Norpocalypse

It had the makings of a perfect fairy tale story:

There stood princess Norcoella, her yellow gown flowing in the slight breeze of the crackhead party.  Surrounded by her fellow patrons; crackheads, pushers, dealers, she was on top of the world.  Everyone bowed down to her yellow goodness.  The lied, cheated, faked to get the privilege of holding her hand just for a moment.  The twins, Tylenol #3 and #4 sat there, thumbing the big 3 and 4 on their chests in disgust and depression.  They were once the kings of the party, now pushed aside to this yellow bitch that everyone wanted.

Then on 12:01am on 10/6/2014.  Her party came to a close.  DEA agents stormed the royal  yellow palace, seizing Norcoella and throwing her into the big-boy party.  Demerol, Percocet, Morphine, Fenantyl, Dilaudid, Oxycontin.  She stood there shocked as they all mocked her for the lack of her analgesic potential.  Then, the undisputed king of the C2 party, King Oxycodone the IR himself made her bow before him.  Her crackhead reign suddenly came to a close, and soon, she’ll be forgotten.

On 10/6/2014, the DEA made all hydrocodone-containing products C2.  No more refills, no more phone-ins, no more faxes.  Hard copy (or EPCS e-scripts) only please.  A day known as C-Day, Norpocalypse.  A day where millions of crackheads screamed out in withdraws, and were suddenly silenced.

I have mixed feelings about having Norco go C2.  As I lurk on the various pharmacist forums, other than the billion of “Will I have a job/Whats being a pharmacist like” newb questions that get posted every fucking day, I feel the pain of some of my fellow brethren.

Some stores require all C2’s to be locked in a safe (rather than be inter-dispersed in your inventory).  Others require an RPh to count all C2’s.  Tons of new paperwork, filing, computer changes are dictated by this DEA decision.  Ambiguous laws and interpretations of said laws about existing refills of Norco run rampant.  Nobody really knows what to do for fear of the DEA’s wrath.  Its a mess, a huge fucking mess.

On the other hand, some doctors offices are closing up.  Last week everyone who comes in gets #120 Norco-10, today the office refuses to dispense any Norco.  If you’re an MD and feel that Norco is necessary for your patient to live a normal life, what difference does it make if its a C3 or a C2? Oh, probably because you can’t justify the bucket-load of Norco you shovel at them to get them out of your office.

This will cure one problem though, no more arguing about refills for Norco.  Doctors will be forced to move to ePrescribing C2s via EPCS to prevent their offices from being swarmed by people scrambling to get a hard-copy.  Nothing good can come of this.

I do however see a huge problem with Norco going C2.  That means the street value of Norco will increase since it’ll be harder to scam your MD with some ‘lower back pain’ bullshit story to get a handful of them.  Doctors don’t want to be under the gun from the DEA for writing C2’s.  You can guess what happens then.

10/06/2014 – C3 Norco, we shall never forget.  Save an empty stock bottle folks to reflect on a time where Norco paved your angst like a yellow brick road.

28 thoughts on “Norpocalypse”

  1. Somewhere, in a government subsidized lab, far, far away, a lonely medicinal chemist is patiently looking for the right salt form in the right position to create: The most powerful weapon in the Galaxy. THE NEXT C-3, LOW ADDICTION LIABILITY OPIATE (WITH AND WITHOUT APAP). cue the John Williams music

  2. My husband had major back surgery 7 weeks ago. His legitimate need for oxy continues for a while longer. Our State, NC, coupled with the new fed law is making the hoops I was previously jumping through to get our weekly rx now seem like rides at a playground. I feel for everyone impacted by these new restrictions…especially us. Couldn’t come at a worse time in my world. Today I will drive (2 hours) to pick up this week’s script. Holding my breath the pharmacy will go ahead and fill it, since he uses his “10 day” supply in 6-7 days (with doc’s knowledge). I get the big picture, but we are amongst those who are collateral damage.

  3. It amazes me how many people are hooked on this crap and can’t/won’t acknowledge it because “It’s a prescription from my doctor, filled by my friend, the pharmacist.” I have had family members lives destroyed because of prescription medication addiction. It’s addiction has such a subtle attack and sets deep hooks. Look at DUI statistics; a large number of DUI’s in every state of our country are due to prescription medication. In a lot of cases the driver showed far worse signs of impairment than than someone who may have been drinking an alcoholic beverage. Send me an empty bottle so I may place it in a shrine! I’ll trade you for a bottle of gin.

