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    Old 02-23-2005, 10:39 AM   #1
    tkgoodspirit
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    Exclamation Some information on the "New Regs" for dispensing controlled substances.

    Hey all,

    I wanted to make this a new thread so it wouldn't be lost in the other thread. I "think" I may have some kind of information about this.


    I think I can post this website here as it is totally informational and it is a .gov

    http://www.deadiversion.usdoj.gov/index.html

    Okay, it is the US Department of Justice Drug Enforcement Agency Diversion Control Program

    It looks to me like it deals totally with controlled substances. Once you reach the website on the left side of the page are all different links. Click on Federal Registration Notices Then there will be a page of all different topics, scroll down to Rules- 2004 Click on that and you will be brought to a page with lots of topics listed:

    The one that lists this "no multiple writing of scripts" is found by clicking on the following topic:

    Dispensing of Controlled Substances for the treatment of Pain (November 16, 2004)

    Okay, here's a bit of what I found at this part of the website:


    Refills of schedule II prescriptions--The August 2004 FAQ stated: "Schedule II prescriptions may not be refilled; however, a physician may prepare multiple prescriptions on the same day with instructions to fill on different dates.'' (Italics added.) The first part of this sentence is correct, as the CSA expressly states: "No prescription for a controlled substance in schedule II may be refilled.'' 21 U.S.C. 829(a). However, the second part of the sentence (italicized above) is incorrect. For a physician to prepare multiple prescriptions on the same day with instructions to fill on different dates is tantamount to writing a prescription authorizing refills of a schedule II controlled substance. To do so conflicts with one of the fundamental purposes of
    section 829(a). Indeed, as the factors quoted above from the Rosen case indicate, writing multiple prescriptions on the same day with instructions to fill on different dates is a recurring tactic among physicians who seek to avoid detection when dispensing controlled substances for unlawful (nonmedical) purposes. It is worth noting here that the DEA regulations setting forth the requirements for the issuance of a controlled substance prescription are set forth in 21 CFR 1306.01-1306.27.



    You can read all the other mumbo jumbo for yourself at the site, as well as take a peek around that home page and check out different links. I don't know if this is what you are all looking for, but I hope it may answer some questions. Especially at the first link I gave you. There are a lot of referals to different sections of laws and what have you.

    Hope this helps. Check it out. I too am like most of you and I get multiple scripts written for my Duragesic Patch and my Percs. Now instead of going every two months I guess I'll go once a month. But won't this over load the doc? You really won't get much "personal time" with him when you go for a script refill appt. like to discuss other meds or what have you, the poor man will be rushed. I know that most times I have a long wait just to see my doc. He has so many patients, (he's very popular!) that a lot of times your appt is at 10 and you may see him at noon! LOL But for me, he's worth the wait. But why can't he just write a script for the Patch or the Percs and just double the amount? This would last you two months. Like for one month my Percs are 120 quantity. Couldn't he just double that? Or is that a "no no".

    Anyway, I hope you all can find some answers here. It is a .gov site and it looks as though it is a branch off of the DEA site.



    Have a good day guys,
    tk

     
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    Old 02-23-2005, 12:13 PM   #2
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    [QUOTE=tkgoodspirit]

    Hi TK,
    Thank you for the site. I can always learn more and NEED to in this everchanging drug circus world.

    > I too am like most of you and I get multiple scripts written for my Duragesic Patch and my Percs. Now instead of going every two months I guess I'll go once a month. <

    Have you been told that to get a script you will need to make an appointment to see yr Dr.? In Calif. we don't need an apt. we just call in and pick up our C-2s at the nurses station, with an appointment every 3rd month. Also, as a chronic pain pt. here in lovely crowded Southern Calif. I find it odd that I have never been referred or pushed to go to pain management; my PCP does all the prescribing. So, with this new "direction" the DEA is taking, so far anyhoo, new and expensive added on Dr.s apts are not a requirement. (here)

    > But why can't he just write a script for the Patch or the Percs and just double the amount? This would last you two months. Like for one month my Percs are 120 quantity. Couldn't he just double that? Or is that a "no no".<

    I believe that what you are describing would def. be a no-no. If not for the DEA then for your insurance. A one month script is for 1 month..no more. But wouldn't it be lovely...................

