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Old 11-21-2009, 10:34 AM   #1
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Take my Percocet as Prescribed, but running out

Hi, I have a question that I need help with. I have been at this pain clinic for over 2 years now and have seen over 6 different PA's come and go. This latest one has been here for about 5 months. Out of those 5 monthly visits, I have seen her 3. The last two, the nurse just came in with my meds and said that we will see you next month, we are really busy today, so this is quick. No questions about pain control or meds.
I am prescribed every 28 days: 120 count Robaxin 500 mg / 4 times a day, 140 count Percocet 10/325 every 4 to 6 hours as needed. I have been on this combo for about 8 months. This month, I was on day 23 with only 5 Percocets left. I had tried calling numerous times before this to speak to someone about the fact I was going to run out. I HAD NOT TAKEN more than prescribed. If I had most days that I took one every 4 hours, that is 6 a day. 6 a day for 28 days is 160. It is feasible that I could run out, right?

Long story short, I went in with my medication and was told by the receptionist that the PA would not give me any more, I would just have to wait until my appointment on Tuesday (This was on Thursday.) The receptionist (who was being very nice and understanding, since she knows me and knows I have never had any problems before.) asked me if I had counted my pills when I left the pharmacy. I told her no, and she said that they could have shorted me (which is possible, since I do not think I should have only had 5 left, even though it was a rough month.) I told her I would like to speak to the PA directly. I waited for over 2 hours for her to pull me back there and tell me that I must be taking more than prescribed. I told her that I wasn't, that I was maybe taking more than last month, but not more than prescribed. I said I was waking up with more pain and taking a middle of the night dose more often this month. She was so mean and accussatory, and told me that I hadn't run out any other month with the same prescribed amount. Nasty as can be, she told me that I was not getting anything else and just take more Robaxin and Ibuprofen. She also told me that I seemed to be blaming her for me running out early. I was just trying to explain that she told me that taking it every 4 hours was okay, and she said that I was telling her it was her fault.

Needless to say, I was crying, my 3 year old who was with me the whole time, started crying because I was . . . It was awful. I have never been treated this way by a PA / doctor before. I was so embarrassed and scared. Are they going to drop me now? Are they going to treat me like a drug seeker if they do keep me on? I am terrified of Tuesday.

SO, my question is has this happened to anyone? Am I wrong to feel so hurt? I am so scared of going through withdrawals and having so much pain . .

Sorry for the long post. Thanks for your time.

 
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Old 11-21-2009, 05:40 PM   #2
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Re: Take my Percocet as Prescribed, but running out

Welcome to Healthboards. This is a great site. Many here have lots of diverse experiences, thus, can offer lots of support and guidance. I'm sorry to hear about your problem.

Have you signed any type of PM contract outlining the expectations of you as a patient? Normally, these type of contracts are pretty clear about no early refills, no missed appts, and etc.

I can certainly understand your confusion. When the directions say every 4-6 hours, that's technically what you should do. So, if you take them every 4 like you said, you run out early. However, they will probably rebut with that some should be every 6. Even though the directions say every 4-6, those are just the directions for taking the med. It doesn't mean that it's your day's supply via the calculation. This is where the confusion comes into play.

Typically in PM, whatever amt they give you is supposed to be the month's supply. So, 140 every 28 days works out to be no more than 5 per day. Your directions say every 4-6 hours, but there is a 5 per day limit. I'm sure the Doc probably didn't spell it out like this, but that's how it works. Early refill requests are a big "no no" in PM. Unless there is a unique situation, like a med transition or something like that. Some PM's will do it once in a blue moon, but that's about it.

In terms of your appointment on Tuesday, I would just apologize and say that you didn't understand. Tell them you had an especially bad month and you were only following directions on the bottle. I would play dumb as best you can. Tell them that you feel bad for bothering them.

The good news is that your appointment is on Tuesday and you should be able to get your meds then. Have you gone into WD? How many pills do you have left? Hopefully you can space them out.

Please let me know if I can help answer any questions, and best of luck to you.

