Dr just cut MSContin by 1/3. Said DEA told all drs that 300mg is new limit, Liar?

[kotira]

Dear Group,
I am nearly hysterical. I have been in constant pain nearly 34 years. A few short years ago, I finally found a dr to treat my pain with narcotics after years of trying every other type of med on the market.

My dr gradually worked me up to 450mg of MSContin, and 32mg of Dilaudid a day. He has been writing this amount for a year or so.

Suddenly, today, he said he can only write for 300mg of MSContin, or risk going to jail. He said the DEA sent out letters and told drs that is the new limit. When I aksed if he could make up the difference in Dilaudid, he said the limit there is 32mg per day.

I am sure he is lying, but he refused to back down. I sobbed and begged him to reconsider as I am moving out of state and need every pill because when I change states my disability and my Rx coverage could take 2 mo to kick in.

I am distraught. He said it was not just in NY. Anyone else here of this nonsense? Any way I can check it out? Can I call the DEA?

Please, any suggestions? He said the DEA had not been in touch with him, but mentioned jail many times. Also said I am the most medicated of any of his patients. Help. Or just some shoulders to cry on...
Sorry for the hysterics...
Kotira

[ErinENj]

I'm so sorry you're having to go through this nightmare Kotira!! The DEA has no right to limit the amount of medication prescribed, and I think that is the law, so I don't know if your doctor is on the level. I'd do two things to see if what he's saying is the truth or if he's just coming up with some excuse to drop your levels: 1- Go on the DEA website, and look around there. If there was some notice sent out to the nation's doctors, it is part of the Freedom of Information act and should be accessible online. It may take some digging, but I'd try to find something there. 2- Do you have another doctor, like a PCP or any doc at all that you can talk to about this? If it were me, my first phone call would be to my primary care doc and then to my spiney to see what they say and if they got a similar letter. Because they both have the ability to prescribe those kinds of medications, they have to have received the same letter.

If it is true, this has stepped way out of bounds on their power. The DEA has no right to dictate what a doctor can prescribe and how much they can prescribe. All they can do is make up some requirements, like here in NJ, a script that is over a certain number of pills (120 or a 30-day supply, whichever is less) has to have written on it "intractable pain." They can't threaten a doc with jail for prescribing a LEGAL medication.

I don't know about this. It really seems shady to me. And you have every right to be upset. That's a completely horrible thing for your doctor to do to you and I think if anything should be illegal, it should be doctors doing things like that. I know I'm on 24 mg of dilaudid and I'm sure I will work my way up to your dosage sooner or later, and if a doc were to tell me that the DEA has said that if they prescribe anything more than 12mg, I'd ask him for a copy of the letter. And if he couldn't produce a copy of the letter, or simply refuses to, I'd be in the market for a new doctor.

There is no reason for your doc to treat you like this. Did he even bother to tell you if there was some other medication that might work as well as the MSContin but that he can prescribe enough of to be effective but not expose him to trouble from the DEA?

There's something weird about all this. I just get this weird feeling about it, so in my opinion, I don't think your doc is being honest. And if he is, I'm scared for all of our futures. Pharmacist Steve would probably be the best to answer this, so hopefully he'll come along soon. For now, I'd say do some research online and see if you can figure out another doctor you could talk to about this to get definate confirmation about this. If this is true, the DEA has completely overstepped their bounds.

Try to keep your head up hun. I know that seems impossible now, but I think this may work out for the best, simply because now you know what this doc is all about and what lengths he'll go to to make a patient do a sudden drop in the meds.

Wait, I just remembered something. Go into the DEA site and look at the requirements for "prescribing controlled dangerous substances." In there, I think it says something along the lines of: in order to prescribe these substances, the doctor must have a clear, written treatment plan, and must occassionally, when it wouldn't be detrimental to the patient's health, decrease their pain medications (but it doesn't say why). I probably got the wording all wrong, but it does say something about how a doc should do everything they can to reduce the dosage level of these 'substances,' including a sudden drop in their dosage. I don't have the site, and I have an assignment I have to do for tommorow, but this weekend I'll take a look at the DEA to see if I can find it again. Maybe the DEA sent out reminder-type notices to remind docs that if they don't make the effort to make us less dependent on these meds then they could be prosecuted.

Again, I'm so sorry that you are stuck dealing with this. I hope that it doesn't take going to the ends of the earth trying to get it all figured out. The best of luck to you and please, keep in touch. Let me know if there's anything I can do to help and also let me know what you find out. I'll talk to my pain doc on Wednesday when I see him and see what he says and let you know if NJ docs got the same thing and exactly what it is.

[Pharmacist.steve]

He said the DEA sent out letters and told drs that is the new limit. When I aksed if he could make up the difference in Dilaudid, he said the limit there is 32mg per day.