    Hey, have you gotten the new generic patches yet? If so..give us your take on them. Again, thanks for the info.
    Sparkles

     
    Old 02-23-2005, 02:07 PM   #3
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    [QUOTE=SheSparkles]
    Quote:
    Originally Posted by tkgoodspirit

    Hi TK,
    Thank you for the site. I can always learn more and NEED to in this everchanging drug circus world.

    > I too am like most of you and I get multiple scripts written for my Duragesic Patch and my Percs. Now instead of going every two months I guess I'll go once a month. <

    Have you been told that to get a script you will need to make an appointment to see yr Dr.? In Calif. we don't need an apt. we just call in and pick up our C-2s at the nurses station, with an appointment every 3rd month. Also, as a chronic pain pt. here in lovely crowded Southern Calif. I find it odd that I have never been referred or pushed to go to pain management; my PCP does all the prescribing. So, with this new "direction" the DEA is taking, so far anyhoo, new and expensive added on Dr.s apts are not a requirement. (here)

    > But why can't he just write a script for the Patch or the Percs and just double the amount? This would last you two months. Like for one month my Percs are 120 quantity. Couldn't he just double that? Or is that a "no no".<

    I believe that what you are describing would def. be a no-no. If not for the DEA then for your insurance. A one month script is for 1 month..no more. But wouldn't it be lovely...................

    Hey, have you gotten the new generic patches yet? If so..give us your take on them. Again, thanks for the info.
    Sparkles

    Sparkles,

    My PCP refered me to a PM doc, standard procedure for my insurance at the time. I've found that most PCP's will not write scripts for opiates, that they refer that to a PM doc or clinic. Most posts I've read here are the same, you are lucky there in CAL. A PM clinic or PM doc usually has a contract with you that you are only to obtain narcotics from that doc, or clinic. And there is no way I could ever just go an pick up a script or have one mailed. I've read some here get their's mailed. When I go every two months to get my refill script, we either see the doc or more recently a PA, this way we can tell the doc face to face how our meds are working, discuss other issues (time permitting) and he can see us and how we are acting, and treat us face to face. I guess a "non-script" appt would be for something different, but I have always found that I can address other issues at my script refill appt. with no problem, my doc takes the time to listen, that's why sometimes he is a long wait! LOL Now I have been waiting for my script appt and he was running so far behind when his nurse would come out into the waiting room and ask each of us who were waiting for the doc who needed to talk with him and who just could "pick up their script". I've only done that once. The other time I had to talk with him because I wanted to ask him about changing my meds. So, after I see the doc, I go right to the receptionist and make my next appt. My meds used to be a two month appointment schedule, when I was just on Lortab it was every three months.

    Now as far as having to see him once a month since the rule change, I don't know. I saw him last in January and he wrote the mutliple scripts for me, and my next appt. is March 2, so I guess I'll find out then. Personally, I like seeing him at a refill appt. Then I can talk with him about whats been going on, and also it is at these appts when we may be asked to submit to a drug screen which is part of the PM clinics contract. He also sometimes asks questions like, "Are my meds helping to improve my quality of life" "Do I feel like I'm living around my pain or around my meds" Stuff like that, just so he is sure that he is helping me. One time I was going in for injections for my cervical spine and I was on the table waiting for the fluorscope and the big needle, and I simply stated to him that I had a lump on my backside. That was that, I got the injection, made my next appt. and was on my way. Well, 4 days later I got a call from a Compound Pharmacy where my PM doc had called in a script for a special cream that has anit-inflammatory, numbing and pain killing ingredients in it. He said I had an inflamed trigger point. I was so impressed that he took the time to call in a special script for something I had just mentioned to him while I was sitting on the table waiting for my injection.

    So, I guess, no most PCP's, at least not here, or not mine, and not from what I read here will even touch narcotics. Mine has prescribed Darvocet, but anything more will be the job of a PM doc. Now I may get Soma or Zanaflex out of them, but any kind of opiate is no way gonna come from a PCP. And I think most people here on the PM board go thru the same, they get their narcotics from a PM, now HOW they get them I think varies from doc to doc. My doc likes to see our smiling faces. I've actually gone for a script appt. and brought up my tension headaches and he had his nurse set up right then and there an appt for a "nerve block" (where they inject a numbing agent directly into the back of your skull). So I may have to wait an hour and half past my appt time, but its worth it to me.

