Yay! More Hate Mail!

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Apparently you have came across neuropathy .. did you ever think that many/most of these people on all these meds & caid was because their pain has developed to such an intensity that they can no longer work and end up on Medicare disability and Medicaid.
Those people are standing at your front door mostly likely because their doc is under-dosing them and they are either out and/or going into or suffering from withdrawal & pain .. not from ADDICTION but DEPENDENCY..
The quack doc my mother-in-laws goes to just told her not to call her pain meds refills in UNTIL she takes the LAST PILL.. as we all know .. docs don’t take refills on nights & weekends
It would be nice .. if everyone was on the same page
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I used to work in pain management dealing with patients who are on a whole boatload of opioids just so their QoL would be somewhat normal (3 x 100 mcg fentanyl patches, or 2-3 grams of Morphine SR/day). I dealt with diabetics with neuropathy to terminal cancer (hospice). I can tell when someones in pain and when someone is blowing smoke up my ass.
When someone laughs, bullshits, and walks normally from their car to the parking lot (from which I have a complete and plain view of) to be instantly be struck by the pain machine and limp, moan, cry once they hit the pharmacy doors, i doubt they are truly in pain. Anything that comes out of their mouth is bullshit. To make things worse, they limp out of your store to walk normally and bullshit with people in the parking lot just fine. Wonderful.
When you see people on vicodin, valium, and soma (three times a day on each) filled once a month for the last year (from your store). Then see they are getting it from 3 other stores (via 3 other doctors) per month when you request the Bureau of Narcotic Enforcement CURES data you begin to wonder how much pain they are in.
Plus, what doctor writes for Vicodin or any short acting opioid for truly chronic pain (including neuropathy), thats stupid and silly. Adding Soma and Valium? Why not Baclofen or Flexeril? Oh, because the patient is requesting Soma because it works ‘better’ even though they have never tried any other one. Somethings not adding up here.
The real chronic pain patients (for those at home) are the ones who are on MS Contin, Oxycontin, Methadone, or Fentanyl Patches. Plus add on some sort of NSAID, Neurontin, and a short acting opioid (usually Norco) for breakthrough pain. If they are tuned perfectly, the breakthrough med would be hardly used at all. They are compliant, will call you (and the doctor) to let you know mid-month that stuff needs to be adjusted, and will not sit and yell at you on Friday night after everyone has gone home that they are out of their pain meds (when they should of known a few days ago they were getting low). They are responsible patients who treat their pain as seriously as anyone with hypertension or diabetes. The doctors who prescribe them are responsible, willing to take input (you talk to the patients a lot more than they do), and just generally a pleasure to work with.
But like all laws we have, the bad apples just ruin it for the good apples. People want to error on whats not going to jeopardize their license, not whats best for the patient.. So yes, everyone is on the same page. If you want to keep your license, and /not/ become a ‘Soft Touch’ pharmacy thats a big red dot on the DEA’s (and every addict in town’s) list, you have to be aware and not just fill everything assuming everyone is honest and legit. I mean seriously, how many excuses can you take on why the patient needs their narcs early before you stop and think that maybe they are lying to you.

Comments #

Comment by Hope on 2006-12-23 17:27:01 -0800 #

My first day in a real pharmacy, a woman came in and dropped off a vicodin script written on another store’s script pad. Being a newly minted intern, I handed it to the pharmacist and asked ‘is that RIGHT?’ Police were called. The ‘patient’ sent her ‘sister’ in to pick up her meds. We asked for an id. The ‘patient’ sent her driver’s license in. So we told the messenger girl that the police were on the way. The ‘patient’ comes in, screaming that she wants her script back (THAT’S gonna happen), and she wants her id back (ditto), and stood there arguing for 10 minutes about it. Even after being told the police were en route. AND – she was on probation, to boot! That was also my introduction to the grand jury process.
An auspicious start. I now ask people what sorts of pain they are having, etc. I figure if they’re legit, they won’t mind talking with me. The ones that DO mind don’t generally come back.

Comment by disgruntledrph on 2006-12-26 20:41:53 -0800 #

Same shit, different day. I had a customer come in today with an 3 rx’s. one for lortab 7, one for robaxin and one for naprosyn. Guess which ONE he wants and which ONES he doesn’t want? I was in a mood…so I told him I wasn’t filling just the “NARCOTIC” without checking with the doctor (an er doc nonetheless). He said he “didn’t have enough money.” Of course, er doc said he must get them all. I am pleased and fill all 3 rx’s. copays are $3 each. DUR on insurance comes back “17 control rx’s in 30 days.” I laugh to myself and am happy to have gotten his last $10 until his monthly check comes.