Sounds pretty simple to me .. ASK TO SEE THE LETTER... my money is on .. that he can't produce the letter.. because there never was A LETTER

Morphine is NOT on the DEA's list of drugs of concern

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

The DEA can't practice medicine - although they have tried in the past.

[Mark N]

Sorry to hear this has happened to you. It does make me feel better about my 180mg of MSContin each day. Normally I would say to see if there is anything that could be taken along with the MSContin but it doesn't sound like your doctor is willing to make any adjustments. I know the cut of 1/3 is a big hit and not easy to deal with especially as the pain gets worse. Challenge him if you think it will do any good but realize he may be looking for any reason to dump you. I wish you the best.

[waggytalk]

just seems wrong to me that the DEA would be telling people that really need the pills to survive and have a postive quality of life that they can't have them.

sigh the US is so fvcked up when it comes to drug laws. I can understand keeping kids from getting Meth, cocaine, opiom etc but not the people that need them to survive.

[mforce00]

Well waggy, here is the flipside. It is very, very easy to fake a pain disorder and get narcotics. Granted you have to go through a lot of testing sometimes, but in the end the prize is still there. If you have a ton of people complaining of pain to get morphine and then they sell it, it is just as bad as putting meth on the street. Pain cannot be proven just remember that.

[Mark N]

It is too bad if it is true but as Dr Steve and others have said it sounds fishy and your doctor may just be trying to limit your intake or has many patients with high level doses that is a red flag for the DEA. It would be nice that only people with real problems with chronic pain would be the only ones trying to receive the medications so there would be no reason to look for abusers but that isn't the way it is. The worst part is we are the ones that pay the price for the abusers and it shouldn't be that way.

[mforce00]

Maybe you should check out the DXM thread and present it to your doctor so you can take less morphine for the same effect.
I still think opiates are mainly useless... at least on their own beyond a few weeks.

[Kira]

I am sorry that you are having to deal with such a large cut in your med doses. I don't know if the DEA has such a restriction or not, but it does sound a little fishy from what some of the other posts have said. Pain sucks.

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

mforce, I don't think I agree that the opiates are "mainly useless"... many of us get pretty good relief from them and many people are able to stay on stable doses for a pretty long period of time. In fact, for a lot of people, they are the ONLY thing that gives relief. I do understand what you are talking about with tolerance and the issue of doses needing to be increased to get the same level of pain relief, but this doesn't happen to everyone. Maybe your type of pain is a type that the opiates don't work that well for? I know that they help a lot with my day-to-day pain but barely touch my rhabdo pain, even in high IV doses. But for some people, they make all of the difference in the world and allow a significant return of lost functioning.

[Mark N]

I have to agree with Kira on the effectiveness of opiates for me. I have been on the same dosage for three years and still get good pain management with it. It doesn't help all pain and if I didn't have Cymbalta for my neuropathic pain I would still be in agony. But I would be in agony without my MSContin too as I have tried to reduce my dosage [I don't like taking opiates] and my pain went through the roof. You have to find the right med for each of our pain and one size sure doesn't fit all of us.

mForce00 has a good idea to check this with your doctor. The combination of certain meds can reduce the need for the opiate. It is worth looking into instead of having agonizing pain.

[mforce00]

Lots of websites I read speak of tolerance developing and then pain relief becoming null and void. My doctor even told me that people had to go through the opiate pyramid because they stopped working. I guess if you get analgesia from opiates beyond a few weeks you are really lucky.

In all honesty, my view is very skewed because I have neuropathic pain, and opiates and neuropathy don't get along very well :(

[BrokenBladder]

I don't know all of the laws that the DEA has set forth, but I do think it sounds fishy to me. Steve had a good point.....ask to see the letter. I once had a doctor who was making me come to his office every TWO weeks to get my hydrocodone. His excuse was that the DEA would only let him write a script for two weeks and that if he went over that amount MY name would be entered into some database!! My pharmacist flat out told me this doctor was only trying to get more money out of me by seeing me every two weeks. I changes doctors and voila....I get a 3 month script.

[waggytalk]

Well waggy, here is the flipside. It is very, very easy to fake a pain disorder and get narcotics. Granted you have to go through a lot of testing sometimes, but in the end the prize is still there. If you have a ton of people complaining of pain to get morphine and then they sell it, it is just as bad as putting meth on the street. Pain cannot be proven just remember that.

aye i know. it just pisses me of.

I have been drug free almost my whole life. I only tried pot once when i was 14 and really was not impressed and had no desire to try anything more.

But as a person with pain that has caused me to stop working (had my own business at one point), stop golfing, stop rideing a motrycycle and where i can bearly play with my children. I NEED those pain meds and having the DEA say well some people may get high off those drugs we are going to punish you for it. it really seems stupid and wrong.

but yeah i have seen people addicted to them. and getting addicted has been one of my fears. but getting over that. knowing i need these to get through days.