    Oh and as for the generic patch, not yet, but I'm sure I'll get it this next time around, since I know my pharmacist carries it. I also need to bring up to my doc that the patch isn't lasting the 72 hours, only 48 hours of "good" pain relief. So that's another reason why I like to "see" him during a script refill appt.

    I suppose I could call the office and ask if I will now have to be seen on a monthly basis, but they are busy, REAL busy, and I'll find out soon enough.

    Have a good day,
    tk

     
    Old 02-23-2005, 02:57 PM   #4
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    I get one script a month and it is dated for that day. Since I only see my PCP every other month (at his direction since I'm stable on the med) and when I'm close to being out and in need of a new script I just call the office and tell them what day I'll be in to get it. I go in and and pick up my monthly script for 540 Methadone (10 mgs) tabs (I know, it's a very high dose!) and it will be dated for that day. Usually, it's not filled for three or four days after I picked it up, because I always call the the head pharmacist where I will be in to get it filled and that way she can make sure she has enough meds on hand (because of the large amount) to fill my script.

    So, I go in to my doctor's office every month, but every other month I don't see him. I get it from the receptionist, where it's waiting for me.

     
    Old 02-23-2005, 03:04 PM   #5
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    [QUOTE=tkgoodspirit] And there is no way I could ever just go an pick up a script or have one mailed.

    I was wondering... I do this every 3 months to get my appointment over and my script picked up. Why can't you? Oh and another difference......along with no PM clinic or doctor..........I have never had a contract offered....even to look at. Funny, Calif is sometimes ahead of the game but we are sure behind in this regard. No contract or pharmacy restrictions. Not even at Kaiser. I have often wondered if other areas of Calif. are different.
    Sparkles

     
    Old 02-23-2005, 10:43 PM   #6
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    Quote:
    Originally Posted by Director
    I get one script a month and it is dated for that day. Since I only see my PCP every other month (at his direction since I'm stable on the med) and when I'm close to being out and in need of a new script I just call the office and tell them what day I'll be in to get it. I go in and and pick up my monthly script for 540 Methadone (10 mgs) tabs (I know, it's a very high dose!) and it will be dated for that day. Usually, it's not filled for three or four days after I picked it up, because I always call the the head pharmacist where I will be in to get it filled and that way she can make sure she has enough meds on hand (because of the large amount) to fill my script.

    So, I go in to my doctor's office every month, but every other month I don't see him. I get it from the receptionist, where it's waiting for me.
    OOOOO....you are so lucky. My PM doc will under no circumstances call in any meds, and you can't call for refills, you have to make an appt. He just wants to see our smiling faces I guess! It's okay, it'll run up my doctor costs, but I just claim it at tax time, besides, he's pretty nice on the eyes, and it gives me somewhere to go, and someone to dress nice for! LOL You are lucky you can do that. I can't even do that with my PCP. It depends on my situation, I've had my PCP for 8 years so there are some things I can get him to call in for me without me going in for an office visit. And my rheumy will also call in scripts. But when you call my PM's office there is a recording that goes through the "no calling in refills" and "no refills without an appt" before you get to even push a button to select who you wish to speak with!

    Thanks for your reply. It sure does show you how different our docs are doesn't it?

    tk

     
    Old 02-23-2005, 11:00 PM   #7
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    [QUOTE=SheSparkles]
    Quote:
    Originally Posted by tkgoodspirit
    And there is no way I could ever just go an pick up a script or have one mailed.

