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  • Are they lying to me?

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    Old 07-11-2014, 07:50 PM   #1
    chosenatrandom
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    Question Are they lying to me?

    I take 15mg of methadone four times a day, and another 15mg of oxycodone four times a day for thoracic compression fractures. It's barely enough, but at my last PM doctor visit the resident shrink told me that they would have to reduce my oxycodone to twice daily because of new federal guidelines that place a new cap on the total amount of controlled painkillers a patient could be allowed.

    I was suspicious immediately since I had read that there are no federal caps on dosages, and asked if it came from the DEA or the FDA.

    He waffled briefly and finally committed to the DEA. This only increased my suspicions since it seems more likely that medical dosing policy would emanate from the FDA.

    So...

    ...is there such a policy? I can find no evidence of it online.

    If not, what should I do? Getting transferred to a new PM practice isn't easy in this market. It seems as though an awful lot of the competing PM doc's refuse to see anyone transferring from another practice.

    This is the first time I've reached out to other patients. I'm grateful for your help!

     
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    Old 07-11-2014, 10:31 PM   #2
    karlee1010
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    Re: Are they lying to me?

    Hi. I'm thinking that a good way to get that question answered would be to call and ask a pharmacist. Just ask to speak to the pharmacist, and then ask if recently, very recently, that has been changed. You may not want to change PM Drs. if you find out thats true. At least find out if that's true, or if they lied to you before you get too hasty and look for a new Dr. There's no perfect one these days (with all the restrictions on them) and you may find out that the next one is way worse after all. And then you'd be stuck. Another time of switching Drs. after that would look like Dr. shopping no doubt. That's just my two cents. Haha. I hope it helps you some....

     
    Old 07-12-2014, 11:40 AM   #3
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    Re: Are they lying to me?

    Welcome! No I haven't heard of that and I think you are right to suspect it may have been a lie. More likely is that your doctor is receiving DEA pressure on the amounts they are prescribing and they aren't comfortable with your dose, or at least the amount of breakthrough meds. They may have not wanted to come out and say the real reason and were using that as an excuse. I think its more the amount of breakthrough meds than the total meds, as your dose isn't too high. Four doses a day for breakthrough though is quite high.

    Did you say to them that you were very concerned about this as its already not controlling your pain very well? Have they actually made the change yet? At your next appointment I'd bring up your pain levels and pain management goals. If your baseline pain isn't well controlled, it may be possible to have them increase your Methadone, so you need less Oxycodone. Taking four doses of Oxycodone a day is around the clock, so its like not actually having a breakthrough med.

    I wouldn't specifically ask for an increased Methadone dose or anything like that, but I would bring up your concerns about cutting down your daily Oxycodone dose, as you feel your baseline pain levels are not well controlled. Or agree to try it but ask what would be done if that doesn't work, as you are afraid of having more pain as you are already having trouble coping as it is. Give specific examples of what you are having trouble with, such as certain activities.

    You can also ask them to clarify the reason why this change needs to be made and see what they say. If it was me I don't think I'd confront them and accuse them of lying though (even if you knew for sure it was a lie).

    If you do want to change doctors, go to an initial visit at a new doctor without formally switching, to ask what their treatment plan would be for you. Don't sign a contract or accept any prescriptions. If it sounds like they could be a better fit, then make the switch, making an appointment at the new place for your next refill date, and ending your relationship with your old doctor before then (either in person or a certified signature required letter). Best wishes.
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    Old 07-12-2014, 02:22 PM   #4
    gmak
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    Re: Are they lying to me?