[Boxerlover]

Kotira,

I am sorry for the problems you are having, we have enough stress dealing with our illnesses, we don't need problems like this. I have no advice as all the others have given wise words of wisdom.

As for the other, my husband said something that makes a lot of sence. As our justice system believes it is better for a guilty person to go free then for an innocent person to go to jail, it is also better for an abuser to get meds than for a legitimate pain patient to suffer. It's time to put the accountability where it belongs. I too am someone who lost my life to my disease and pain and the meds have allowed me to get some of it back which is priceless to me. I also am blessed that in 4 years I have remained stable on the same dose except when I get kidney stones then it is upped until no longer needed and then I go back down with no problem. I know we are all different and to those who need them, they are a godsend.

Melissa

[curiousforever]

I know what you're saying. My doc actually said the ohter day that "People don't die from pain". I guess he hasn't heard of the number of chronic pain sufferers who either turn to illegal drugs or suicide.

I wonder about if he'd give you the fentynal patch - or *something* different. I'm finding I like the patch. I seem to throw up a lot on ms contin - and this way when I do throw up - I don't lose any meds.

[lobelsteve]

The DEA has not nor will they ever be able to place an exact number on how much pain medicine is too much as far as milligrams goes. They will certianly investigate any doctor who writes and Rx for more than a few hundred tablets a month for any given patient. Writing over 1000 tablets for a patient within a month is on the face of it drug dealing. This should require approval of the state medical board and automatically qualify a doctor for peer review.

The dose reduction of 1/3 is supported in some of the textbooks regarding opioid tapering, however- many patients will get a mild withdrawal at 2/3 of their prior dose. Cutting back to 1/3 is either ignorant or punitive.

[Mark N]

I also wonder if your doctor has heard about our blood pressure skyrocketing and the log term effects. Pain has its side effects that do cause death so I am not very impressed with his comment. I would also say that proper levels of pain meds don't kill people either. His attitude really ****es me off:mad: .

[kotira]

Thanks, everyone for your kind words and encouragement. I was 99 per cent sure he was lying.

It sure hurts: I have been going to him for 5 years; he started me on long term meds and told me they were great, there was no ceiling for dosage. Ha. After 34 years, I had finally begun to get some tiny relief lately, and he pulls the rug out.

Something frightened him and I don't know what it is. He has been writing this high dosage for over 2 years now.

I did ask to see the letter but he just shrugged. At the time, I did not want to press it in case I need something in the time before I find a new dr. I did not want to totally crush him---well, I DID want to, but thought better of it.

I asked him to make up the difference in dilaudid, but he said the limit there is 24mg a day. That was when I was convinced he was lying. That could never be the case, that is absurd.

He also told me that if he wrote it, the pharmacy would not fill it. That stopped me short, I never expected him to tell such a blatant lie, and one I was sure to check, but he told it anyway. When I said I was going to call the pharmacy, he told me that if I did, he would give me nothing. Nice guy, eh? Trouble is, until this, he has been kind and supportive. I am a very difficult case, I have tried 112 different meds, and not for a week or two, for at least 3-6 months each. (With few exceptions).

Nothing has ever helped me, and more than a few drs have dropped me when they were not able to reduce my pain even a tiny amount. Most drs do not want to deal with narcotics, so they had nothing left to try.

This is such a vicious blow. He cavalierly called over his shoulder as I was leaving, "You'll be fine." "No. No, I won't, " I replied. Not until I get a new dr."

Then, he hid in the tiny room the receptionist uses until I left. I have never ever seen him go in there in over 5 years. Chicken.

Thanks again, everyone, for all your help. I wish I could figure out what frightened him so much.
Kotira

[mforce00]

What's your diagnosis?

[BrokenBladder]

Kotira maybe it wasn't you that scared him but instead maybe he had a problem out of another patient that was receiving a high dosage of narcotics. I say this because there was a doctor here in my town that was brought up on the news because one of his patients died. The real reason for his death was drinking alcoholic beverages will taking a high dosage of Schedule II narcotics, but of course, rather than just pointing the finger at the patient they had to involve the doctor.

[tenacious]

i also am sorry for what your doctor did to you. i agree with the others; i don't think that there was a letter.......but i think he was concerned if you went to a conservative pm in the state you are moving to, your current pm could have looked bad. i hope you understand what i am trying to say.

although what you are going through isn't right, i encourage you to look forward and start searching for an anest. pm doc in the state you are moving to. call there and get some general info from the nurse, and when you find one that sounds like what you want, make an apt. even if it is going to be awhile before you move, it may help anxiety levels by knowing you already have a pm doc to see??

[kotira]

Thanks again, everyone, for all your advice and sympathy.