    I was wondering... I do this every 3 months to get my appointment over and my script picked up. Why can't you? Oh and another difference......along with no PM clinic or doctor..........I have never had a contract offered....even to look at. Funny, Calif is sometimes ahead of the game but we are sure behind in this regard. No contract or pharmacy restrictions. Not even at Kaiser. I have often wondered if other areas of Calif. are different.
    Sparkles
    I usually do that. My appointments to see the doc are two months after I am there for my script, and they are made to pic up my next script refill. Like I went on January 2nd, got my two scripts for Duragesic and my two scripts for Percs. Both were for "right now" and then there were the two "do not fill until" so as to prevent me from coming back every month since my supply is only a month supply. I have to refill once a month. Just as you know, it's not like a script for Soma or Klonopin where you get your script and you have 5 refills. Percs and Duragesic have NO refills. That is why PM docs always wrote multiple scripts, to keep there patients from making monthly trips to the office. Lortab is a three month visit, must be a different class of med. And a lot of PM clinics have contracts as to protect themselves as well as their patients from "doctor shopping, hopping", what ever it's called. I feel comfortable knowing that I'm being looked out for and like Shoreline says, he doesn't want to go to his PM doc's office and find DEA tape across the door! LOL I believe he has the same kind of deal with his PM doc, he has a contract also. It's not uncommon. Someone else here posted as to the fact that they had to sign a new contract because of the new rules for schedule II meds. It says that you won't receive your narcotics any where else or from any other doc unless your PM doc approves. I remember one visit I mentioned that I was taking Ultram, and the nurse had to write it down, the dose as well as the doc who prescribed it for me and how many refills I get. So now, my PM doc knows pretty much that he prescribes me anything that has to do with pain, even my muscle relaxants. And like I said in my last post, we are regulated by random drug tests, just to be sure we have in our system the narcotics that are in our charts. I also had to tell them that I had taken an old Lortab the day before my appt. because my refill appt. was a couple days late, and I had ran out of Percs for a couple days, so I took some old Lortab that he had prescribed me way back when. But I had to tell them everything I took, so that it showed up in my screen. I know they do this to protect themselves, cuz what if I was an addict and I was out there buying Oxycontin by the buttloads and it showed up in my urine specimen, well, if it's not being prescribed to me by my PM doc, I'd lose my PM priviledges. And I have seen plenty of stories here where people lost their PM privlidges. Some by not abiding by their contract, some by calling and calling demanding early refills. You just have to be careful with PM. To me it's a privlidge and I am not going to take any chances to lose that privlidge.

    I wish it were as easy as it is for some of you, but in a way, I am glad it is the way it is for me, cuz I feel like my doc is taking extra precautions so as not to get his butt in any sort of controversy that will end his practice and therefore put me looking for another PM doc. Like Shoreline says, "you don't want to see that DEA tape across their doors!"

    Here's wishing you a good spirit,
    tk

     
    Old 02-23-2005, 11:22 PM   #8
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    [QUOTE=tkgoodspirit]

    >I feel comfortable knowing that I'm being looked out for and like Shoreline says, he doesn't want to go to his PM doc's office and find DEA tape across the door! <

    > Like Shoreline says, "you don't want to see that DEA tape across their doors!" <

    I guess Shoreline has made it clear to you how he feels about that DEA tape, eh? I confess I am most aware that this occurance can happen anywhere in the USA these days, however, along with the more relaxed way of handling pain meds at my medical group, there is plenty of charting and plenty of offers of treating chronic pain peripheral to scripts. The pharmacy is friendly and more than willing to help pts. learn proper pharmacy etiquette without seeming like the Spanish Armada has pulled into town. Different areas of the country will have different ways of getting their jobs done.......doesn't mean either is any less concerned about their clients/patients. Or their medical license.
    Sparkles

     
    Old 02-23-2005, 11:45 PM   #9
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    [QUOTE=SheSparkles]
    Quote:
    Originally Posted by tkgoodspirit

    >I feel comfortable knowing that I'm being looked out for and like Shoreline says, he doesn't want to go to his PM doc's office and find DEA tape across the door! <

    > Like Shoreline says, "you don't want to see that DEA tape across their doors!" <

    I guess Shoreline has made it clear to you how he feels about that DEA tape, eh? I confess I am most aware that this occurance can happen anywhere in the USA these days, however, along with the more relaxed way of handling pain meds at my medical group, there is plenty of charting and plenty of offers of treating chronic pain peripheral to scripts. The pharmacy is friendly and more than willing to help pts. learn proper pharmacy etiquette without seeming like the Spanish Armada has pulled into town. Different areas of the country will have different ways of getting their jobs done.......doesn't mean either is any less concerned about their clients/patients. Or their medical license.
    Sparkles
    I think you hit the nail on the head when you made reference to your pharmacey being right there. My PM doc has a private practice, that he shares with a Urologist. He used to be in the Medical Center Clinic and there was an on sight Pharmacy. Here he writes the scripts and we go off to our own pharmacy. It is probably much easier to control and keep tabs on the PM patients where you are when you are all using the Pharmacy right there.