Comment by nikki on 2006-12-28 20:39:07 -0800 #

I’m not quite sure if this warrants being posted or not, but this is an incident that I posted in a blog I wrote a few weeks ago on my own page. Not much pharmacy related information, but it happened while I was at work and really got me fired up.
So I’m minding my own business, typing in prescriptions and a old lady tries to drop off a prescription for her elderly aunt. I tell her it’s going to be about an hour or so and she says she’ll come back then. As soon as she walks away, one of my favorite customers walks up. She’s Muslim, and she’s one of the sweetest people I’ve ever met in my life. She wears the full muslim garb, the long black dress and the face covering. Her 15 year old daughter wears the dress and just the headdress with no face covering. They drop off the prescription and I take care of them because they’re waiting in the store.
A few minutes later the first lady comes back and says she’s going to wait in the store also. So they go over to the pickup window while my nice customer sits down in the chairs by drop off.
Everyone is minding their own business for a little while, and it’s really really busy. There’s about 10 people in the lobby waiting and all of a sudden the lady gets up from her chair, walks across the pharmacy and tells the Muslim lady (i absolutely hate calling her that, but i cant say her name) that she and her daughter are terrorists and that they’re stupid. That they need to go back to their own country and that they dont need to be dressed that way, and that they have no respect for anyone. (First of all, the muslim lady has lived here her whole life and she’s never said a rude word about or to anyone in the three years I’ve been taking care of anyone. The older lady is a bitch everytime I see her.)
All the customers are hearing this, everyone back there heard it, and yet she didnt say or do anything. She just sat there, and let that bitch say those things to her.
My boss told the other woman to get out of the pharmacy and not to come back. I walked up to her and apologized for everything and told her that she shouldnt have to deal with that. And she took my hand, told me that it’s okay, that she loves me, and that someone like that will always believe that and nothings going to change it… It upsets me so much that she’s so used to people saying things that like, it doesnt even phase her. It makes me sick to my stomach that someone has to live their life that way. She gets ridiculed and harrassed every place she goes, all because of what she believes in. She’s an amazing woman, and without a doubt, has more respect from me than that uneducated hick.

Comment by Pharmacy on 2007-01-21 14:36:02 -0800 #

Artificial disc replacement and lumbar spinal fusion are two surgical options for many patients with unremitting low back pain that has not improved with non-surgical treatments. WBR LeoP

Comment by Ian MacLeod on 2007-06-17 17:35:31 -0700 #

I’m a 52 y/o veteran, with 23 years of chronic pain and 6 back operations (after tewn years of being ignored/called a druggie) behind me. I was Navy Hospital Corps, an EMT 1-A, a Paramedic Neonate Transport Specialist, and I’ve kept up on medicine regarding my own condition as well as I’m able. I have SSDI, Medicare and VA. Those 6 back operations, which were for multiple ruptured disks, one of which almost severed a nerve, the last of which removed 13 grams of material. I’ve had tons of tests including multiple MRIs with and without contrast, neuropsych tests including the MMPI II that say I’m not a addictive personality, and I was a rock climber, a martial artist from age 9, an outdoorsman in general and very active, with no history of drug abuse – ever.
Current meds include fentanyl 200 micrigrams/hr Q48h, Vicodin 10/325 for nreakthrough, and 15 mg MS for breakthrough pain the Vicodin doesn’t work for (my doc’s idea – he though I should have something “stackable”, and my mother’s side of the family has a very high natural tolerance; some docs think my endorphin receptors are, many of them, wrongly shaped. I HAD a regiman that worked relatively well. The VA is perfectly willing to give me as many valium as I want, which I don’t – I HATE the damned things. It helps with the muscke spasm and sleep (sometimes) but leaves me drug-dragged, stupid and forgetful, ruins my perfect pitch and coordination and is in general a BIG problem. Carisoprodol ALLOWS me to rest without FORCING it, which is really necessary. Even with it I only sleep 1-4 hours (a sleep study concluded that my pain is under-controlled). I am the sole caretaker (thanks to funding cuts) of a wife in end-stage COPD, and I must be awake when she is on top of when I wake up; she can do almost nothing for herself.
While my regular doc was on vacation the nurse asked his replacement for the soma refills. I had just awakened for about the fifth time that day and wasn’t all there, so I said okay.
It turns out that I use less pain meds when I take the soma with the pain meds I have – the Vicodin, that is. This doc counted pills without reading ANY of the rest of my chart except for the drug seeking behavior flag (this means that every time the VA screws up and I have to call and straighten it out, it’s DSB). I always bring my doc a copy of my Excel med chart when I go to see him). The new doc called me (waking me up again after 45 minutes of more-or-less sleep) and told me I had been “abusing the drugs” and gave me a titration dose to get me off the Soma as he says it causes seizures. (I’ve quit on my own to make sure I wasn’t just waking up to take the pills; no seizures). Soma is one of my more helpful meds.
Anyway, being my doc’s supervisor, this new doc’s word was final. My doc said to find another doc and get them from him – as though I can afford a few hundred bucks each time I go in to talk to another doctor.
So now I use more pain meds than before, rest less, weigh 70 lbs less than before, and due to the valium am exhausted and with all the other side-effects.
Could somebody please tell me just what it is about soma that some doctors hate so much? Some treat it like aspirin; others have told me it’s worse than heroin, which frankly I would also use if it helped. I was about to go in for another operation when my wife got pneumonia, an empyema, and lost all that weight (40 lbs, and at 5′ tall, that’s a lot. I can’t leave her for very long now. Motly for short shopping trips, and I get someone, usually a cousin, to stay with her when I can.
Every time my regimen gets altered, it screws me uo for months, and here we go again. I can have morphine, hydromorphone, fentanyl, LOADS of valium and pretty much anything else I want. I’ve refused marijuana because a)it only helps with the nausea, and b)law or no law, the DEA goes after docs who prescribe it, and I don’t want to get my doc in trouble.
So what is it with soma? It metabolizes into maprobamate, a relatively innocuous medication. So what? It WORKS. I rest, but my wife can wake me if she needs me, and I don’t feel like I weigh 400 lbs with maybe two whole brain cells functioning when I do wake up.
Ian MacLeod