Lisa, he told me I was his highest dosed patient, and that he had not had any problems as yet. Also, he had been writing this amount for over 2 years with no indication it was going to suddenly end.

I have been in severe pain for 34 years, and the pain has escalated and stayed at that new level several times during those years. The last time was 8 years ago, and it took 3 years in bed 24/7 for me to adjust to the increased pain. We had discussed several times how I would have to be on these meds for the rest of my life, and hopefully could stay at the same level for some time.

Tenacious, that was a good guess, but he just sent me my records (or a very few pages of them) and they clearly state my dosage for the last 2 years. And of course he did not dare include his latest change.

By the way, he told me the pharmacy would never fill a script for the larger amount, and of course they said there was no problem filling it.

Thanks again, everyone,
Kotira

[tenacious]

kotira,

do you happen to have chosen a new doctor for where you are moving to? i am just concerned that when you get moved, you may have to wait awhile to get in to see a new doctor. we all know how horrible withdrawals are when switching docs, if we run out of our med.

i don't know if you will ever know why your doc did what he did........and it doesn't make any sense. but, i have high hopes that you won't go through this with your new pm doc.

[ASkicker]

I still think opiates are mainly useless... at least on their own beyond a few weeks.

I saw in another one of your posts that you are only 19. All I can say is that I hope you gain a little perspective as you get older--the sentence above is, frankly, complete nonsense. While I do take other drugs for my ankylosing spondylitis, if someone put a gun to my head and say "pick one, that's the only one you can take for the rest of your life," it would be a no-brainer--I'd select my oxycontin. It is the only one of my meds that is guaranteed to reduce my pain every time I take it. The other two--enbrel and celebrex--usually help, but not always, not during the worst flares. I have been on oxy for roughly 8 or 9 years now, 80mg twice a day, and without it, I would have lost my job a long time ago, I never would have gotten married, I would have no social life, and I would, in all likelihood, be bedridden. Oxy has been a miracle drug for me, one that has lasted much, much longer than your "few weeks" standard, and to say that they are "mainly useless" exhibits an ignorance about chronic pain that, I am guessing, simply comes from not having experienced it for very long. I know you have been in severe pain for 11 months, and pray that your pain gets better and you don't have to find out what it's like to live with horrible pain your entire life, but until you do, your opinion on the usefulness of opioids is, frankly, "mainly useless." (And yes, I realize that it is in fact just an opinion, which is why you are completely entitled to hold said opinion; I, in turn, am completely entitled to hold my opinion that your's is laughable).

I love it when people with chronic pain do the DEA's work for them with completely uninformed statements like this.

[mforce00]

http://www.medscimonit.com/pub/vol_11/no_5/7201.pdf
You should read the above article because it states the history of the opiate receptor and its true function. You misunderstood my statement to mean "opiates are bad don't give them out", when I really meant, "opiates shouldn't be long term solutions."

http://opioids.com/tolerance/molecular.html
Here's an article which talks about tolerance, and how every single molecule of opiates you ingest, some form of tolerance in the body occurs.

Now, my type of pain is different from most, since it is neuropathic, and there are MANY, MANY articles stating how opiates are almost totally worthless for neuropathic pain.

I do have perspective, and you discredit anything I say due to my age so just read the articles. They aren't published by the DEA, just scientists. Just because you're special doesn't mean I'm stupid.

[Matuboo]

http://www.medscimonit.com/pub/vol_11/no_5/7201.pdf
You should read the above article because it states the history of the opiate receptor and its true function. You misunderstood my statement to mean "opiates are bad don't give them out", when I really meant, "opiates shouldn't be long term solutions."

http://opioids.com/tolerance/molecular.html
Here's an article which talks about tolerance, and how every single molecule of opiates you ingest, some form of tolerance in the body occurs.

Now, my type of pain is different from most, since it is neuropathic, and there are MANY, MANY articles stating how opiates are almost totally worthless for neuropathic pain.

I do have perspective, and you discredit anything I say due to my age so just read the articles. They aren't published by the DEA, just scientists. Just because you're special doesn't mean I'm stupid.


Well, until someone comes along with a better solution I think opioids are the only option for many people, including myself. I think I can speak for many people here when I say that we'd rather not have to take anything at all! Unfortunately, that's not an option.

Clearly the euphoric effect is a relatively short term side effect but the reduction in pain is long term for most, at least from what I've been able to ascertain from this and other groups! Obviously there is the issue of tolerance, which is why many people here are on higher doses but to say that opioids in general are not an effective way to treat chronic pain has no medical credence. I'm sorry they don't work for you.

I've tried drugs like Neurontin and Bextra (which is now thought to greatly increase the risk of heart attack and stroke) and they did nothing for my pain. I'm just glad I didn't stay on the Bextra for an extended period of time, even though my doctor practically insisted on it. So much for the "flavor of the month" drugs. Opioids are very safe if taken as prescribed and work for the vast majority of people with CP. Again, I'm sorry you are not one of them.


