I know this is probably something that happens to people all the time, but now that it has happened to me...I am at a loss, scared and offended. Please bare with me as I vent..
I have arthritis in my back, a condition that has worsened a lot in the past 2 years or so. I have had the same MD all this time, seeing her about twice a year at the most. I am on a monthly regime of 180 Norco's, and these work quite well for the most part. Recently I sought out extra medication to help with breakthrough pain while I am sleeping. The doctor I saw, who was a doctor on call as my doctor was on leave, suggested MS Contin. In the past I have been prescribed many different things, Tramadol, Percocet, etc. Not much luck with them and I had the same experience with the MS Contin. Mostly stomach upset, constipation, headaches. Anyway, when the doctor prescribed the MS Contin he at that time had me sign a pain contract, surprised that my actual primary doctor had never had me sign one. I signed it understanding the gist being that I don't seek out other doctors for pain meds for the same conditions.
In the end, I discontinued the MS Contin, determined to make due. Well, recently my back has been really flaring up at night and I realize that I truly do need extra relief sometimes. I called my doctor, asking to give the Percocet another try. After a few days of not hearing back, I called and was told that not only will she no longer fill the Percocet...but she was referring me to pain management. I think pain management is a great idea, as I would love to find a way to need less meds through physical therapy. I WAS a bit bent out of shape that my doctor did not at least call me in to discuss changes in treatment, but felt it no real big deal.
Now is where it gets hinky, so please bare with me! Last month I asked my primary if I could try Vicuprofen to see if it works any better than Norco, simply because I do take Ibuprofen on occasion and it does give relief. I tried it for about a week and HATED it. For some reason, though I can take Ibuprofin alone, I cannot take it with hydrocodone. So, I asked my doctor to switch me back to Norco and she did, no problem. At least there should not have been..
I have about 4 or 5 monthly prescriptions, and I write the numbers down in my planner. Obviously I don't want to carry bottles around, so this is easier. Apparently I wrote down the script numbers incorrectly, and on the automated refill service pressed in the number for the vicuprofen...(which was not being taken) when I meant to press it in for my meloxicam. No big deal, the pharmacy called and told me that since the Norco had just been filled recently that the Vicuprofen could not be filled. After going over all of my script numbers and figuring out the snafu, it was agreed that the Meloxicam would be filled...not the Vicuprofen. I went to pick up my scripts, there were 2 other ones, and thought nothing else of it. Till a few days later when I went to use the Meloxicam and found....the VICUPROFIN!! I called the pharmacy, they were kind of snippy, told me they could not take them back, refund my co pay, that I had picked them up and that was that. In retrospect, YES...I did pick them up. Never occured to me to check the bag. My bad I guess.
Since these pills are worthless to me, and since I have kids around where I would not feel comfortable just throwing them away, I flushed them. Now, keep in mind...when I told the doctor that I did not like the Percocet originally....he had told me to flush them. THEN when I had the doctor switch me back over to Norco I still had about 140 of the Vicuprofin left that I flushed...So, in my mind I didn't do anything off the wall. Until I went to refill my normal Norco script this week. Now all hell has broken lose and I am basically being treated like a scumbag drug seeker AND being red flagged.
And there is more. When all this happened, my doctors office pulled up a history of sorts on me, I am guessing my insurance information? Well, on there it shows how I have gone to the dentist several times this year. I have major dental problems, always resulting in antibiotics and painkillers. Of course the kicker is that I got painkillers from my dentist while having Norco from my doctor for my back. My reason for this is that in the past I have been berated for running out of painkillers early because I used extra for dental pain. Was told that my painkillers from the doctor are for my MEDICAL condition....and that if I have a need for painkillers for tooth issues I need to go to the dentist. This advice is of course null and void now in light of this fiasco. I understand, they think I am drug seeking, I get that. However, the pharmacy should never have filled the early prescription as it was...especially after pointing out my mistake in ordering them. I assume that signing the pain management contract changed the way they deal with me? That though in the past I went to the dentist and got my meds and it never was a problem? Or that this episode with the incorrect painkillers made them think I was up to something?
In closing, I spoke to the patient advocate at the medical center who tells me I am pretty much out of luck. That this incident changes everything and I am red flagged. WOW. Even told me that they could assist me in getting into a rehab for my "drug" problem. I don't need rehab, if I don't have painkillers my back will surely suffer as will my way of life...but I will survive it without rehab. It is just ludicrous to me that I am even having to think about or type about these sort of things. Any advice from anyone? What to expect going forward? I am supposed to start pain management this week and have been informed that they are aware of my situation. Situation???? This makes my blood boil!!