    I see that some PM clinics or docs are more "relaxed", even allowing some pts to "phone in" refill requests, but I honestly believe that is not the norm, and no matter how your PM works, as long as we are treated and cared for, then we are all getting what we need. I always get what I need, and I get one on one doctor time with my doc every time I go in for a refill, which looks like it may be every month now! LOL Bless his soul, I feel sorry for him somedays, he is so backed up, and like I said on those days, the nurse will come out and see if some of us only need our refills and not to actually talk to the doc, so she will hand us our script and we make our return appt and be on our way. There has only been one time, where the doc was so over whelmed by patients, it was right when he moved from the clinic to private practice and he was trying to get all his patients "caught up", we ALL went without our regular meds for over a month, this is when our PCP's stepped in. I got Darvacet from mine, and that was a biggie for him! LOL Anyway, I only encountered one time when I was just given my script and sent on my way. But we always get to see the nurse, and I get to actually chit chat with her a bit, I like her, it was her that I originally asked about the med Fiorocet for tension headaches and she said she'd talk to the doc and she'd call it in for me.

    And, yes, Shoreline, is one of my hero's here on the board! Ken (Streetcar, I think is his handle, if not, I apologize Ken!) and Twisten. All my hero's. But Shoreline is kinda like a close "girlfriend" who knows everything you want to know about and end up calling on the phone all the time. Only Shore isn't a girl, and the board is the "phone"!


    Thanks for the late night chit chat!

    tk

     
    Old 02-24-2005, 05:50 AM   #10
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    If thgat's what they want to do then thy need to ameend the drug control act of 1970. It seems to me they are disposing the only tool a doc has to demand absolute cmpliance? It's interesting the dea sees it as a away around the law however it ties the hands of the docs and allows patients to fill on the day the script is wriiten. We will see more and more patients get dismissed over minor compliance issues . Now it's our job to count days supplies and wait untill the 30th day to fill a script.

    They took control of the patients away from the docs in order to control the docs that were using the only tool they had to enforce a 30 day supply. If they think the docs will be seeing every patient the day their script runs out , they need to wake up and realize it's not logistically possible. What if the script is due on a weekend or holiday? Tough luck for the patients. A few days of withdrawal never hurt anyone?

    It's not a refill on a single script, It's an entirely new script, that hasn't been post dated and the fill on or after date demands complete compliance from the patient. Where is the diversion aspect of this problem? A patient has his next script he cant fill untill day 30 versus having a script they can fill the day of their apt whether it's time or not? Ughhh. And these are our leaders?
    Be careful what day you fill your scripts, the only way they are going to catch folks is demand pill counts and to see the bottles and what day they were filled.
    It was conveineant to drop a script off a day early because I drove right passed the pharmacy or only had a ride that day won't fly, no excuse will be excepted because they have already heard them all and this is the only tool they have left to enforce compliance. It may get folks dismissed from practices. But won't stop abuse of drugs.
    Oh well, take care, Dave

    Last edited by Shoreline; 02-24-2005 at 07:17 AM.

     
    Old 02-24-2005, 07:07 AM   #11
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    I just read that page it it's basically what I described, a new ninterpretation of a very old law due to perccieved increase in prescription drug abuse. I guess if people were not abusing prescription drugs this would be a non issue. and we wouldn't need the DEA and dept of justice to re interpret the law to force docs to comply with the new interpretation of the law, If this was indeed illegal, they could shut down half the exsting PM docs in the country, but they didn't because it's not against the law, It's now what the DEA wants andhow they interpret the reasoning behind writing scripts with fill on or after dates but still takes away the best tool to ensure compliance the docs have.