M

[mforce00]

Actually come to think of it... I don't like any painkillers and I'm bitter because I even have to take one. I guess my real view is that I don't like any painkillers, and I least hate opioids. If people all accepted opioids there wouldn't be advances in pain management. I guess the best solution I can think of is implanting inhibitory neurons onto the spinal cord/brain, but science can't do this :(

[jena1225]

http://www.medscimonit.com/pub/vol_11/no_5/7201.pdf
You should read the above article because it states the history of the opiate receptor and its true function. You misunderstood my statement to mean "opiates are bad don't give them out", when I really meant, "opiates shouldn't be long term solutions."

http://opioids.com/tolerance/molecular.html
Here's an article which talks about tolerance, and how every single molecule of opiates you ingest, some form of tolerance in the body occurs.

Now, my type of pain is different from most, since it is neuropathic, and there are MANY, MANY articles stating how opiates are almost totally worthless for neuropathic pain.

I do have perspective, and you discredit anything I say due to my age so just read the articles. They aren't published by the DEA, just scientists. Just because you're special doesn't mean I'm stupid.


I do not think there was anything about your statement that could have been misunderstood. You clearly stated: "I still think opiates are mainly useless... at least on their own beyond a few weeks"

Being "useless" can only mean that they "have no use" - now, I doubt there is a so-called "study" out there that could say that... :rolleyes:

Not everyone succumbs to the "tolerance" part of opiates, and not everyone can be relieved by other types of drugs for instant relief.

[mforce00]

I can't find the link, but some doctors back in like 1930 found that opiates don't relieve neuropathic plan at all, and since then debate over this occured. Some studies do say outright that opiates are useless for neuropathic pain, and there are also some molecular mechanisms to back this up. I think it boils down to if the neuropathic pain is ongoing or not... I mean if the nerve healed or not. So in my experience, opiates were "ok" for a short amount of time, and I was in my mind just speaking about opiates and neuropathic pain. So I guess let's append my comment to be "I still think opiates are mainly useless... at least on their own beyond a few weeks" for me.

Also, I don't understand how people have ongoing relief from opiates. Why are some people not becoming tolerant? Genetics? Genetics isn't the answer to everything :/

[lobelsteve]

I can't find the link, but some doctors back in like 1930 found that opiates don't relieve neuropathic plan at all, and since then debate over this occured. Some studies do say outright that opiates are useless for neuropathic pain, and there are also some molecular mechanisms to back this up. I think it boils down to if the neuropathic pain is ongoing or not... I mean if the nerve healed or not. So in my experience, opiates were "ok" for a short amount of time, and I was in my mind just speaking about opiates and neuropathic pain. So I guess let's append my comment to be "I still think opiates are mainly useless... at least on their own beyond a few weeks" for me.

Also, I don't understand how people have ongoing relief from opiates. Why are some people not becoming tolerant? Genetics? Genetics isn't the answer to everything :/

Grasshopper, you have much to learn about pain. You quote 2 articles that generally fall outside the mainstream of what most textbooks and mor respected journals would publish. There are 10's of thousands of articles on opioids, tolerance, and opioids for neuropathic pain. Opioids certainly do have a role for neuropathic pain, they are just not generally as effective sa they are for nociceptive pain.

A good starting point would be the text from Ashburn and Rice on Pain Management. It is an easy read compared to Bonica's textbook. Patients and doctors can both get good info from Ashburn and Rice's book.

At 19, a chronic pain condition is life altering, just like getting a diagnosis of MS or getting a spinal cord injury. There are many things you will find helpful along the way, and many more that will only be futile attempts to treat your pain. At least you will be trying. Sometimes the only thing that I have to offer my patients is hope, other times it is validation, and rarely, a cure.

[tenacious]

I saw in another one of your posts that you are only 19. All I can say is that I hope you gain a little perspective as you get older--the sentence above is, frankly, complete nonsense. While I do take other drugs for my ankylosing spondylitis, if someone put a gun to my head and say "pick one, that's the only one you can take for the rest of your life," it would be a no-brainer--I'd select my oxycontin. It is the only one of my meds that is guaranteed to reduce my pain every time I take it. The other two--enbrel and celebrex--usually help, but not always, not during the worst flares. I have been on oxy for roughly 8 or 9 years now, 80mg twice a day, and without it, I would have lost my job a long time ago, I never would have gotten married, I would have no social life, and I would, in all likelihood, be bedridden. Oxy has been a miracle drug for me, one that has lasted much, much longer than your "few weeks" standard, and to say that they are "mainly useless" exhibits an ignorance about chronic pain that, I am guessing, simply comes from not having experienced it for very long. I know you have been in severe pain for 11 months, and pray that your pain gets better and you don't have to find out what it's like to live with horrible pain your entire life, but until you do, your opinion on the usefulness of opioids is, frankly, "mainly useless." (And yes, I realize that it is in fact just an opinion, which is why you are completely entitled to hold said opinion; I, in turn, am completely entitled to hold my opinion that your's is laughable).