Anyone else gone through something similar to this?? Help...and thank you for any feedback AND for even reading my dilemma!
Sorry this has happened to you, it's tough, but for doctors the rules around pain meds, if you are in pain management, are stringent and any violation can end treatment. My PM practice says they will do random urine tests, most insurance will not cover this and if I refuse to pay out of pocket for this my treatment ends. My PM practice is SO good that I agreed.
If it's the PM practice that is upset, can you have an appointment to discuss? In retrospect you might have done that and taken them the full bottle of the vicoprofen to show you did not intend to order/use it. Bring records that show the two prescription numbers are very similar, etc
I keep my PM informed of everything, first via call then fax to confirm what we discussed. I called them post-surgery to tell them what I was prescribed and then saw PM around 3 weeks post-surgery and brought all Rx bottles, called them when I tore ligaments in my ankle and was prescribed percocet and provided them ER records to back up what happen, and called them when I had to make an emergency pharmacy change (old one closed with no notice).
Taking any narcotic medication from another provider, or refilling something you used to use that another doctor prescribed, is grounds for dismissal from most pain management practices. See if they can give you a break and move forward with total transparency on your part.
Thanks for the response, and I am learning quickly the ramifications of signing a pain management contract.
I saw my PCP for over 5 years, with my medication doses increasing steadily. She even prescribed Percocet with no mention of a pain contract. It was not until she was out on leave and I had to see another doctor who was surprised that she had never done a contract with me who made me sign one. I've never gotten pain meds from anyone than doctors in my PCP's practice, with the exception of the dentist. Up until this incident it never even crossed my mind that I was doing anything wrong.
Even with the contract in place, I truly understood it to mean I was not to go to numerous doctors for issues with my back. I had to stay in the group, which I always have. I guess the sticky wicket is the dentist and I can see how it LOOKS like I was stocking up on the meds. It's just that I got berated for going through my monthly meds too soon when I also used them for dental pain--so I kept the two separated. What a disaster!
The mistaken refill, I don't even know HOW that happened. I always have to call a few days in advance to get my refills...and this one they refilled without doctor authorization, telling me that perhaps it was accidental on their part? However...my doctor DID find out about it, so who knows what went down. I do feel bent out of sorts that they questioned me about flushing them, when it was their office that told me to flush unused pain meds. I guess I never expected the Onus of proof to be on me for this sort of thing.
My first pain management appt. is tomorrow. If they choose not to treat me OR not to treat me with pain meds, what could be my options? I have insurance so I could change groups if necessary...but would I be forever flagged as a result of this and never able to get pain relief again? This has me in tears that something so careless can be causing all of this. I know in the end the responsibility lies with me...I just don't understand WHY this had to happen. I'm scared that I am doomed to a life of back pain because of this mistake...
Last edited by feelikedirt; 06-28-2010 at 10:58 PM.
Pharmacy denies even having a conversation about it with me. I guess I "could" kick up a stink about how they should not have filled it to begin with, but don't think that will solve anything. The stance is that I picked it up and originally DID order it, tho was denied it at first by the pharmacy.
Oh my gosh. I listen to these stories and I cringe. I don't know how so many wires get crossed. I deal with one doctor and one pharmacy and mistakes still happen.
Last month when I went in to pick up my breakthrough pain med, there was a prescription at the front desk for my LA pain med! I stopped and had the gal get my nurse. My nurse who I really like a LOT called me out back to show me that I had NOT filled my LA for over a month according to her records. I pulled out MY BOTTLE which showed that I had just filled it, not 2wks. before. Guess what? They had forgot to write it down in my records? IF I had been a drug seeker, it would of looked like I was trying to get 2 prescriptions for my LA med in TWO weeks time, if I had taken that to the pharmacy!!!!! I was FURIOUS!!!! I told my nurse that this is WRONG and that my records need to be EXACT and now I am thinking "what if" what if along the way they write down the wrong date? What if they write the wrong thing.
I SEE how these things happen. We have to be so diligent in watching EVERYTHING that we fill and EVERY conversation that we have. We have to take names!! I don't flush anything. I keep the bottles and the meds, if I say, have stopped one med and started a new one. This is serious business and good people like yourself are being punished.
Whenever I have a procedure I call my doctor that prescribes and ask him to prescribe extra for the procedure and write on my prescription "for procedure" so that the pharmacy does not wig out!!! I have refused pain meds at the ER when I broke my toe 2 years ago for example, because it gets to messy and I did have ONE pharmacist refuse to fill something for me 3 years ago when I had a switch!
Again, I am so sorry. I would write everything down as you did here, with dates and times, the conversations that you had and with who and when. And I would take that to the PM and have a long talk. I would get a lawyer if needed to get that FLAGGED BS off my record. That will follow you around for the rest of your life now and that is not fair. Sorry this was SO long.
