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Old 03-16-2011, 07:08 PM   #1
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Breaking a pain contract with PM

Hello all,

I have a question.....My wife and I both see the same Primary care doctor. We have been going to him for around 18 months. We are both treated by him for lower back pain. My wife experiences more pain than I do however my pain is very strong. The Dr prescribes us both the same med. We are both prescribed Oxycodone 30Mg IR tablets. Both prescribed 12 per day and given 360 pills per month.

Now here is where my question comes in. We are both on a pain contract with this doctor. Well about 9 months ago the doctor had my wife on oxycodone 15 Mg pills. 2 weeks after she was given these she contacted the DR and they discussed the medication and he decided he would up her strength. So I happened to be at the pharmacy picking up my medication and was discussing this with the pharmicist. He told me to make sure not to flush the remaining medication. He told me how to properly dispose of the medication she was being taken off. So that night after she took her last dose I properly wasted the remaining medicine. The following day she went to pick up her new script and the DR asked her for the remaining 15mg med. She informed him on the discussion I had with the pharmacist and what I had done. He then got angry with her and told her he was placing A strike against her contract because I had disposed of the medication.

While that bothered us we accepted it and moved on. That brings me to today...... A while back I had a discussion with the DR about getting this medication from the pharmacy and how they rarely have it in that amount. So we are either stuck waiting 5 days until the pharmacy gets the meds or go somewhere they have it. So..... last week we were out of town for a funeral. While gone my wife somehow misplaced her makeup bag with her medication in it. SO rather than tell me she just figured she would tough it out because she was due for a refill in 11 days. After a day without her meds she felt ill. She figured it was because she had this med for so long and was going without it. SO she phoned in to the DR and left a message on the refill line. That day the DR refilled her prescription.

Later the same day she called the pharmacies and located one of the local places with enough in stock to fill the script. She knew the ins would not cover it so she told the pharmacy she was paying cash. Well a few minutes go by and they come back and hand her the script and said.... It is too soon to get this filled. You still have 11 days on your old script. She said ok and left. Well she decided to take it to the other local pharmacy we go to and explained to the pharmacist she was out of her meds and how she lost her old bottle. She asked them to fill it and allow her to pay cash. He said he would like to but he better not. So he suggested she take it to a pharmacy where they did not have her information for the ins. Just as she was leaving the nurse from our primary called in with a script for another person. The pharmacist asked her if it would be ok to fill the script a few days early. The nurse said the other pharmacy already called in and told them my wife was trying to fill early. They told her to come in and see the DR the next day.

So the next morning she went into the DR office and the first thing he said to her is..." so your over using your medication huh?" she explained it had nothing to do with her overusing the meds.... she had lost her bag and the meds were in it. He told her he needs to void her contract due to her misplacing her meds. He then told her he would not write her any more of the pain meds. He instead wrote her a script for Methadone... to be taken 3 times a day for 7 days. And she has to come in every week to pick up a new 7 day supply for this med. He also told me I would not be getting a refill for my oxycodone because we live in the same house and she could steal mine so we needed to be on the same drug.

I went in to see him the next day and he asked my wife..."does he take this as prescribed?' she told him I did and he said... ok I will write you a 3 week supply only if your wife comes in for a drug test once a week. She agreed and we left. Well after a week on the methadone she phoned the DR today and asked him to reconsider her meds. She explained that she would come in weekly if needed so he could monitor her meds. The DR told her... I do not want to keep you on the oxy because I could lose my license. He said the pharmacy wanted to turn her in to the DEA and he told them not to.

What I do not understand is first... how she broke the contract. On the contract it says lost or misplaced medication will not be replaced. It does not say it voids the contract. Second what she did for the pharmacy to turn her in to the DEA? This whole situation is killing her. She has been bed ridden and this new medication is giving her NO relief from the pain. She is in a very tough spot right now and were looking for advise. Is there anything we can say to this doctor to change his mind? He says he wants us to both continue with his practice because he really likes us and does not want to see us leave. SO why is he giving her Methadone if he cant continue her on the medication that was working..... HELP

Last edited by digginhistory; 03-16-2011 at 07:15 PM.

 
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Old 03-16-2011, 09:37 PM   #2
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Re: Breaking a pain contract with PM

I'm sorry your wife is experiencing so much pain. How long has she been on the Methadone? I'm thinking the pain she's experiencing could be partly from the transition from the Oxycodone to the Methadone. Once her body adjusts, she may actually find it is effective. It may just be about giving the medication time.

