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WHO ultimately decides what the "violations" to PM are?


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Old 04-21-2018, 02:22 PM   #1
trm0002
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WHO ultimately decides what the "violations" to PM are?

The Doctor's always take about "they". Who are "they"? "They" don't want anyone on pain management to have even a glass of wine with dinner because "they" consider it also an addiction. If you (at 52) fail another drug test due to alcohol, you'll have to go for counseling, and a third offense will mean discharge. I have no choice because that's the rules "they" have set.

To be completely honest, I never read completely through the pain management contract because I figured it was pretty straight-forward. Take what you're supposed to take, how much you're supposed to take, and when you're supposed to take it. Don't doctor shop for multiple Drs/scripts. Don't take any illegal drugs while on PM. Lastly, be ready to prove it all through random drug tests. I mean what else could there be to it? Ok, sign here, I'm in.

Wait, what? After THREE years I failed a test because it showed alcohol keytones and it's a prohibited substance because "they" said so? I'm surprised I didn't fail a bunch of them. Not once did I consider having a glass of wine when out to dinner a violation. Which brings me to what prompted me to write this post. The Dr. was completely sympathetic but said it is completely out of his control because they say so. He went so far as to tell me to feel free to continue doing it BUT make sure I don't within 5 days of any appointment.

How do "we" get to "they" and bring them down off of their uninformed high-horses? It's pretty obvious that if it took three years for me to violate that stipulation that I don't have an alcohol problem/addiction and I'm sure most people in PM are in the same boat.

WHO ARE THEY? Is it Federal? State (In my case NY)? Both? I'd like to have a direction on who "they" are to contact to have them review this policy. Obviously one correspondence from me isn't going to do anything but thousands or millions from people on PM just might. The problem is it seems to be as impossible to find "they" as finding the right person to talk to in a large corporation. Help us all find "they"...

 
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Old 04-23-2018, 11:30 AM   #2
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Re: WHO ultimately decides what the "violations" to PM are?

Dear trm,

Don't get me wrong. I suffer pain daily and I love pain relief. I can barely remember back when I had no pain, and I can't even remember what it felt like to feel good. I am not in a hurry to leave this sod, but I look forward to having no pain. Also because of liver disease I choose to not live on pain pills. I do take some overthecounter pain relief when it gets bad enough. It just take the edge of of the pain.

I understand your frustration with the promise of pain relief then getting what seems like punishment. It's not your fault that so many people abuse the drugs so that there is a pain pill crisis going on. The more cooperative you will be, the easier this will be on you. If you just found out that you cannot mix the pain med with alcohol, then just do not do it. That is a common message with any pain med and many other prescriptions.

Alcohol is not a health food and mixed with pain meds it is deadly. The pain meds by themselves are poison. Alcohol is from fermented food and so is poison, too, but I know, some people acquire a taste for it. It's for you to decide - drink and risk losing the pain meds, or follow the doctor's instruction. You choose. Your doctor was very kind. He could have just cut you off from the drug. The pain pill instructions are clear about alcohol. It's our own responsibility to use drugs as directed.

The overall goal is to cut back the unhealthy model of drug dependence and addiction. Pain or not, pills are drugs with unhealthy side effects. Pain pills are not health food. In fact, the way to pain relief can be deadly. The drugs used to put our bodies to sleep for surgery are poisons and so are the drugs used to dull pain. Many of the other prescription drugs are poisons, too. They are not building up the body. We just like the drug side effects.

I understand your frustration since basically honest folks like you trying to be sure to be compliant are getting caught in a snare caused by drug dealers and by drug manufacturers who besides wanting to make money also do want to create effective pain relief. I don't believe this is a big conspiracy. The fact of the matter is pain medication is not healthy for the brain or body. People just are not infallible so mistakes are made along the way then there is that painful process of back-tracking which affects all of us.

I personally from experience don't believe pain meds are a healthy way to live so I live with pain and I deal with it in other ways. I always have some pain. How I handle my pain is just my choice (not going to explain the 52 years of pain and suffering due to accidents and illness, surgery, etc). To me, pain is just part of life.

You can look into other means of pain management beyond taking pain pills.
The doctor is right that you can choose healthy living or suffer the consequence of the health profession not trusting you with the pain meds. It is the same for all of us. That's the law. It's a good law made for our safety and health, too.

Those who refuse to live healthily affect all of us. So blame those people, not the rules or the rule enforcers.
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Last edited by Administrator; 04-23-2018 at 11:50 AM.

 
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Old 04-30-2018, 08:55 AM   #3
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Re: WHO ultimately decides what the "violations" to PM are?

Trm,
The physician determines what is in their contracts, based on best medical evidence. Some, not all, doctors do not allow alcohol at all, while others may.
There are several pain medications when combined with any alcohol can potentiate respiratory suppression and alcohol is strictly forbidden.
Every patient should and is expected to read and understand what they are agreeing to. Saying you didn't bother to read it because you thought it was standard.Random urine tests, pill counts, fill at one pharmacy, no early fills, refills etc are typical, but there are typically things specific to each provider.

Last edited by Administrator; 04-30-2018 at 09:24 AM.

 
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Old 05-01-2018, 06:38 AM   #4
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Re: WHO ultimately decides what the "violations" to PM are?

Yes, the doctors are responsible for rules and such for opioid patients. However, they are doing this because they are getting pressured from all sides - DEA, FDA, insurance, government, etc. Some states (Washington for example) have released guidelines, even publishing a "maximum" allowed dose. Many insurance companies are requiring prior authorizations for any long term opioid script, and require conditions to be met for them to authorize payment.

If doctors don't limit prescribing to reasonable doses for vetted patients with a documented diagnosed pain condition who have failed multiple other treatments, have patients follow contracts, screen them for issues like addiction, do UAs, etc, then they are at risk of getting their license suspended. I doubt doctors want to have such strict requirements, they are being backed into a corner.

Some good has some from these new "rules", with pill mills and such being shut down, but I have also heard of seemingly legit doctors losing their license and pain patients being released from care without having a doctor willing to continue prescribing for them (just due to being associated with a "bad" pain doc).

Doctors have to justify every prescription for every patient - lots of paperwork. The way I see it, contracts and such also protect patients in addition to doctors, as they reduce the risk of our being cut off by a doctor due to them losing their license. I'd rather be restricted a bit and get pain meds then get nothing at all. The pain management climate is moving away from using opioids long term for chronic pain, without a real alternative for folks who have failed other treatments. I am hearing of folks being cut off or having their dose dropped, for no reason other than their doctor is no longer comfortable with the risk.

I think you are very lucky to have not been dropped as a patient for testing positive for alcohol if your contract says that is not allowed. I suggest you read your contract thoroughly to ensure you aren't missing anything else, and follow the rules. We don't really have a choice if we want to keep getting pain meds. Best wishes.
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