From now on, really watch EVERYTHING and take notes. I wish you the VERY best!!
I am sooo sorry that you have caught in the mess of being flagged. I agree with Spine that the doctors control the meds and they don't forget it.
PM is very strict. Once you signed that paper you got trapped by their rules-and strict they are. I guess they should have explained them a little more clearly for you. I get my scripts filled at Target..and I can't even go to another Target! It has to be the one that I listed at the beginning.
I would suggest that the next time you get meds from the dentist you call your PM immediately and tell them that you were prescribed meds from the dentist. Then ask them what you should do, or do they want to give you comperable ones. this way the onus is on them.
Before you have your meeting with the new PM, write down with dates-and times if you can, everything that happened, including the lack of clarity from the doctor that had you sign the form. Did they give you a copy of it the form you signed by any chance? If not you can lay blame there because how can you follow rules that you don't have a copy of? I digress. Make sure that you lay everything out in order. Take your hubby with you if you can. It always helps to have another adult along. My hubby comes to 99% of my appointments. When he doesn't come my PM is so funny...he considers us a three some and keeps telling me that he can't treat me w/o my hubby because he and my PM are a team against me! what a hoot!
I hope that it works out for you. Please let us know how the visit turns out. We'll keep our fingers crossed.
Thank you sooo much for everyones responses and advice. While I hate that anybody else has had to go through this, I take some comfort in knowing that I am not alone.
For sure everything changed once I signed that pain contract. Not making excuses, because the responsibility IS mine, but when you get accustomed to doing things a certain way...and have done things that way for years, example being getting pain meds from the dentist, it is a big shock to be told you are breaking the rules all of a sudden. Especially after being reemed out for "self medicating" with the pain meds my PCP prescribes for my dental problems. A pharmacy tech actually said that to me once when I got an early refill, she asked why I ran out early, I explained I had dental pain and used extra. She was nice about it but very firmly told me that I was self medicating myself by using my back pain meds for my teeth and that I needed to see my dentist for medicine for my teeth...(which I did, but was not able to get in for a few days..)
Yes, I got a copy of the pain management agreement and I dropped the ball not reading it thoroughly. Seriously, the doctor..(who was the doctor on call) who made me sign it totally downplayed it, making it sound like they have to do it to make sure I don't sell my meds OR go from ER to ER getting meds for the same condition. I truly did not realize the depth of what I signed. This doctor is a real piece of work now it seems. Because of the fiasco with the early fill on the unusable/flushed pain meds...and because my doctor is working limited hours these days...the patient advocate I spoke to talked to him about getting me a refill...as I am COMPLETELY out of my regular meds. Mr. Compassionate Doctor stated that I am out of luck, that I would just have to deal with cold turkey but if necessary could go to the ER for a shot or something. Also I should look into rehab. I mean...really??? I understand they see drug seekers all the time and he has no reason to look at me any different--but he almost seems thrilled at the concept of throwing me into cold turkey! (Jokes on him...my back hurts like HELL today, but no cold turkey).
Isn't there some sort of oath that doctors have to make...something like cause no harm?
Again, I understand that my naivete got me into this and I need to deal with it. I did just get a call from the patient advocate who finally spoke with my regular PCP. My PCP stated that since she I have been her patient for a long time that she will work with me on this. That I should go to pain management, which I will today for my first visit. Problem is she is STILL adamant that she will not refill my pain meds till the 16th because of the mistaken refill. This will seriously impact my quality of life as my pain has become constant and have been on a 6 pill a day regiment for years. Now I am being told I have to suck it up for over 2 weeks. I'm not sure how I will deal with this...
Thanks again for listening. I guess we live and we learn...I sure have.
If your new PM doc won't issue you meds today-which some won't on a first visit, you will go through withdrawal-which is less than pleasant I've been told. The runs, pains, aches, headaches..you name it. I don't know what to suggest except going to the ER-and explain that you are out of meds...
Went to pain management doc, she wants to do an MRI and some other procedures to more specifically pinpoint where my pain is coming from. I've been diagnosed with arthritis already, but she seems to believe there may be some other issues. She says a 42 year old woman should not be in this much pain from arthritis...and the pain has totally escalated in the past year. She laid out a treatment plan with the end result hopefully being my need for opiate medicine will be greatly reduced. As I told her...5 years ago started on a little script of 30 vicodins, for low back pain. Since then I have escalated to 180 10/325 Norco's---and these are beginning to not be enough as my tolerance is through the roof! So, maybe it is good that this whole fiasco happened...as I don't think my liver will appreciate even more acetaminophen coursing through it!