I do know being from being with a pain management Doctor for the last year and a half that my Doctor is very strict about the pain contract and there really is no wiggle room. The medication is viewed as MY responsibility (I keep my medication in a safe in my home and when we go on vacation I just take enough for the trip and leave the remainder in the safe at home). As far as lost or stolen medication, there is just no compromise. Since its safe keeping is viewed as my sole responsibility, there would be no way that I would I ever approach my Doctor for an early refill. I think that is the "sticky" point for your Doctor - your wife attempting to a fill a medication 11 days early when it says in the pain contract that stolen or lost medication will not be replaced. Basically, pain contracts are totally at a Doctor's discretion and if the Doctor feels the contract has been broken in any manner then he can make adjustments to the treatment or drop you from pain management at anytime. I don't want to sound like I'm lecturing, I'm simply sharing my understanding of pain management. And now with Doctors feeling more and more pressure by the FDA and DEA where prescribing narcotic pain medication is concerned, they take the rules where "early refills" are concerned very seriously, being their the ones "writing the prescriptions" it is their medical licenses at risk.

I think that fact that your Doctor is willing to continuing to be willing to treat your wife with Methadone, shows he has compassion for your wife's pain. It shows he is very concerned about her that he is continuing her care and I seriously don't think at this point there is anything that will change his mind where the Oxycodone is concerned. At this point I think the best thing for your wife to do is keeping her Doctor in the loop about about the pain she's experiencing and focus on pain levels and this way he can possibly make adjustments to her current medication and possibly add an anti-inflammatory or a muscle relaxer to her medication to help ease your wife's pain. Given that this a new medication, it is definitely important to keep him in the loop regarding her pain levels.

I wish I could be more help. I do hope your wife starts feeling relief from the pain she's experiencing.


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Last edited by Fiona_Jo; 03-26-2011 at 02:24 PM.

 
Old 03-16-2011, 10:47 PM   #3
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Re: Breaking a pain contract with PM

What dose of methadone is she taking?

She was on a pretty high dose of oxycodone (60mg 6 x a day), so its likely that she isnt getting an equivalent dose of methadone into her system, and is getting some withdrawl symptoms - these shoul pass off in a week or so. Maybe she can talk to the doctor about a dose increase?
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Old 03-16-2011, 10:50 PM   #4
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Re: Breaking a pain contract with PM

Quote:
Originally Posted by jonnstar View Post
What dose of methadone is she taking?

She was on a pretty high dose of oxycodone (60mg 6 x a day), so its likely that she isnt getting an equivalent dose of methadone into her system, and is getting some withdrawl symptoms - these shoul pass off in a week or so. Maybe she can talk to the doctor about a dose increase?


He is giving her 10Mg 3 times a day. I asked him the day he gave the script to her if there was a higher dose. He said that 30 Mg is the most he can give her. That is the MDD.... I have a friend who is on Methadone and he gets 80Mg a day.... SO I do not know.

 
Old 03-17-2011, 01:36 AM   #5
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Re: Breaking a pain contract with PM

You both go on vacation, she forgets her bag with the item that she takes every two hours -in it. And you forgot your Pills also? Otherwise you would just 'loan' her some of your doses until you got back, right?

Each of you was taking 30mg Oxy, 12 times a day = 360mg per day x 2 people = 720mg of Oxy consumed in the household a day.....? Now, what Doctor in his right mind would want to be responsible for that? A guest could be in your home, next thing you know they are dead on your bathroom floor after exploring your medicine cabinet. Those quantities are a deadly weapon which need to be tracked.

You should have been placed on Fentanyl long ago due to the potency needed. As far as 'Contracts' go, at your level of household intake.....

If you lose, misplace, or forget your meds somewhere, then you need to make no mention of it and just deal. Between the two of you, you're saying you can't 'cover' the other during these events? Anyway, As soon as they heard those words, you were done. Then, you Pharmacy shop with $-Cash-$ in hand......... Any competent Pharmacist or Doctor would drop you like a hot potato. And you say this DR is still working with you? Consider yourself lucky.

Why no Fentanyl?

If your wife is truly in such bad shape then you should go to your local ER, perhaps with admission, and work out a new plan. It sounds like the Oxy addiction is winning -which means that the pain will only increase.