    But we live in america, where laws can be reinterpreted to suite the desire of the DOJ and DEA or any dept looking out for national security. Still very sad and still not part of any law untill they amend title 21 of the drug control act of 1970. I guess chronic pain patients are not allowed to travel for more than 30 days at a time. Seems that infringes on my right to pursue happiness. But what the heck, It's only our declaration of Independence.

    The Declaration of Independence: A Transcription


    --------------------------------------------------------------------------------

    IN CONGRESS, July 4, 1776.

    The unanimous Declaration of the thirteen united States of America,

    When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

    We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, --That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.--Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.
    ................................
    It seems to me a rise in the drug abuse rate is a light and transient cause to change our legal foundation.
    I'm now a prisoner in my own country, unable to leave or travel for more than 30 days because I'm disabled and require medical treatment? Hmm what other civil rights can we trample on.

    What other countries don't allow their people to travel or leave the country, OH yeah, all those countries that we have declared war on/ called our enemies or a threrat to world peace and fought for their citizens right to pursue happiness and stop tyranny.
    JMO
    Dave

    Last edited by Shoreline; 02-24-2005 at 07:30 AM.

     
    Old 02-24-2005, 10:51 AM   #12
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    Right on, Dave!!!!
    I hadn't even thought of the traveling issue....probably because most of the folks with chronic pain issues have no $$$ to travel for that long cause we've given all of our moola to the docs and drug companies!LOL

    Thanks for the original post, TK. It will be interesting to see what happens at my next appointment. I got my 3 months worth of prescriptions in Dec and don't go back to see my doc until March sometime. ~Mush

     
    Old 02-24-2005, 12:07 PM   #13
    tkgoodspirit
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    Quote:
    Originally Posted by Shoreline
    If thgat's what they want to do then thy need to ameend the drug control act of 1970. It seems to me they are disposing the only tool a doc has to demand absolute cmpliance? It's interesting the dea sees it as a away around the law however it ties the hands of the docs and allows patients to fill on the day the script is wriiten. We will see more and more patients get dismissed over minor compliance issues . Now it's our job to count days supplies and wait untill the 30th day to fill a script.

    They took control of the patients away from the docs in order to control the docs that were using the only tool they had to enforce a 30 day supply. If they think the docs will be seeing every patient the day their script runs out , they need to wake up and realize it's not logistically possible. What if the script is due on a weekend or holiday? Tough luck for the patients. A few days of withdrawal never hurt anyone?

    It's not a refill on a single script, It's an entirely new script, that hasn't been post dated and the fill on or after date demands complete compliance from the patient. Where is the diversion aspect of this problem? A patient has his next script he cant fill untill day 30 versus having a script they can fill the day of their apt whether it's time or not? Ughhh. And these are our leaders?
    Be careful what day you fill your scripts, the only way they are going to catch folks is demand pill counts and to see the bottles and what day they were filled.
    It was conveineant to drop a script off a day early because I drove right passed the pharmacy or only had a ride that day won't fly, no excuse will be excepted because they have already heard them all and this is the only tool they have left to enforce compliance. It may get folks dismissed from practices. But won't stop abuse of drugs.
    Oh well, take care, Dave

    Hey Dave,

    I'm not sure I quite understand your post. I don't know how your clinic works, but at mine when I go in for my two month refill appt. My next one is March 2, which means my last visit was Jan. 2, (sometimes give or take a few days, and its usually earlier than I will run out if the receptionist notices that I will be out on a weekend or holiday). So when I see my PM doc he hands me two scripts for each narcotic I take, in my case the Duragesic Patch and the Percs. One script is dated to fill that day and the other is dated to fill on exactly one month from that date. And it always says in bold type DO NOT FILL UNTIL..... You are right, it isn't a "refill" that's why it says "do not 'fill' until", it has always been this way for me, since I started seeing my PM doc in 2002. I always had mulitple scripts. But from what I understand now, when I go on March 2nd I will walk out with only two scripts, one for Duragesic and one for Percs, both to fill on that day (or later if I have some left, which I NEVER have patches left, but sometimes I have Percs left, but I always get them filled right after I leave his office.) THEN I'll make my next appt. to get my "new" scripts from the do for the same meds for the NEXT month, not the month AFTER next? Am I understanding this correct? That is what I'm taking away from this new "reg". The only scripts I walk out of my PM docs that have refills on them are my Zanaflex and my Fiorocet, which always have 2 refills so that I run out insync with my narcotics. So I'm wondering about those meds now, I guess it will stay the same, I'll just get a new script for them every other month. Boy this is confusing. But from what I am seeing here, I will now only get my scripts for my Duragesic and my Percs written for THAT day, the day of my office visit. No more multiple scripts that I hang on to and fill when the date specifies? I have never had a problem running out before the DO NOT FILL date.