Regards,

Ex

 
Old 11-21-2009, 08:14 PM   #3
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Re: Take my Percocet as Prescribed, but running out

Thanks so much for your reply. I did sign a contract, and as far as I can remember, it says essentially the same things you stated: "No missed appts, no early refills for lost or misplaced meds, no rescheduling appts for earlier dates, no pain medications from other doctors, etc. . . ) I am sure I signed it not looking at it "COMPLETELY"
I truly, honestly thought that when I went in showing them the amount I had left and the bottle of 4 to 6 hours, they would realize it was their mistake and either do my appointment then, or write me 15 to hold me over. Never in my wildest dreams did I expected to be told "you should know better." I think that is what bothers me most about it all. I used to be on Vicodin 10/500 PRESCRIBED EVERY 4 to 6 HOURS with 180/ MONTH (granted, a less potent medicine, but when I was switched the PA at the clinic at the time, told me that now I could get better pain control with the same frequency of pill taking.) While she was telling me that she hadn't changed the amount of pills I had been receiving for the last 3 months, I was thinking " You haven't even seen me in the past 2 months, and no one that has seen me as asked how many I have been taking a day! All of them just wrote 5 a day in my chart!"

About the withdrawls, I have had some aches and general tiredness. I actually had some of the Vicodin that I used to be prescribed (only 10 of them, but it helps.) Now I am worried that they will do a drug screen and see the different medication, but I have to get through this- I have a child who needs me. I know Tuesday is only a few days away, but I am so scared they will dismiss me over this. The receptionist told me that if I would have been called in for a pill count, they would have dropped me. Who knows, I need to worry about that when it comes.

Thanks again, and sorry for rambling . . .

 
Old 11-21-2009, 10:58 PM   #4
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Re: Take my Percocet as Prescribed, but running out

Quote:
Originally Posted by Sands7 View Post
While she was telling me that she hadn't changed the amount of pills I had been receiving for the last 3 months, I was thinking " You haven't even seen me in the past 2 months, and no one that has seen me as asked how many I have been taking a day! All of them just wrote 5 a day in my chart!"
Unfortunately, this is what happens when they "turn and earn" patients....Move em on through quickly and just fill out scripts. They write stuff in patient's charts really quickly and spend little to no time with the actual patient.


Quote:
Originally Posted by Sands7 View Post
About the withdrawls, I have had some aches and general tiredness. I actually had some of the Vicodin that I used to be prescribed (only 10 of them, but it helps.) Now I am worried that they will do a drug screen and see the different medication, but I have to get through this- I have a child who needs me. I know Tuesday is only a few days away, but I am so scared they will dismiss me over this. The receptionist told me that if I would have been called in for a pill count, they would have dropped me. Who knows, I need to worry about that when it comes.
I'd stop taking those Vics immediately. Just your luck and would get an UA. In fact, since you had this issue, they might schedule you for one to see if you took other meds to get through. The good news is that detection time is only 36-48 hours, so if you stop now, you'll be fine. I know you have a small child who needs you and I don't mean to be crass, but you can't afford to be dismissed over a failed UA. Then, finding good PM care could be really tough. You just need to deal with it for a couple of days. I don't mean for that to sound rough....Just trying to help.

I doubt seriously they'll dismiss you. It was a mistake and you have a very good rationale for it. Plus, you've never had any issue there before, so your history there is a big benefit for you. I would just focus on it being a really bad month and you taking the meds as directed on your bottle. I'd then ask them what are you to do if you have a bad spell....Should you call before taking more, go to the ER, or what....Just so you know.

Just as any fyi, pill counts are usually for those who they suspect something is going on with. They don't typically use them for everyone, or even randomly. If you stay to the 5 per day, you'll be fine from here on out.

Again, I'm sorry about all of this. Hang in there as best you can. I know it's tough, but you can do it. The worst is over and that's the initial shock of realizing you'll be short or run out. Try using Mylanta. Not only will it calm an upset stomach, but it has small amts of the same metabolites that your meds have, but they don't cross over the blood brain barrier...Thus, it's legal OTC and will help keep you out of WD. If you're having trouble sleeping, take Bendryl, or some type of OTC sleep aid. They're good for short term issues.

Best of luck to you.