I love it when people with chronic pain do the DEA's work for them with completely uninformed statements like this.

my comments have nothing to do with your opinion, which we all are entitled to. BUT i wanted to tell you that i really like your username, and was glad to read your message, because i also have AS.............which we both know isn't fun. do you have rheumatoid arthritis also? i was on enbrel, and then eventually was switched to methotrexate, subQ, and humira. now i am rx'd to inject humira weekly rather that the 'normal' rxing of every other week.

i don't mean to steal anyone thread here; it is just not very often i hear of someone else having AS.

[Leila]

Hi, according to Kentucky's DEA website an individual can only recieve 8 GM of narcotics in a 30 day period. I think the government let the doctors deciede what thier patients need!!!

[Pharmacist.steve]

Hi, according to Kentucky's DEA website an individual can only recieve 8 GM of narcotics in a 30 day period. I think the government let the doctors deciede what thier patients need!!!

Do you have that website/page ... if somone was taking 240mg morphine/day that would be 7.5Gm in 31 days and that is not counting breakthru .. it you allowed 2 - hydrocodone 10/500/day they would be over.

[Matuboo]

Hi, according to Kentucky's DEA website an individual can only recieve 8 GM of narcotics in a 30 day period. I think the government let the doctors deciede what thier patients need!!!


Yep, that's why good ol' KASPER'S in place, to make sure that there's no encroachment.;)

In all fairness, it can be a good tool for doctors and pharmacists when it comes to preventing diversion but there is always the DEA and privacy issues. What can you do?

[Kira]

From the KASPER website:


Who can obtain a KASPER report?
Access to KASPER reports is carefully controlled through identity and credential checks and secure Web access. KASPER reports are available only to the entities and health care professionals listed below:

Prescribers for medical treatment of a current or prospective patient,
Dispensers for pharmaceutical treatment for a patient,
Law enforcement officers for a bona fide drug-related investigation,
Licensure boards for an investigation of a licensee,
Medicaid for utilization review on a recipient,
A grand jury by subpoena, and
A judge or probation or parole officer administering a drug diversion or probation program.How do I recognize a prescription drug problem?
Prescription drug addiction warning signs include:

Physical: Fatigue, repeated health complaints, red and glazed eyes, and a lasting cough
Emotional: Personality change, sudden mood changes, low self-esteem, irritability, irresponsible behavior, poor judgment, depression, general lack of interest,
Family: Starting arguments, breaking rules, withdrawing from the family
School or Work: Decreased interest, negative attitude, many absences, truancy, visiting many doctors Social Problems: New anti-social friends, problems with the law, withdrawal from friends


I am deeply disturbed that licensure boards can access KASPER. That is scary for me.

I am also distrubed by the list of "symptoms" of prescription drug abuse. All but the "new anti-social friends" and "problems with the law" are also symptoms of being sick all the time! And the stuff about cough and red eyes... ummm... have they heard of allergies? My god. Hope WI doesn't do this anytime soon. Remind me not to apply for any residencies in KY.

[Leila]

Hi Pharmasist Steve...My bad, it is 9 GM of psuedofed that can only be purchsed in 31 days...

SORRY for the mistake.

The website that I found this info on is

www.operationunite.org/invest/pharm.php

Again, I sorry for posting erroneous info.

Leila

[Kira]

Well, I read a little more specific stuff about KASPER because it was really bothering me that licensure boards can look up your prescription drug history... and then I realized that they probably meant they could look up the docs doing the prescribing to make sure the docs weren't prescribing all sorts of excess drugs, not that they would look you up in KASPER to find out if you are on any meds before giving you a license to practice. Sure enough, when I read more info, I found out that the licensure boards are allowed to look up docs as prescribers, not to look up potential candidates for licensure to make sure we're not on drugs or whatever. So I guess it doesn't "deeply disturb" me that the licensure boards have access, once I thought for a second and realized why they have access.

I still don't like the description of what someone addicted to prescription drugs would be like, though. I think it is ridiculous. Those are symptoms of being miserable in general, mostly... and anyone in enough pain to be prescribed the drugs in the first place is likely:
fatigued, has repeated health complaints, has personality change, sudden mood changes, low self-esteem, irritability, irresponsible behavior, poor judgment, depression, general lack of interest, starting arguments, breaking rules, withdrawing from the family, decreased interest, negative attitude, many absences, visits many doctors, and has withdrawal from friends.