Comment by Ian MacLeod on 2007-06-23 15:23:05 -0700 #

Thought I’d answer that one question of yours, tho it looks like you don’t check here. It was “Why prescribe a short-acting pain med like Vicodin for a chronic pain patient?” My doc thinks I should have them for added levels of pain, relatively speaking. They do work, but I make sure I have the lowest level of acepaminophen I can find. Don’t trust that stuff over the long haul.
The fentanyl seems to keep a steadier “pace” than any of the time-release pills, catching maybe half the pain or more for the most part. Lately, with taking care of my wife, I should likely go up a notch instead of adding pills, but that scares the doc, I guess.
So – I have to clean the kitchen enough to fix supper, then fix supper, help my wife get out of bed, (vacuum the L.R. first and get the stuff off the carpet), check the oxygen machine’s level and the humidifier, etc. Pain levels go up. I’ll start w/ a 10/325 Vicodin (I know, that’s really a brand name). If it still doesn’t do it – I know from my own behavior as much as the pain: I hold still more, do less; it’s odd how consciousness of one’s internal state can change under chronic pain – then I’ll try 1/2 or a whole 15 mg morphine sulfate (generic from the VA). That generally does it, unless there’s been a problem, like tripping over a cat, or something else that causes a lot of muscle spasms. Those I can recognize as distinct from the usual damaged nerves screaming. Pain or no, I’ve quit on the damned diazepam. I can only afford to be so stupid and tired and clutzy. I’ll just hae to see if there’s anything new out there I haven’t tried.
Sometimes, tho rarely lately, I don’t need ANY of the pills! THAT is a wonderful day. Well, I still have the L-thyroxin, the testosterone (narcotics destroy it), lysinopril, Simvistatin – but sometimes I can ignore the narcotic pills and just noodle along. Carefully, but doing okay on just the patches. It never lasts like this and I end up hurting enough to add the shorter-acting pills again for awhile, but that’s life in the pain lane I guess: some day you’re the dog, some days you’re the hydrant.
BTW – you’re welcome to send a note to the email; try to be careful w/ the subject line tho, or the spam filter’ll eat it.
One more thing: there were times in that decade of being ignored when I’d do things similar to what you describe to get a little relief, a little rest. When you get tossed out of doctor’s offices as soon as you describe your symptoms, ER’s don’t believe you, no one will run any tests to see what’s causing the problem even when THAT’S the first thing you ask for, you get desperate. I’ve seen, sadly, that most have to experience real pain before they can come close to understanding, but I’m certain that some of those “scammers” (and many or most are doubtless addicts, who also can’t find help in this system, BTW, just persecution and derision)are chronic pain patients who have no other options. Your self-righteous attitude bothers me a bit. Try to think: what would it take to make someone that desperate? What kind of pain, physical or other?
I’ve seen – working ambulance – addicts so desperate they’d shoot up WATER! I pity that at least as much as someone with nerve damage. Nerve damage may be fixed some day. The damage that causes an addict is still so poorly understood they may NEVER find help. And God! What a way to have to live!
Ian

Comment by dan on 2007-06-25 13:54:05 -0700 #

The reason many doctors and pharmacists are wary of Some is because it is a predrug of meprobamate which is an old antianxiety agent and a controlled substance and causes quite a bit more sedation than some of the newer muscle relaxers

Comment by burnedoutrph on 2007-11-04 13:43:05 -0800 #

please get me approved to leave comments on your site, this place is therapeutic. my prayers have been answered. burnedoutrph