Take care,

Ex

 
Old 11-22-2009, 12:01 PM   #5
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Re: Take my Percocet as Prescribed, but running out

This happens to mostly all of us. Our pain is so great we usualy take more then what the doc ordered. So if you have run out just go to the ER and tell them about your medical problems and bring your records and tell them you need this type of medication. Then when you see your doc tell him to write the script different. tell him to write it 2 pills every 4 hours the that gives you 12 a day. And make sure you have him add refills to your norcos or what ever it is uless its a stronger medication which then needs a script handed in every time

 
Old 11-22-2009, 12:25 PM   #6
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Re: Take my Percocet as Prescribed, but running out

I have to agree with Ex again. I also have to disagree with Poweraid. No offense, but we are bound by a very strict, very blunt contract with PM doctors. We are not allowed to get any kind of written scrip for pain medications from another doctor. Doing so will get us kicked out of our PM's care immediately. It is written very clearly in our contracts.

There have been instances where a PM patient has had to go to the ER for acute pain issues, however, if they are treated, they are treated with some kind of injection in the ER and are not given a written scrip. I had to go to the ER once with a different issue and I even refused to allow them to give me any kind of narcotic injection. I just didn't want to take a chance. I still called my PM the following morning and told them about the visit and offered them the paperwork I left the ER with.

Anyway Sand- Like Ex said, it may be tough, but please just try to stick it out until Tuesday. I know when you are in pain a couple days can seem like an eternity, but you can make it. Take Ex's advice and things should be ok. You did nothing wrong Sands, so don't kick yourself too hard, ok??

I wish you the best with this and am sending positive thoughts. Please let us know how it goes.

PS- I also have to respectfully add that not all of us take more than prescribed as that is another way to be kicked out of the practice immediately. I have to account for every pill prescribed to me. I have to take all medications to each and every appointment and if they don't add up properly, then I will be excused from treatment. This is required for all of my PM's patients. It's for our protection as well as the doctors.

Last edited by ozzybug; 11-22-2009 at 12:30 PM.

 
Old 11-22-2009, 12:40 PM   #7
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Re: Take my Percocet as Prescribed, but running out

I truly appreciate all of your suggestions and support right now. It is so good to know that you are NOT ALONE! I feel so blessed I found this forum, especially during this tough time.

Ex and Ozzybug, you seem to understand the medication process very well at Pain Management. Do you count your pills when you receive them? I never really thought I would need to, although I have seen mistakes made. I was just kind of wondering if this is something people do and whether or not you would do it in front of the pharmacist or at home . . . I guess I am just grateful when they have it in stock!

Thanks again ~
Sands

 
Old 11-22-2009, 01:01 PM   #8
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Re: Take my Percocet as Prescribed, but running out

Hey Sands- Hope you are feeling ok today sweetie.

I don't count meds at the pharmacy, and as a matter of fact, I usually buy a couple of other things and have them put all my stuff in a larger bag. I don't want people seeing me carry prescriptions out of there, because there have been cases where people are jumped in the parking lot and had their meds stolen.

I count my meds as soon as I get home. It's a good thing too because on more than one occassion, I've been shorted. One time, they didn't fix it because they said their counts came up correct. (I think one of their pharmacists or techs skimmed some. It was short by 12 pills) Another time, I was shorted over 20 pills. Both times I called the pharmacy immediately. The second time, they found that they had indeed made an error and I was able to run back up there and get the pills they shorted me.

It's such a blessing to be able to get appropriate care for our pain issues, yet is also such a responsibility too! One rule I follow personally is that you can never be too careful when it comes to your medications. I don't tell people I am in pain management (my family knows), and I even have a safe bolted to the floor in the back of our closet that I keep meds in.

A few years ago, I had an experience where someone actually called in for and picked up a refill on my pain medications! This pharmacy allowed someone other than me to get MY meds. (I have to add that I live in a small community and the pharmacy knew who I was. They also knew I was the only person who ever picked up my own scrips. My hubby never even picked them up for me) When it was actually time for me to get my refill, I couldn't get it. I notified my doctor immediately, however even though the pharmacy made the error, I had to go without my meds for a month. It was awful. That pharmacy didn't require signatures, so they tried to trace by seeing if the person used a debit or credit card and they didn't. It was a cash purchase and there was nothing else that could be done. I stopped using that pharmacy. My doctor could have kicked me out of the practice but thank goodness he didn't. I had a spotless record with him and he knew I wasn't lying. I don't know who got those meds, or how they knew I had medications and refills, but now I even take the label off my empty bottles and stick them to a piece of paper in my office and shred them.