With these stunts and the quantity of Narcotic involved, don't blame the Doctors and Pharmacists when they reach for the phone. They gotta do some CYA to protect their livelihood in the event that heat comes down on them or someone turns up in the morgue.



I'm just sayin'


Last edited by Isotope; 03-17-2011 at 12:33 PM. Reason: ~ * ~

 
Old 03-17-2011, 09:11 AM   #6
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Re: Breaking a pain contract with PM

You could have shared your meds with your wife and she could have "payed you back " when she got hers filled at her regular scheduled refill date. That would have kept her form getting sick ( probably from WD's)
Everyone in PM knows that we have to be SO CAREFUL with our meds because the bad people have used all the excuses.
Why did the pharmacy threaten to call the DEA ? Was it the one that just happened to get a call in from YOUR Doctor ?

 
Old 03-17-2011, 11:52 AM   #7
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Re: Breaking a pain contract with PM

Get another pain doctor. The doc said the pharmacy called the DEA! The doc probably said that as a scare tactic. These people have a corner in the market and they seem to think that what they say is final. Just get another doctor for pain management and after you do, go back and tell the other doc he's fired! That is what I did after my last pain doc came into the treatment room and said that my cannabis levels were normal (after I submitted a urinalysis),

 
Old 03-17-2011, 12:14 PM   #8
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Re: Breaking a pain contract with PM

I'm all for firing lame Doctors and leaving PM Contracts when one is truly being mishandled but I don't see that here.... I see a Doctor scratching his head and practically offering to have daily drug tests administered just to get a grip on the situation..... I see Pharmacists who are put in the middle because they don't have 4 extra unopened 100tab bottles of Oxy available at all times to a particular client. To top it off the client wants early refills, they lose their pills, they portend to dispose of previous scripts and they come with 100$ bills in hand right before closing....

If this Doc were to be fired, it would be for continuing to treat with IR Oxy when he has reached a psuedo-ceiling of responsible dosing....

The poor Pharmacist is merely hoping his front door doesn't get broken down by the Feds for running hundreds and hundreds of Oxy's to a single household....

I'm just sayin'


 
Old 03-25-2011, 11:29 AM   #9
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Re: Breaking a pain contract with PM

Wow. I am amazed that you are able to even find a PCP who is willing to rx those meds at those doses to two people in the same family. It's rare to find a pcp who is willing to rx narcotics at all anymore. With those dosages I can't understand why you both haven't been switched to some type of LA medication such as fentanyl as the other poster suggested. You really should consider yourself lucky to still have this doctor willing to care for you. Are you on any other meds besides narcotic pain meds to control your pain? Any nsaids or muscle relaxers? Any physical therapy or other modalities to address your pain?

I'm also curious as to how the pharmacist instructed you to waste the unused medication? He told you NOT to flush the remaining med? I'm surprised he didn't advise you to save it and take it to your doctor to protect yourselves. I'm also shocked that he told you to take it to another pharmacy who didn't have your insurance information and try and get it filled.

I think you are both very lucky to have found a doctor who is willing to treat you but I can't help but wonder if you both might be better served in the long run to find a good PM specialist to help you. There is so much more to good pain management than just rx narcotics. I wish you both the best.

 
Old 03-25-2011, 10:02 PM   #10
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Re: Breaking a pain contract with PM

I won't get all smug and prejudiced on you or your story, because I don't know you personally and won't pretend to, but I will say that you're lucky to even have the same doctor right now. In fact, on that thought, you probably won't have him much longer anyway if he is prescribing ungodly amounts of meds to people the same way he did with you and your wife (ESPECIALLY you and your wife...). I think the guy is just begging to be shut down at that rate.

Some friendly advice for the future:

Never call for an early fill. I don't care if you just fell off the roof and there is a bone sticking out of your groin and you ran out a couple days early. Don't. Do. It.
Early refill is translated to "drug addict" in a doctor's office or pharmacy. Given the amount of meds your wife was getting and then trying to fill again 11 days early, I wouldn't be surprised if they did call the DEA. Most pharmacies will scoff and pout but fill a narcotic a day or maybe two days early, but 11 days... no way.

Second, the pain management branch of medicine is literally drunk with prejudice and paranoia. From day one you're an addict until you prove otherwise, and even then you're one slip up from being an addict anyway as far as they are concerned.
You're walking on glass, basically. Be very careful and consider that every step may be your last if you screw up even slightly.