    Quote:
    Originally Posted by chosenatrandom View Post
    I take 15mg of methadone four times a day, and another 15mg of oxycodone four times a day for thoracic compression fractures. It's barely enough, but at my last PM doctor visit the resident shrink told me that they would have to reduce my oxycodone to twice daily because of new federal guidelines that place a new cap on the total amount of controlled painkillers a patient could be allowed.
    I was suspicious immediately since I had read that there are no federal caps on dosages, and asked if it came from the DEA or the FDA.
    He waffled briefly and finally committed to the DEA. This only increased my suspicions since it seems more likely that medical dosing policy would emanate from the FDA.
    So..
    ...is there such a policy? I can find no evidence of it online.
    If not, what should I do? Getting transferred to a new PM practice isn't easy in this market. It seems as though an awful lot of the competing PM doc's refuse to see anyone transferring from another practice.
    This is the first time I've reached out to other patients. I'm grateful for your help!
    Hi chosen, I think it depends on if the state has developed a policy guideline or maximum recommended dose per day & i have read that Ohio has a 90mg of morphine equivalent per day cap maximum but i dont know if it is just a recommendation or if it is enforced, also i cant recall if it was Oregon or Washington state that also has some kind of suggested maximum dose of milligrams of morphine or morphine equivalent per day & i think it was 100 mg per day, nothing official but a patient was stating it was in place, & some pain drs have a maximum that they are comfortable prescribing & wont go over, but a renowned pain mgmt dr that has been a pioneer in the pain mgmt field assured me that there is no ceiling cap set by the federal government as of yet. Would it have seemed too pushy, impolite or too aggresive to ask the pm dr the amount that is allowed after he explained that you needed a lesser strength milligram per day amount? Im so sorry that you are still hurting so much with the long acting methadone dose & breakthrough pain meds are required too to manage the severe pain. I recently fell & wedge compression fractured a thoracic vertebrae & boy did it ever hurt & in addition to my usual arach pain. I am so glad that you decided to join us because you are not alone! I will never forget the first time on healthboards when someone else said to me that they were really hurting too instead of the "Im sorry's" that i hear from well meaning family & friends but they have no idea what it is like to have chronic pain & it was a life changing moment for me to talk to someone that truly understood me, my pain & " got it"! Welcome & i hope that the dr will find the exact combination of meds that help you to function better & feel better!

    Last edited by gmak; 07-12-2014 at 04:56 PM.

     
    Old 07-13-2014, 03:01 AM   #5
    chosenatrandom
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    Re: Are they lying to me?

    It sounds like you guys went to a lot of trouble to unearth definitive answers, and I'm very grateful. Frankly, I can't trust this practice anymore, so I will take your advice and carefully find myself a new PM doc.

    I'm unsure yet of what else I may do, but I feel pretty strongly that this doctor needs to be held accountable.

    Bless all of you.

    CAR

    Last edited by mod85; 07-13-2014 at 04:43 PM.

     
    Old 07-14-2014, 04:45 AM   #6
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    Re: Are they lying to me?

    Hi Car, There actually are prescribing guidelines in PM that suggest if you need BT meds more than twice a day they should look at adjusting the base dose, 2 doses a day has always been the standard at the group of docs I saw for the last 13 years. Are they federal law, not that I am aware of, but they are part of the standards of practice suggested in pain management by each PM board certification body. Their are only 3 board certification program specialties in PM, One for anesthesiology, one for neurology and one for physical medicine. If a doc follows his specialties standards of practice like only using BT meds twice a day he is less likely to get himself in trouble. Yes they have made exceptions in the past for some patients, including myself, But I am aware its their policy to limit BT meds to twice a day. So in that respect I don't think they are lying. I am seeing a new doc this week as the only remaining doc certified to manage pumps is leaving the practice and have a pretty good suspicion the new doc who teaches at the local medical school will reduce my BT meds. I have have been reducing my BT med use myself just so its not a big whack when or if the new PM group does reduce them which I expect will happen in 2 days. Hang in there, Dave

     
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    Old 07-14-2014, 06:34 AM   #7
    beamybea
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    Re: Are they lying to me?

    Hi all, just wanted to add that a couple of years ago, my PM doc changed my medicine and dosage. His explanation to me was that there were new guidelines and parameters for pain medications.
    He told me that the PM community expressed these new guidelines as a "standard of care" . I didnt ask and at the time he didnt indicate any law or government entity had anything to do with it. I for one am grateful that my doctor stays updated and is interested in practicing safe pain management. The drugs worked for me but I hated the side effects. The adjustments he made took awhile to adapt to but in the end, I was able to work with him and he within the accepted standards so we both were comfortable with the care he provided me. I know we all dont fit into a textbook and everyones situation is unique. I wish you well, bea

     
    Old 07-14-2014, 01:12 PM   #8
    karlee1010
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    Re: Are they lying to me?

    That was a great question you asked. Ever since I started PM 2 years ago, they've had me on 4 bt meds per day if needed, and I never knew that was considered a pretty high amount. I'm grateful to have learned yet another valuable thing from Healthboards here! Since 2 a day is standard, I'm wondering why from the very beginning my Dr. just started me out at 4 per day if needed. I'm certainly not going to challenge this, but it sure does help me to be grateful for it. Thank you for the answers to that question too, and by the way, Welcome to Healthboards......

     
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