I brought that example up to kind of give you a picture of why I always say you can't be too careful when it comes to your meds. This is also why I don't tell anyone I take meds.

No, you are not alone and we are hear to help you through this!! Hang on and be strong.

Last edited by ozzybug; 11-22-2009 at 01:02 PM.

 
Old 11-22-2009, 01:51 PM   #9
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Re: Take my Percocet as Prescribed, but running out

QUOTE- I also have to disagree with Poweraid. No offense, but we are bound by a very strict, very blunt contract with PM doctors. We are not allowed to get any kind of written scrip for pain medications from another doctor. Doing so will get us kicked out of our PM's care immediately. It is written very clearly in our contracts -Quote-

I didnt say to get anothern script from another doc I said to get the script written from the same doc but written differently so you can have more in a 24 period if you need them.And if you do run out yes thats what a emergency room is for to help our pain they cant refuse you and most likely can give you enough until your visit with your doc or give you some to help.And if you decided not to take the meds that was up to you but your doc will not kick you out if you went to the emergency room for your chronic pain.And let me get this right if your out of meds you would want to go threw the withdrawl pain which can be even more painful but you say try and stick it out. I dont know about you but with 4 of my disks herniated and a few fused already and 2 more gettng fused I wont go through withdrawls and wait I will get ER help right away if I needed to. But I dont go through my meds early but yes there have been times that I have because the pain was that bad. So to each is own. But if one is in agony and needs the pain meds and are out then the ER is your best choice. And then tell your doc you went there. If your doc kicks you out then he really doesnt give a crap about you or your pain and injuries because they should help us no matter if we run out sooner.And if you do run out early then maybe try a different kind of pain pill a stronger one that can help you better.Good Luck

 
Old 11-22-2009, 07:08 PM   #10
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Re: Take my Percocet as Prescribed, but running out

Quote:
Originally Posted by poweraid View Post
tell him to write it 2 pills every 4 hours the that gives you 12 a day. And make sure you have him add refills to your norcos or what ever it is uless its a stronger medication which then needs a script handed in every time
With all due respect, I have to disagree with this. She is permitted 5 per day and going in and asking for 12 per day is not something that I think would be taken seriously. In fact, I think a Doc would think something was astray. Additionally, 12 per day would be far more Tylenol than recommended for daily intake. I don't think too many Docs, if any, would authorize this.

Sands just had a bad month. She's never had a need for an early refill before. If the pain is in fact worse on a more consistent basis then this whole experience may be a good avenue for a slight increase, to say 150 per month, or every 28 days. However, before going up in qty, I suspect they'd go up in dosage. Again, I would play dumb and just talk about how bad a month it was and you were just following directions on the bottle. You may even tell them that you've noticed that you used to be able to wait 6 hours between doses, but now it's closer to 4. Don't give any explanation, but just state the fact. This should be a tip off that tolerance is an issue, which is very normal for those on LT meds.


Quote:
Originally Posted by Sands7 View Post
I truly appreciate all of your suggestions and support right now. It is so good to know that you are NOT ALONE! I feel so blessed I found this forum, especially during this tough time.
No problem....Glad to help. Yes, it's comforting to know you're not alone. Many of us have been in your situation or something similar to your situation. I'd be glad to help with any issue you may have.

Quote:
Originally Posted by Sands7 View Post
Ex and Ozzybug, you seem to understand the medication process very well at Pain Management. Do you count your pills when you receive them? I never really thought I would need to, although I have seen mistakes made. I was just kind of wondering if this is something people do and whether or not you would do it in front of the pharmacist or at home
Ozzy is right in that you can never be too careful with your medication(s). Some people count right when they get home, while others do it at the pharmacy. If I had been shorted more than once, then I'd start counting at the pharmacy before I leave. As uncomfortable as that may seem, I'd just tell them that you've been shorted a couple of times and you want to make sure it's right. From my standpoint, I'd rather it be an uncomfortable couple minutes (while it's recounted) vs an uncomfortable couple of days because of a shortage. I'd venture to guess that once a person did this a couple of times, it would be more accurate from there on out.

