You don't get anymore until the next due date. We are lucky to have such a tool... but getting the doctor to that point is tedious and exhausting. They don't have any idea that our license is on the line ("oh i don't believe you" they say) and they don't see that we are in a shitty position because of their poor narcotic enforcement. They also don't see that they are being manipulated by their patients: once a patient said boldly and without hesitation - "don't worry, i'll be back. I know exactly what to say to get what i want." And he did.

We have a lady who wants her Xanax filled five €days after they were filled for a 33 day supply. She does it every time. No more 2 days early for her, we hold her to the day no matter what anyone says. On a seperate note, I've got to tell you that my favorite excuse for an early refill was that this man's rx was confinscated when he was arrested.

Just an Australian perspective - I guess we are lucky, working in a fairly small state, with a Health Department with the time and resources to do all this.
A record of all prescriptions dispensed for S8s (narcotics ?=CII) and S4Ds (eg.benzodiazepines ?=CIII) are sent to the State Health Dept by every Pharmacy at the end of the month, who then compile the results by doctor and patient (even if they are paying cash for prescriptions - to try and stay off the record). It certainly picks up the doctor-shoppers! They can also send out directives limiting the supply for some patients to specific doctors and pharmacies, breaches of which will be picked up in next months report! For patients who breach these (they may get a couple of tries) they can then be forcably refered to the Drug & Alcohol service.
They also pick up prescribing patterns in the doctors. We have also recently had a local GP have his right to prescribe narcotics removed - hearing the perspective of some of his older patients has been amusing to say the least! The rest of us knew what he was like all along.

I am personally a Pharmacy student in North Carolina. My father had a tooth removed by a dentist about 5 months ago and had been experiencing pain ever since. The doctor noted that he "beat him up pretty bad" and would schedule check up appointments every month or so. After every appointment he would feed my dad prescriptions for Percocet 5/325 like they were lollipops at a bank drive-through. My dad took one of them the first time and didn't like the way they made him feel and has been shredding the scripts ever since. My mom was telling me about this and I told her it just didn't seem right. The dentist wouldn't even ask my dad if he needed them for the pain and when I asked my father about it, he told me the percocets made him feel too out of it and that tylenol and oragel worked much better because they didn't make him feel like a slave-laborer after a 23hr workday.

My advice was that they should see another dentist for the next checkup since anyone who writes a CII for a "checkup" 5 months after a tooth removal is clearly in some shady business. I've had teeth removed before and aside from the nitrous oxide administered during the procedure, I received no pain management.

After seeking the advice of another dentist some X-rays were taken, which showed something alarming. My father had a broken jaw in which fragments were strewn throughout his lower mouth and inside his face. Basically he had to have another procedure to remove the fragments so his jaw would finally heal. My parents aren't seeking any retribution in this scenario due to their belief that lawsuits just aren't the way to handle things and that with all the forms they signed for the dentist that they would lose the suit anyway. However, I am pretty sure there is no where on the form that says "If I accidently break your jaw, I can and will cover it up with a waterfall of CII narcotic prescriptions."

Just wanted to share my experience with exactly what you mentioned because this dentist clearly messed up badly and tried to basically persuade my dad with pain meds. Granted, in this scenario, the patient DID need the meds but Christ not that many.

Cliffs:
-Dad had tooth removed from back of mouth
-Dentist "really beat him up"
-Every month dentist would give him a new Percocet script
-Dad never asked for them and through out the scripts
-Parents asked me why they do this
-I said it sounded shady, esp when my dad never asked for pain meds, I say see another dentist.
-They go to another dentist b/c pain was present.
-X-ray reveals broken jaw and bone fragments all over
-Parents won't sue but probably should.

Free country?
what has happened? Prescription ? fill it?
drug abuser? let them abuse...
Why ask why.. life is to short to be in pain.
Legalize everything and tax the hell out of it.

I totally agree with the comment above me.

"Free country?
what has happened? Prescription ? fill it?
drug abuser? let them abuse...
Why ask why.. life is to short to be in pain.
Legalize everything and tax the hell out of it."

As a chronic pain sufferer it makes me sick to see some of the comments from these pharmacists. Just rubbing your hands together trying to catch someone ANYONE out doing something wrong.

I require narcotic based pain meds daily, just to get through the day. Do you think that's FUN??

If you do then you're sorely mistaken. It's even worse when you get some 'urkel' type pharmacist looking at you suspiciously and eyeing you up and down like YOU'VE done something wrong just because your Dr. has changed your meds to something that hopefully will work better and make my quality of life better. If it gets changed in the middle of the month theres no chance of medicaid paying for it until time to re-fill, even though I'm not even taking the ones that aren't working. So I usually end up paying cash for it (because I have no choice) and praying that this will finally be the medication that works and I can have some sembelance of a life.

Of all the pharmacists i've worked with over the years I've yet to meet one who isn't full of themselves when they have absolutely no reason to be. A pharmacist is nothing more than a pill-counting failed wanna-be REAL doctor.

You all need to just shut up and do your job, which is to fill prescriptions that REAL doctors have written for their patients. Instead of thinking that YOU (BIG LAUGH) know more than the doctor does and more about the pain I deal with on a daily basis than myself or my doctor know.

If you're such 'angry pharmacists' then get a different job and a life while you're at it and stop acting like the nerdy snitch from school.

Just stop whining over your failed aspirations of being a figure of authority (such as a erm DOCTOR?) and either do your job, fill the da*m prescriptions and get on with your life.

If you don't like it, well, the world needs plenty of bartenders.