  4. Hi Guys and Gals,
    nice dig on the docs ! I’m a doc (Internist) with more than 2,000 patients and have 1-2 patients on pain meds at any given time. I emphasize exercise, yoga, physiotherapy, ice, meditation, weight reduction, walking and water therapy. I have a great relationship with my Pharmacists in the community and always ask if they have checked out the Angry Pharmacist website. I empathize with you as to the BS WE are all being subjected to by all branches of this ridiculous government and their inept policies. The business models and lack of educated Americans point toward further and progressive deterioration of healthcare. We just can’t understand…. we no longer matter !

  5. I know you hate me saying this but we think outside the box in maryland. maryland just instituted the maryland Prescription Drug Monitoring Program in january 2014. If we find out that the person is going to more than one doctor, we dont fill his oxycodone 15mg or 30mg.

    1. Re: Richard (10/8)

      Yeah, that sounds like a much better approach. As it is we hear far too many cases of patients receiving inadequate pain control because the docs are afraid of the DEA.

      I think it makes a lot more sense to go after the doctor-shoppers first and see how bad the problem is with them out of the picture.

  6. So as a patient, I have already been affected negatively. For over 12 years I have been taking hydrocodone based meds. to help with back pain. A result of an unsuccessful 2 layer fusion L-4 L-5 L5-S1, 3 different surgeries, permanent nerve damage. While Hydrocodone was no magic bullet it truly helped improve quality of life for me, and I am sure many others. Now even though I have never abused it, continue to see my doctor regularly, have always gone to the same pharmacy, and have a hard copy prescription, I can not get it filled ??? suddenly overnight the DEA considers me a drug addict??? as do many here ????

    1. I don’t! No pain in the world like back pain. It radiates like lightning especially during a bad flare. You can still get your meds filled you just have to go to your doc to pick up your prescription. This is just a control factor which is good for everyone. Just make sure to move, move, move! It helps alot with mobility.

  7. I had a spinal fusion 3 months ago. I left the hospital with a lower dose of pain meds than when I had a tooth pulled a few years ago. Anyways. Still taking Norco 7.5/325, 2-3 a day. Trying to cut down. Ugh. I understand how someone can get hooked. Of course I would like to have a refill of 7.5…but I will ask for 5/325. I am returning to the work next week and I know… the more I do the more it hurts. I hiked a little bit last week. I guess hiking and going to back to work 3 months after a fusion is ok, could be worse. But I still need the flipping meds ugh

    1. You will make it. I’m 3 years post-op and other than an occasional flair, I’m doing great. I still need meds sometimes so I just shared all of my files and information with my family doctor who helps with my pain management when needed. Keep exercising and moving…that will help the most! I ride the recumbent every day no matter what – the back pain usually subsides for a while -enough to keep me out of the pill bottle during a flare.

      Good luck with your recovery and don’t try to be a hero. Those meds are helping you move which is the key to recovery! Just take them as prescribed and when you can, take a “drug holiday” when the pain is not too bad so you can get that stuff out of your liver.

    1. I hate that goddamn phone message that takes 30 seconds of my time when I’m dealing with an angry customer, and it’s completely unrelated to the patient.

      Yes, Express Scripts, I know Norco is a C2. I don’t need your reminder every time I call.

  8. I read you blog because my son is in last year of his Pharm.D. I admit. I am a user. Started legitimate and now for legitimate/addiction reasons, completely screwed. Had well meaning doc prescribing from office at a rate set by me that can only be described as excessive. What an awakening last week when I went to get first script filled at pharmacy. Did everything right, “no hurry”, please and thank you and on my way. Return next day to be told “no way” would this script be filled anytime soon and he was flagging me for excessive use in CURES (whatever that is). I only use one doctor and always got pills when asked. Pharm called doctor and confirmed but still deemed it excessive. It was the wake up call I needed, but man, was it a shock to be called out. I feel so dirty, just wish doc said WHOA, just once. But, I’m no victim, I knew it was spiraling, but still….

  9. This will solve N O T H I N G except putting more addicts on the road ever month instead of once or twice every 6 months.

    IF a prescriber is willing to write hydrocodone+apap with refills, they will be willing to write one on a monthly basis….especially if the patient has been on the med for a long time.

    Manufacturers are, once again, taking this opportunity to raise the price of their hydrocodone-containing products FOR NO REASON OTHER THAN THEY FEEL LIKE IT. Prescribers also get to bill for extra office visits, and because of OBAMACARE, that cost everythimg will be passed on to the taxpayer.