As with Ozzy's experiences, sometimes they'll make it right and sometimes they won't. They are supposed to keep an active count at all times of all their controlled meds, so if you come up short, they should be able to account for it. However, if someone is skimming as Ozzy suggested, then they're inventory won't account for the shortage because the missing meds are in someone's pocket! If one were to suspect this was going on, it's best to count at the pharmacy. If your meds were found to be short, they'd immediately know it was an inside job because their inventory would be correct internally.

Isn't it a darn shame that this is even an issue??

Take care and best of luck at your appointment. Please let us know how it goes. I'm sure it will go well. You're a good patient and I'm sure all will be fine.

Regards,

Ex

 
Old 11-28-2009, 03:49 AM   #11
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Re: Take my Percocet as Prescribed, but running out

My goodness, I have never thought to count my pills. I am going to begin doing so.
Another thing, and please do not take this wrong. I would struggle with a PM center for treatment. I could NOT stand their strict rules. And I take my meds EXACTLY as prescribed! I mean these people won't even allow for what just happened to this person and will let her go without meds for TWO days?

I remember when I had a lump out on my breast. I remember being in "extra" acute pain because of some issues that came up with the tests and surgery. In any event my doctor gave me something extra for the pain, understanding that this was an exceptional thing and that I would need something. I cannot imagine someone withholding my meds because I missed an appt? My Lupus dictates when I can and when I cannot get out of the house without warning me.

I know PM centers helps people. Please don't think I am being mean about them. But dang, I hear some horror stories and can you imagine your car breaking down on the way there and you miss and appt. and someone withholds your medication? OMG!

I am sorry this happened and I would do I guess what was required of me. But I still don't like the idea of these rules with NO exceptions ever! Life is just not like that.

Madison104

 
Old 12-02-2009, 03:13 PM   #12
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Re: Take my Percocet as Prescribed, but running out

LOL...
if it were only that easy!!

 
Old 12-02-2009, 07:29 PM   #13
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Re: Take my Percocet as Prescribed, but running out

Quote:
Originally Posted by Madison104 View Post
I remember when I had a lump out on my breast. I remember being in "extra" acute pain because of some issues that came up with the tests and surgery. In any event my doctor gave me something extra for the pain, understanding that this was an exceptional thing and that I would need something. I cannot imagine someone withholding my meds because I missed an appt?
I think there may be a simple misunderstanding here about PM, so I'll attempt to explain things a bit if that is ok.

Situations like what you described are often treated much differently than those in PM programs. For example, when I had my surgeries, my surgeon threw pain meds at me from all directions and refilled my scripts at each appointment without any discussion on running out, how many I had left and etc. Looking back, it's almost as if they'll give you all you need (and then some) for a specified time period (depending on the type of surgery you had) and then cut the faucet off at some point (6 weeks, 8 weeks or whatever) when they think pain mgt is really needed any more. In fact, many surgeons will write each script for less qty.....Sort of as a signal that they are cutting you back....i.e you shouldn't need as many as before.

However, in PM, once you are deemed "chronic" and thus need meds over the long term, they try to get you to a place where you are stabilized, and that's when the strict rules kick in....They want your blood levels consistent and pain mgt is about this consistency...NOT treating big swings in pain, like what often accompanies acute type pain. Things like the monthly appointments, refills, and etc. are fairly strict because PMs have to be tough as otherwise, there would be no institutional control over the meds.

Also, it's important to note that not all patients are treated equally. Those who have been in PM a long time and have a good relationship with their Docs, can often be trusted more. Thus, they may get a little more leeway and etc....Not a lot, but more so than say a new patient.


Quote:
Originally Posted by Madison104 View Post
I know PM centers helps people. Please don't think I am being mean about them. But dang, I hear some horror stories and can you imagine your car breaking down on the way there and you miss and appt. and someone withholds your medication? OMG!