    It is the following statement that you made that I don't understand:
    "It's interesting the dea sees it as a away around the law however it ties the hands of the docs and allows patients to fill on the day the script is wriiten. We will see more and more patients get dismissed over minor compliance issues . Now it's our job to count days supplies and wait untill the 30th day to fill a script." I don't understand how "we will see more and more patients get dismissed over minor complience issues" Do you mean that given that 30 supply of our meds that we are given on the day of our office visit possibly runs out say a day or two early we are at the mercy of waiting for our next appointment to get relief? Is that what you mean? Which I can totally understand, as some times even I will take an extra 1/2 of a Perc if I am in a lot of FM pain, and all I can do is go from the chair to the bed most all days, and yes then I will run out early maybe by a day. But I still couldn't get my next script because of the DO NOT FILL UNTIL date on my ohter script I have sitting on my dresser in my bedroom. So, I'm not understanding your point, I guess. Don't take offense, sometimes you go over my head a bit! And YES I do see where it will totally overwhelm the PM doc or clinics patient load by having to see us all each month. I know my PM doc sets aside one day a week for "procedures" like the epi injections or whathave you. His nurse always called those her "easy" days! So now I'm wondering if he will even have the time to do those. I know he's done them for me but always between my "script appointments". I just can't imagine, going in for an injection and getting your scripts on the same day, when do you have time to discuss the possibility that maybe your meds aren't quite working for you? I know that I have discussed surgery possibilities as well as other meds while my butt was totally exposed on the table during an epi injection. Yeah, there's a picture! LOL I also know that he has hired a PA, and his plan was that they would "rotate" appointments. One time I would see the PA for my scripts and then the next time I would see the doc. I suppose if it was my turn to see the PA and I had a question about maybe changing my meds he'd talk to the doc if need be, or I'd simply have to wait until my next appt. with the doc.

    Whew! My mind is totally blown now. Shore, can you clarify for me how this will disrupt my reltationship with my doc? I simply love my PM doc, he seems to be the only doc, besides my PCP, (who won't write narcotic scripts because of my contract with the PM clinic , and personally I think most PCP's would rather their CP patients belong to a PM clinic so they DON'T have the responsibility of writing the narcotic scripts) who understands my pain both coming from my back and my FM, which I believe the worse my back gets, the more my FM flares up. Vicious circle.

    Oh and did I tell you that I will be getting back surgery FINALLY? I am going to talk to my PM doc about it at my next appt. (God, if there's time!) so he can refer me to a Neuro, and when he does so, I am going to ask if that Neuro will treat my FM instead of my Rheumy. Now all I have to do, once I get the name of the Neuro is call my insurance company to get an idea of how much all this mess will cost. New MRI, surgery, PT all that mess.

    Please tell me, is there PT after surgery? I imagine there would be, but it costs so much. My insurance policy says there is a $2500 cap on surgery, but I don't think that includes the PT that follows. I have pretty crappy insurance, with very high copays. My husband had to empty out what was left in our 401K so I can have the surgery. But I simply cannot stand this imobility now, and now I am told that I may have permanent nerve damage, ICK! My only hope now is that I get SSD so that I can use part of that money to rebuild our retirement fund, which is now non-existant! LOL

    Anyway, I'm sorry I got off topic, I just wanted to let you know about my decision to have surgery, and maybe you can tell me what to expect knowing how my condition has worsened with the inability to raise my leg or my foot and the numbness in my shin. And do you think I should have it before my SSD hearing?