    Yay!

  10. This is great! Very creative writing. I think this new law will be good for everyone. These medications should be better respected.

  11. So it just me or have our trusted associates in the medical profession just stated handing out percocet and oxy like it’s candy now that hydrocodones difficult for them too.

  12. If you are such an angry pharmacist, you could always quit. We don’t need people who hate everything about our profession to be a part of it. You not only decrease the patient’s trust and reliability in us, but you also discourage young pharmacists to be such as myself. Congratulations

  13. Is pain one of the most under-treated conditions in America? YES!
    However, no one has ever died, directly, because of too much pain. Conversely, far too many people (including my own mother) have died from opioid pain medication overdoses.
    Your doctors aren’t taking away your pain medications just to be dicks. They just don’t want to be responsible for your premature death.

  14. All of this is total BS. I get a one month supply of hydrocodone 10 because of chronic neck pain. This month supply lasts me nearly 4 months because I do not want to become addicted. AndI only take ’em when I need a break for a few hours from the pain. Also i have issues with sleep problems if I take to much acetaminophen. I would love to be out of constant severe pain all day every day. but the sacrifice isn’t worth it to me. The idiots that abuse these drugs make it really bad for those that truly need them just to get through the day. One pill just to get a couple hours break is getting really old after 8 years of this crap.

  15. Would like to edit post. I have only been on hydrocodone for maybe 2 years from the addition of C7 being connected to my fusion of C4-C6 in 1995 after I couldn’t deal with the pain any more.The pain comes from falls on ice since then that has severely damaged C1, 2 and 3. Been dealing with the pain for 8 years and only started taking meds after the C7 surgery a couple years ago because of the falls.

    Babbling idiot out. just delete it all…

  16. I think I’ve solved the ‘conspiracy theory’ behind why JFK was assassinated!!! He most likely hired a hit on himself. It took living with lifetime hypothyroidism, ulcerative colitis, pituitary failure, an immunodeficiency, severe infections 3-4 times a year, and continuous chronic pain to put the pieces together. I’ve lived with similar conditions as did John F. Kennedy, and can’t imagine the pressure that living with such an illness in a position that by and of itself brings on continuous public scrutiny. Worse, I can’t imagine the judgement of the public at large would put on a person of political power if any idea of how difficult the maintenance and management of such a medical condition is. The ignorance of the public at large regarding health conditions never ceases to amaze me; even in the ‘Age of the Internet’ is amazing. However, going back in time to the early 1960s, few people had access to learn quickly about medical conditions. It only makes sense that it is possible that any leader in such a position of power as JFK was might create the possibility that he would chose to end his career in ‘infamy’ as an American icon rather than as a frail and ill man. One characteristic of our modern age is that the value of all our lives has become commoditised. Thus, if any person is viewed as having an illness or deficiency, great effort goes into hiding it. I have often experienced this through discussions with people claiming, ‘no one wants to listen to anyone about their problems.’ Unfortunately, this aspect of our society is rarely addressed or questioned. In truth, often emotional and physical suffering builds greater character. Regardless, I am postulating another conspiracy theory in the death of John F. Kennedy after having lived with the negative commentaries I have received simply from having very similar health problems as he has. The result being that close friends have suggested I consider suicide by observing what suffering I endure (and I don’t suffer the scrutiny of the media).

    Three weeks ago, I went to see my Internist. I have seen her for 14 years. For a little background on me, I am in my early 50s, I’m retired, I am in too much pain to hold a job, I don’t need to, but would like to so as to ‘break the boredom.’ My medical condition, especially the frequent infections dominate my life.I have taken the exact same pain medication for 14 years. As well as thyroid medication, hormone replacement for less time – BHRT for the problems associated with being an ‘older female’ as well as the necessary hormones for being in pituitary failure (menopause in 2004/pituitary failure 2009). I don’t have any family to help me or back me up. I should and could take more medication – that is IgG, but my blood type is very rare. I am very wary of where any source of blood plasma comes from: just visit a plasma donation center, any day will do…and the majority of the ‘donors’ are giving their plasma for what appears to be ‘alcohol and drug’ money. It’s not like trying to donate at the American Red Cross, where most of the donors are primarily clean cut middle class people, whom are donating their blood for free. So I refuse plasma. Okay, so it’s established that I WILL BE REQUIRED TO TAKE HORMONES THE REST OF MY ADULT LIFE TO LIVE AT ALL, AND I CAN’T DEPEND ON ANYONE TO HELP ME…UNLESS I PAY THEM. I can’t remember more than 5 days in the last three months were I didn’t have unbearable pain. I have had 4 life threatening infections in the last 10 months – all of which required very strong antibiotics to manage…I’d say my health is a MESS…but although very ANXIOUS about my health…let’s just say that I feel best wearing an N95 mask to do grocery shopping. I spent my holidays (from Thanksgiving through New Years – in bed in immense pain – not to mention the losses from not doing my ‘job’ – making trades on my portfolio). So, to sum up my life quality, I’m physically miserable and in pain…but never miss a weather forecast with 100% accuracy.