I am sorry this happened and I would do I guess what was required of me. But I still don't like the idea of these rules with NO exceptions ever! Life is just not like that.
Almost all the PM clinics I know will give patients a pass or two for a couple missed appointments, and then they crack down. The reason for the rule, (as well as other rules) in the PM contract is this....The regular dispensing of narcotics (especially CIIs) over a long time period is very serious business. Therefore, there are many rules / expectations that are required in order to participate. The PM contracts specifically outline those expectations so that there is no misunderstanding. Additionally, there is a strong correlation between certain behaviors and addiction / abuse / diversion. Therefore, they keep a very close eye on patients to ensure that they pick up on any "warning signs" (like early refill requests, lost scripts, and etc.).

Reasonable situations like a car breaking down and other type things, would not be held against a patient....Unless they became a regular type thing and a patient was known for a million excuses. PM is serious stuff and therefore, the Docs have to be firm....A much different scenario than acute pain, surgeries, and even hospice care. With those latter situations, there isn't much institutional control, but the time period of narcotic dispensing is very short, so there doesn't have to be as many rules. About the time someone may get "caught" doing something they shouldn't, there time period is up for meds anyway, so it sort of solves itself....That's how I think many Docs look at it.

Hope this clarifies things. PM is very strict, but not unreasonable.

Regards,

Ex

 
Old 12-03-2009, 04:50 AM   #14
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Re: Take my Percocet as Prescribed, but running out

Thanks Ex, knowing how responsible I am, but how each day for me is so very unpredictable, the PM way scares me. For me, things can vary moment to moment. I have a dental clinic where if you miss 2 appts. in the lifetime of belonging to the clinic, they throw you out! You must supply a doctor's note to stay a patient there. I have already had two notes. One for sickness, one for a house fire. Still, with all of the stress of my house fire, then I had added stress to get them the darn note.

I DO hear what you are saying Ex. and it does make sense. I can imagine that they must have to have control or the place probably could not run. I can see where they could quickly lose that grip on the patient/doctor relationship. And if someone is an addict opposed to legit. chronic pain patient, that is a big problem that needs their attention.

I guess I will be grateful that I have a doctor that takes good care of me, and nothing happens if I miss an appt. What I mean is I HAVE TO see him of course, but if I reschedule and get in within the month, nothing happens if my meds are due to be filled. Then again, I've had the same doctor for what feels a lifetime. So, I guess we have long ago established trust

 
Old 12-03-2009, 10:09 AM   #15
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Re: Take my Percocet as Prescribed, but running out

Quote:
Originally Posted by Madison104 View Post
I DO hear what you are saying Ex. and it does make sense. I can imagine that they must have to have control or the place probably could not run. I can see where they could quickly lose that grip on the patient/doctor relationship. And if someone is an addict opposed to legit. chronic pain patient, that is a big problem that needs their attention.
Yes, that's exactly the issue. All it takes is one bad apple to spoil the bunch, and it can close down a clinic and cause the Doc to lose his license and / or go to jail. Scary really.

Conversely, surgeons and acute pain care doesn't really need the same level of caution....Although it is important obviously. But, from a surgeon's point of view, if he operates on someone for something and they end up abusing the meds, it's totally out of their control. They have to medicate following surgery and it's only for short time period. If something does happen, it doesn't for long. This is why those type of Docs have completely different attitudes re: PM. However, even some of these Docs are very cautious. To be honest, it's really all over the board and often depends on the Doc and the particular surgery / condition.


Quote:
Originally Posted by Madison104 View Post
I guess I will be grateful that I have a doctor that takes good care of me, and nothing happens if I miss an appt. What I mean is I HAVE TO see him of course, but if I reschedule and get in within the month, nothing happens if my meds are due to be filled. Then again, I've had the same doctor for what feels a lifetime. So, I guess we have long ago established trust
Yes, I'm sure there is a big trust factor that has been built up over time. Also, it sounds like you have a very understanding Doc who works with people and isn't a hard liner....Unlike you're dentist.

Regards,

Ex

 
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Put on oxcontin with percocet for breakthrough, when to take the percocet? sammyo1 Pain Management 7 12-18-2007 02:27 PM
If percocet is taken during day, is it safe to take the norco at night sammyo1 Pain Management 12 12-14-2007 05:14 AM
Previous Percocet addiction...Now severe back problems justjustine Addiction & Recovery 1 05-02-2005 04:26 AM

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