The only ones that wouldn't automatically happen just from being sick would be truancy (because you'd have a legit excuse/doctor's note), new anti-social friends (but it could happen as a coincidence), and breaking the law (unless you get prosecuted for taking your prescription meds, at which point oh no, this red flag goes up, too).

Oh, and the red eyes and cough don't happen to everyone that's sick... but I have bad allergies and get red eyes and cough (along with wheezing and sometimes hives) whenever I go somewhere with too much cat dander or mold or a bunny or a dog or too much dust or pollen etc... all spring I have red eyes and a cough... must be a junkie.

[Matuboo]

Well, I read a little more specific stuff about KASPER because it was really bothering me that licensure boards can look up your prescription drug history... and then I realized that they probably meant they could look up the docs doing the prescribing to make sure the docs weren't prescribing all sorts of excess drugs, not that they would look you up in KASPER to find out if you are on any meds before giving you a license to practice. Sure enough, when I read more info, I found out that the licensure boards are allowed to look up docs as prescribers, not to look up potential candidates for licensure to make sure we're not on drugs or whatever. So I guess it doesn't "deeply disturb" me that the licensure boards have access, once I thought for a second and realized why they have access.

I still don't like the description of what someone addicted to prescription drugs would be like, though. I think it is ridiculous. Those are symptoms of being miserable in general, mostly... and anyone in enough pain to be prescribed the drugs in the first place is likely:
fatigued, has repeated health complaints, has personality change, sudden mood changes, low self-esteem, irritability, irresponsible behavior, poor judgment, depression, general lack of interest, starting arguments, breaking rules, withdrawing from the family, decreased interest, negative attitude, many absences, visits many doctors, and has withdrawal from friends.

The only ones that wouldn't automatically happen just from being sick would be truancy (because you'd have a legit excuse/doctor's note), new anti-social friends (but it could happen as a coincidence), and breaking the law (unless you get prosecuted for taking your prescription meds, at which point oh no, this red flag goes up, too).

Oh, and the red eyes and cough don't happen to everyone that's sick... but I have bad allergies and get red eyes and cough (along with wheezing and sometimes hives) whenever I go somewhere with too much cat dander or mold or a bunny or a dog or too much dust or pollen etc... all spring I have red eyes and a cough... must be a junkie.



It's my understanding that KASPER is available to law enforcement, doctors and pharmacists to ascertain whether a patient is seeing multiple physicians for the same drug so yes, they can access a patients prescription record; for scheduled drugs anyway. It was mostly put in place to prevent diversion and of course, so-called "pill mills."


So, if an individual was seeing Dr. Smith for Lortab and Dr. Smithe for Lorcet and neither doctor was aware that the patient was seeing another doctor for the same med, it's illegal and is a class D felony. It's called "doctor shopping" and it's part of what KASPER does. As you know, pain docs have contracts also and that's part of it. I once read about a man in Lexington Kentucky who was seeing 10 different doctors for anything from OxyContin to Vicodin to Xanax, none of the doctors were aware that he was seeing anyone else for pain.


I don't know how often "doctor shopping" is prosecuted here in Kentuckiana but I know it is on occasion and is considered a relatively serious offense. Forging scripts is still probably more of a problem, even though it's more difficult now days (assuming) with exsisting technology.


As for privacy issues, yes, it's a major concern along with a lot of other things.

[Leila]

I do know for a fact that the Kentucky Board Of Nursing can access KASPER and can get a report on any nurse (LPN/RN) in the state of Kentucky

[Kira]

Right, I know they have access... but was wondering if that access is for looking up "pill mill" docs more than for looking you up, say, when you were applying for licensure after taking boards in that state. Because I am on pain meds (nothing illegal going on; one doctor, legit reasons, relatively smallish doses) and also am deciding about doing a residency in the near future... and licensing is part of that... and I can just imagine how horrible it would be for them to be looking up what meds you are on just so you can get your license in the first place. But if they are looking up what you are prescribing, that is a whole different story. Does that make sense?

I do think it is a good idea to have a centralized list of what people are getting filled, b/c then you can't get people doctor shopping, as matuboo pointed out. I just worry when they do things like give licensure boards access. Can't they just make the licensure boards have to act on your conviction via law enforcement? So, law enforcement finds out you're a junkie, or you're running a pill mill, or whatever... and if you get convicted, the licensure people can say "sorry, no license for you." Why do the licensure people also get to look at what you are on?

I just can see them saying "you can't practice medicine with a fentanyl patch on," etc... when really it is none of their damned business, as long as I am functioning fine, not impaired, etc.

[Matuboo]

Well Kira, I am reasonably confident in saying that as long as you are playing by the rules (which I'm sure you are) you have nothing to worry about. It's the presribing docs who have to worry. In the case of an individual who is taking meds for intractable pain and getting them from one doctor only and filling them at one pharmacy, I just don't see a problem there. I mean, it's still an invasion of privacy but.....