    I'm sorry I got of topic of the DEA, but I really didn't understand your post. Clarify for your "medically illiterate" friend. And I did mean it when I said that you and Ken were my heros! LOL Oh and Twisten too of course! I think there are just some folks on the board you form a kind of "bond" with. I know that a lot of folks here on the board look to you for a lot of answers, and I know you like to help us, but I worry that it only adds to the extreme pressures that you have in your everyday life that doesn't include our constant pleas for help.


    Take care my friend, and I'll wait for that clarification whenever you are ready. Oh and wasn't your appt with your doc this week? If so, how'd it go?


    Sincerely,
    tk

     
    Old 02-24-2005, 12:23 PM   #14
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    Quote:
    Originally Posted by Shoreline
    I just read that page it it's basically what I described, a new ninterpretation of a very old law due to perccieved increase in prescription drug abuse. I guess if people were not abusing prescription drugs this would be a non issue. and we wouldn't need the DEA and dept of justice to re interpret the law to force docs to comply with the new interpretation of the law, If this was indeed illegal, they could shut down half the exsting PM docs in the country, but they didn't because it's not against the law, It's now what the DEA wants andhow they interpret the reasoning behind writing scripts with fill on or after dates but still takes away the best tool to ensure compliance the docs have.

    But we live in america, where laws can be reinterpreted to suite the desire of the DOJ and DEA or any dept looking out for national security. Still very sad and still not part of any law untill they amend title 21 of the drug control act of 1970. I guess chronic pain patients are not allowed to travel for more than 30 days at a time. Seems that infringes on my right to pursue happiness. But what the heck, It's only our declaration of Independence.

    The Declaration of Independence: A Transcription


    --------------------------------------------------------------------------------

    IN CONGRESS, July 4, 1776.

    The unanimous Declaration of the thirteen united States of America,

    When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

    We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, --That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.--Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.
    ................................
    It seems to me a rise in the drug abuse rate is a light and transient cause to change our legal foundation.
    I'm now a prisoner in my own country, unable to leave or travel for more than 30 days because I'm disabled and require medical treatment? Hmm what other civil rights can we trample on.

    What other countries don't allow their people to travel or leave the country, OH yeah, all those countries that we have declared war on/ called our enemies or a threrat to world peace and fought for their citizens right to pursue happiness and stop tyranny.
    JMO
    Dave

    Hey Dave, good point on the 30 day travel thingie. I know that when my mom was sick and dying from Cancer, I had to be in Iowa past my script appointment and I made many calls back home to my PM doc who actually DID call in a script for Lortab 3 week supply( I was on Lortab 7.5 at the time) to a pharmacy in my mom's hometown so that I could be okay until my next appointment. I was shocked he did it at all. I was very lucky.

    But, this part of that "rule" makes me wonder given the wording that it only "suggests" it is not okay for the doc to write multiple s****ts, not written in stone or law, or am I not seeing the "law"?

    Here's the part I'm speaking of:
    The first part of this sentence is correct, as the CSA expressly states: "No prescription for a controlled substance in schedule II may be refilled.'' 21 U.S.C. 829(a). However, the second part of the sentence (italicized above) is incorrect. For a physician to prepare multiple prescriptions on the same day with instructions to fill on different dates is tantamount to writing a prescription authorizing refills of a schedule II controlled substance. To do so conflicts with one of the fundamental purposes of section 829(a). (This was copied from my original post which included the whole phrase.) It says that it "conflicts" with the fundamental purpose of section "yada yada yada", it doesn't necessarily say it breaks the law. Or does it and I'm just not seeing it or reading far enough?

    Boy is this a hot topic! LOL, I'm glad I got everyone going on this! YIKES!

    I am anxious to hear more, wondering if anyone will or has spoken with someone of "higher power" on this subject, or has anyone spoken at length with their PM doc yet?

    Wondering?

    tk

     
    Old 02-24-2005, 12:24 PM   #15
    kellyp
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    Re: Some information on the "New Regs" for dispensing controlled substances.

    Can I ask when this is/was supposed to take effect? I have already seen my PM doc this year and got my usual two months worth of scripts. One set to fill the day of my appt, and one set dated for the current day, but with a do not fill until date. My doc usually makes it for 28 days so I don't run into any problems.
    I go again on Mar 2nd, I'll be interested to see if it's any different.
    Kelly

     
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