Lastly, you should find a new doctor. This guy sounds like he is either way too compassionate and perhaps a tad uneducated at best, or a fly by night script dispenser at worst. Either way, it's no good for you.
I would be shocked if you find another doctor like this one. More and more they're getting away from the narcotic prescriptions and gravitating heavily towards PT and injections,etc. They in turn keep their hands clean and liability much, much lower.

I have personally been through hell trying to get my pain taken care of. I had the vertebra in my L1-S5 broken and splintered into my nerve bundle and of course surgery (plus a few other conditions that are less serious but painful just the same). Then after 4 years of constant prejudice and bias I begged my way into 30mg of oxycodone a day. 2 of the 7.5mgs every 12 hours and I was pretty much treated like some hobo junkie for it. White guy, mid 30s, midwest.... best of luck with that.

Last edited by Brokend; 03-26-2011 at 12:17 AM.

 
Old 03-26-2011, 02:54 AM   #11
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Re: Breaking a pain contract with PM

I agree, to paraphrase oscar wilde, to have one patient on 12 x 30mg oxy a day could be considered unfortunate, but to have a husband and wife both on them at the same time looks like carelessness.

Not saying anything at all bad about you and your wife, but perhaps your doctor is a bit reckless with his narcotic prescribing, out of a wish to help people. It must be so tempting, as a doctor, to write for a narcotic every time you see someone in pain, but narcotics have to be a last resort, not a forst response.

Have you and your wife tried and failed all other modes of treatment for your pains, and found that extremely large doses of oxy are the only thing that works?
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Old 03-26-2011, 09:13 AM   #12
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Re: Breaking a pain contract with PM

I too wondered why the same meds weren't shared, but, oh well. Why you haven't been switched to fentanyl patches OR a spinal cord stimulater? Geez, either would an improvement to dosing every few hours.

I'm on my third PM doctor in 15 years (due to ins switches) and have never been treated suspiciously by any. But I certainly understand that they have to be careful. I would like to think they look at everyone on a case-by-case basis.

 
Old 03-27-2011, 08:49 AM   #13
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Re: Breaking a pain contract with PM

I don't think that I can add much that hasn't already been said. After having been on both Oxycotin (long-acting oxycodone) and Percocet myself, I would say that treatment with this amount of short-acting pain medication is wrought with peril. Both you and your wife are in need of 24-hour pain relief such as that which long-acting pain meds such as the Duragesic patch provide. Plus, the longer you remain on these already high doses, the more your tolerance will increase and the more medication you will need and the cycle goes on and on with no end. You might consider getting off the narcotics altogether to avoid problems. Have you tried anything such as Lyrica or Cymbalta? This would keep both of you in the clear and out of tough situations such as this one. Your doctor does sound caring and sensitive and the longer-acting Methadone might be just the right thing.

Last edited by CaliGirl; 03-27-2011 at 08:50 AM. Reason: typo

 
Old 03-27-2011, 11:35 AM   #14
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Re: Breaking a pain contract with PM

Wow same thing happened to me and my ex,we were on the same meds and i think one of my exs friend called in (they got into it over money he owed to my ex)and told our dr that he wasnt taking his med right. He was out of town they called us both in for a pill count,this was at noon and we had to be there by 4.30. So he couldnt b there at all,i told them i could and they said we both had to be there with all our meds cause they all were the same. Now my ex did take a few extras sometimes,but i dont think they would have kick us out. I never thought this was fair,we are not the same person just cause we are married,if that was the case why did we have to pay 2 dr visit fees. We got cut off they wouldnt even let us come in the next day. so you arelucky we never got any more meds at all. we had to find different dr. NEVER USE THE SAME DR. NEVER TELL ANYONE YOUR DRS NAME. This happened years ago, me and him broke up years ago too. Look for another dr get you records yourself and see what bad things are in there,so that you know what you are up against. good luck

 
Old 04-04-2011, 01:43 PM   #15
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Re: Breaking a pain contract with PM

Doctors hear all kinds of "reasons" why people need their meds early...so don't take it personally...They have made themselves into concrete...they don't care anymore...if they did they wouldn't be able to do their jobs.. they can't believe everything they hear...no matter the reason...
I hate that you went through this, but just take it, learn from it, and find a better Dr. They are out there....

Rhonda

 
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