As far as the pain contract situation. My PCP says she will allow only one more refill and that from now on I need to get my pain meds from the pain management doctor, which makes sense anyway. I AM a bit bent out of shape that it was stated to me that the reason she will not refill anymore is because I breached my pain contract--I HATE being looked at or judged for this stupid and careless mistake--but I understand that rules are rules and even if I broke them innocently--I still broke them. I know she probably has to protect herself, also.
You know, though...part of me wants to kick up a stink. I reread the pain contract and though it does state I am not to get pain meds from any other PHYSICIANS, for the same ailment, nowhere does it say I cannot get pain meds from my dentist. Not trying to shirk my responsibility here, but when that one doctor made me sign the contract he blatantly stated that the contract was to keep people from going to different doctors, emergency rooms, etc. seeking meds for the same condition. I feel it's a bit of a sticky wicket but in the end...not worth fighting over. I will just start pain management and do whatever she wants me to do.
I did run into a hot dog little pharm tech today, though. Kind of chapped my hide a bit. I went to pick up the refill and was told it was too early per my insurance. Since I DID go to the ER the other night, as advised by the on call doctor at my med center, and they prescribed me 12 Norco. Because of that my script cannot be filled till tomorrow. I am out of meds, my back is screaming, and this kid seems to be enjoying the power he has of telling me...NO CAN DO! So, I ended up paying for a few pills out of pocket and am told I can pick up the rest under my insurance tomorrow. When I told the kid I would just pick up a few for today...he said to me, "What...you don't have ANY medicine left? You used it ALL?" Uh, wow...you are certainly a brilliant one, pharmacy tech dude. I told him...yes, I was out..HENCE the doctor calling in the refill TODAY. Ugh. I know they see all kinds of hinky stuff over pain meds but, still. Questioning me just made me feel dirty...as if I owe him any explanations anyway, you know?
I guess this whole experience has me on edge and feeling defensive.
I'm sure we could get technical and say a dentist is not a physician but they are doctors. If one understands the pain contract it's implied that you have to notify the PM doc of any other pain prescriptions. For people in PM things do happen, people break a leg, get appendicitis and have surgery, and have dental surgery. In these cases most pain management doctors are agreeable to you filling a prescription from your dentist as long as you notify the PM doc before they find out any other way. Talk about it next time you see your PM.
Hmmm...now I wonder if I am being pushed to do something I'm not comfortable with?
The pain management doctor gave some options, including physical therapy, behavioral therapy and then perhaps injections at some point. The injections were brought up as a "see how you feel about it" sort of thing. She stated also that an MRI is in order. She also said she wanted me to try gabapentin and amiltriptyline--and sent this info to my PCP.
Because of all of the drama over the pain medications, it seems that no one really wants to take responsibility now for my meds. My PCP agreed to one more painkiller...(Norco) refill, but said than any other meds for my back now have to go through my pain management doctor. I called the doctor and told her this and she seemed...peeved that my PCP would not order the other meds for me. Long story short, the only way the pain doctor is going to fill any meds for me is if I agree to steroid injections. Now, I'm not opposed to them...it's just that she downplayed them when I sat in front of her and now that the onus of prescribing meds is on her--she wants to do them. Maybe I am naive, but shouldn't she be doing an MRI first...to determine if my original arthritis diagnosis is the root of the problem? I feel like I'm being bullied to do something that was barely even touched on...and I am uncomfortable with it.
I feel that if I ask for the MRI first or physical therapy she will tell me NO MEDS!!! I understand she is wary, and even told her that I am willing to attempt to get by on less while trying the other meds she suggested..
Tonight I just feel like pulling out of this medical organization and starting fresh elsewhere. Just wonder if there is indeed a "red flag" waving over me in regards to the mistakes I made with my pain meds. Any thoughts on just breaking free from this group and moving on? Or am I over reacting and this is all standard procedure?
I appreciate any and all comments....truly...and hope everyone is having a pain free night..
Sounds like some mistakes and misunderstandings have gotten things all messed up for you, so sorry to hear that.
I'm fairly new to this world of Pain Management, and fortunate to still be working with my PCP to manage my scripts, no contracts, no random blood or urine tests.
I was taking Norco for quite some time at the rate of 30/Month but as soon as I asked to 'up' that count I was immediately switched to a more conventional Long Acting Base Med with Norco as the Break Through back up. 180 Norco a month (If that is correct) is not the optimum (LA, sole) drug for long term Chronic Pain management from everything I have read. If MS Contin was not working they should have run down the list of other LA Meds like OxyContin, Opana, Exalgo, Kadian, et....