    The last week in January, the doctor refused to prescribe me the Norco 10/325. I went home and spent the next ten days in bed with severe abdominal pain. I was mentally exhausted. Also, for the note. I took one year completely ‘off’ this pain medication in 2009. At best, only with the help of others, I was able to purchase groceries and take care of myself. I worked on a sofa translating Russian to English medical dictionaries at the Michael Gorky School of Medicine in Donetsk, Ukraine. One thing I really learned was WHAT A FANTASTIC LUXURY access to pain medication IS. THE ONLY PAIN MEDICATION ALLOWED IN UKRAINE AS A LEGAL PRESCRIPTION DRUG IS TRAMADOL HCL! Many of the physicians I worked with told me horror stories about cancer patients that died in terrible pain…whom at best were aided out of pain by their family of whom brought them Vodka. Russians by per capita drink less alcohol than Western Europeans. However, our media has most Occidentals believing that Russians are downing vodka at almost every opportunity – NOT TRUE. Point in case, I’m not ‘addicted to pain medication, but I am disabled, and they help me to function normally. When I returned to the US, it became more of a luxury to be able to have 5-8 hours a day where I could be alert and functioning…what a luxury. Point in case, I despise anyone whom may abuse pain killers, I recommend that they are sent to fight in Donetsk and get injured…:) Pain medication is a LUXURY!!!!!

    So enter the new ‘drug laws.’ I prefer to stay with my physician of 14 years since I’ve been with her as my physician for so long…that’s reasonable? I think so…I have no criminal record – fact is, I avoid leaving the house for epidemiological reasons…okay, so enter the new pain laws. Now, once a month, I have to expose myself to the physician’s office every 30 days…In the last decade, my basal pain level has NEVER changed, I’ve tried yoga, have a TENS unit, tried antidepressants (and gained and had to lose 60 lbs because of them – which I did by not eating…since exercise is TOO PAINFUL). Not to mention that in the year of 2014 alone: 7 of 5 months I spent in terrible pain from infection. In addition to my hand pain, constant feeling of having the influenza and abdominal pain from an adhesion, add a stabbing pain in my upper left abdominal quadrant. I lost interest in life, working (yes – trading on the market), reading short articles, and for a while found sending a text message to be difficult. Mind you, how can a woman alone in this condition even FEED HERSELF ?????

    Well, the last week in January of this year, my ‘Primary Care Doctor’ didn’t want to prescribe pain medication for me. I WAS IN INTENSE PAIN…HOWEVER, SHE ALSO DIDN’T GIVE ME A PHYSICAL EXAM, NOR A CBC OR ANYTHING, BUT SIMPLY DID NOT PRESCRIBE THE PAIN MEDS….I RETURNED ONE WEEK LATER;

    First, I brought my personal driver with me as a witness. I demanded the prescription again. But it gets worse….I HAD TO DEMAND THAT SHE DO A CBC ON ME…it was 19.0 x 10 (3) uL!!!!!!!
    Well – my ‘basal’ WBC on the steroids still hovers from 9.5-10.5 x 10 (3) uL at the highest (on prednisolone). But when the infection began, it went up to 14.8 x 10 (3) uL in November, and by December was at 15.9 x 10 (3) uL Also by December, I was in the beginnings of Kidney Failure, but my Primary Care physician didn’t even notice it on the lab test UNTIL I MENTIONED IT!!!!! She replied, “Oh, I see.” then told me; “You might want to consult a Nephrologist….okay, this woman knows I’m alone, and have to hire someone to drive me, she knows I have to brace myself for a lonely holiday…but what does she do? She complained the Norco 10/325 that I am taking (by the way – I wouldn’t have had the ability to bathe myself and dress myself to get into her office without them…but unlike the overweight amorphous sacks of type diabetes flesh that comprise what appears to be most of her practice, I wear beautiful clothes, and always dress up. I wear sweats ONLY when I’m around the house and no one can see me…I’m not a plebe…then after the pain pill prescription she mentioned that I shouldn’t; sell my pain pills or smoke marijuana (I’ve never smoked cannabis in my life, and I simply can’t imagine selling my pain pills from my late model Audi S5!)!!!!!!

