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
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.