    So here we have a physician more interested in not prescribing pain pills than my health. IT TOOK 9 DAYS OF 1 GM OF ROCEPHIN 2 TIMES A DAY TO GET my WBC down to 11.5 x 10 (3) uL…so please anyone, do you have an idea of what should be done to her…because I was bent over walking into her office in pain…I HAVE HYPOGAMMAGLOBULINEMIA, PITUITARY FAILURE, SELECTIVE IgA DEFICIENCY, A DAMAGED RIGHt HAND THAT THE BEST SURGEON AT THE MAYO CLINIC COULD NOT REPAIR…BUT MY OWN PRIMARY CARE PHYSICIAN DIDN’T WANT TO DO A WHITE COUNT ON ME!!!!! FACT IS, I HAVE NOT HAD A NORMAL LAB REPORT THAT DID NOT INDICATE A NORMAL RESULT IN ALMOST A DECADE….BUT THE DOCTOR IS MORE INTERESTED IN SAVING HER MEDICAL LICENSE FOR NOT PRESCRIBING PAIN MEDS, BUT NOW SHE CAN LOSE IT FOR NOT DOING THE CORRECT LAB TESTS!!!!!! THiS LAW HAS GONE TOO FAR. I THINK SHE NEEDS TO BE MADE AN EXAMPLE OF!

    ‘Why haven’t you killed yourself?,” I have heard this statement several times uttered from the mouths of close friends.T I point out that I paid too much money to have a better quality of life, and remained living in a country where I could get better pain relief, so I want a little quality of life because I PAID FOR IT!!!!! I want strong pain medicine, and I want bioidentical hormones. I can only get such at in the US and Canada. Ok, I’ve lived all over the world, honestly, neither of these places are top of my list…and before any of you diehard Americans judge me…my first question to you is, “have you lived in any other country to just sight-see for more than one month for non-military or job-related reasons?’ If you haven’t – ferme la bouche!!!!!! If you think the USA is the greatest place in the world, than you are easy brain-washed.

    If I want to die, it’s very easy for me to obtain a termination. I go to one of my ‘other countries’ of citizenship with my medical records and say…I can’t take this pain anymore…how bad is my pain? Put it this way, the last trip I made to Paris, all I wanted to do was spend a month in my hotel room reading…because I hurt too much (with my pain medication).

    In the last year alone, I’ve had three life threatening infections. My basal level of pain increases 100% during these infections, however, I remain on the safe pain medications; norco 10/325s for it…I have my rules: never take a pill after 18:00 because at night, since I’m not going to do anything, I simply lie in bed as a human vegetable. Personal friends have advised me to commit suicide: they can’t imagine living with the low quality of life that I have had to because of chronic illness.

    My experience of living with multiple illnesses; hypothyroidism, selective IgA deficiency, pituitary failure, hypogammaglobulinemia for IgG (it varies between 50-90% below normal), a permanently damaged right hand which according to a hand surgeon from the Mayo Clinic, Dr. William Cooney, is inoperable – but causes constant pain (although is great at weather prediction), and a basal level of complete body pain (fibromyalgia – most likely from the hypothyroidism/pituitary failure/immunoglobulin deficiency), has made my life a hell.

  17. I THINK SOMEONE NEEDS TO DESIGN A PAIN GENERATION MACHINE THAT WILL SIMULATE WHAT DIFFERENT TYPES OF BODILY PAIN FEEL LIKE…AND SUBJECT BOTH PHARMACY AND MEDICAL STUDENTS TO EACH POSSIBLE TYPE OF PAIN THAT THE BODY CAN BE FELT BY THE BODY…FOR AT LEAST 15 MINUTES….OTHERWISE, THEY SHOULD NEVER BE ALLOWED TO BE LICENSED…..IF YOU CAN’T FEEL THE SUFFERING AND UNDERSTAND IT, YOU HAVE NO RIGHT TO HELP TO TREAT IT… if you can’t feel the pain, don’t judge us patients….

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