That's my take but I'm not an expert, nor do I have a lot of knowledge about this subject as I am not in the medical field, a cop or pharmacist. Perhaps someone else with more knowledge can chime in.

[Pharmacist.steve]

I am licensed in KY .. last week I worked for a indy who needed a day off .. I got a Rx for Hydrocodone and while the Rx was mostly likely legal .. this guy was throwing RED FLAGS.. He lived several miles from the store, the Rx was from a doc in his neighborhood, it was the first time at this pharmacy and he was paying cash.. I asked the technician how to get on line to KASPER.. I got so many mis-directions . it is only on this one computer and only so-and-so knows how .. shes not here.. There was NO INTEREST to see if this fellow was a doctor/pharmacy shopper.

In regards to professional impairment... I know that, technically, in Indiana a Pharmacist can have a licensed suspended if he/she is working while suffering from DEPRESSION. I have never heard of the board going this far .. but DEPRESSION is considered an IMPAIRMENT.

The really bad thing about KASPER type databases is that it takes "good clinical judgement" to properly evaluate all the data that could be present. As rushed as all healthcare professionals are these days and all too often the initial decision is delegated to ancillary staff... who may not have enough "background" and seeing multiple screens of data... jump to the conclusion that "no one could need all these meds ... must be a addict.."

[Matuboo]

I am licensed in KY .. last week I worked for a indy who needed a day off .. I got a Rx for Hydrocodone and while the Rx was mostly likely legal .. this guy was throwing RED FLAGS.. He lived several miles from the store, the Rx was from a doc in his neighborhood, it was the first time at this pharmacy and he was paying cash.. I asked the technician how to get on line to KASPER.. I got so many mis-directions . it is only on this one computer and only so-and-so knows how .. shes not here.. There was NO INTEREST to see if this fellow was a doctor/pharmacy shopper.

In regards to professional impairment... I know that, technically, in Indiana a Pharmacist can have a licensed suspended if he/she is working while suffering from DEPRESSION. I have never heard of the board going this far .. but DEPRESSION is considered an IMPAIRMENT.

The really bad thing about KASPER type databases is that it takes "good clinical judgement" to properly evaluate all the data that could be present. As rushed as all healthcare professionals are these days and all too often the initial decision is delegated to ancillary staff... who may not have enough "background" and seeing multiple screens of data... jump to the conclusion that "no one could need all these meds ... must be a addict.."


An interesting take. Ironically, I read just recently that they had improved the system and that an individual's records could be pulled up in a matter of minutes without much effort, apparently, this isn't the case.


I've come across quite a few articles on KASPER without really even looking, just reading the local newspaper (on line) here in Louisville. I guess it's probably better than it was years ago, I think Kentucky was the first state to have a system of this nature go on line. If it prevents diversion and doesn't hurt patients, doctors or pharmacists than I'm all for it but it seems as though there's always a price to pay.


I've never had any problems myself but I've used the same pharmacy and received meds from from the same two doctors (my psychiatrist and pain doc) for many years. The only time I've received pain meds outside my pain docs office is once or twice at the hosptial, the attending and my pain doc where informed of my situation. My PCP prescribes meds but they are not scheduled drugs.


"Good clinical judgement" is indeed the key, no question. I wouldn't want to be in the medical field or a pharmacist, I wouldn't have the patience!

[curiousforever]

The same things Kasper says about being 'addicted' could simply pertain to being in pain, being a smoker (which I am)...and many other things.

[Pharmacist.steve]

The same things Kasper says about being 'addicted' could simply pertain to being in pain, being a smoker (which I am)...and many other things.

Isn't it amazing... the fed/state gov TAX alcohol, liquor, gambling - big source of revenue for them... and for some .. a major addiction and creates financial hardships on them and their family..

Our society if full of hippocrits... a store that sell tobacco BUT is a smoke-free store and the typical chain pharmacy ... in the back of the store .. they will sell you stop smoking products and up front they will sell you tobacco products.

[BrokenBladder]

You're right about the hippocrits for sure!! I have a friend whom I've known for years who is totally against narcotics. Okay fine so we just steer clear of those discussions, but then the other day she tells me that she hurt her back and is getting Soma from someone at her work because the pain is killing her. Well needless to say I just couldn't keep my mouth shut so I told her, not only have you given me h$$l about this but now your taking it illegally. I haven't heard from her in about a week. Oh well!!

[jena1225]

Everyone has something to say until they are in pain :confused: Judgemental people, I stay away from.

[kotira]

Thanks once again, everyone, for making this a fascinating and valuable thread.

Kira, thanks for posting the information about Kasper, especially how to recognize if someone has a problem with prescription meds:

Signs that there is a problem with meds, by Kasper:
"Physical: Fatigue, repeated health complaints, red and glazed eyes, and a lasting cough
Emotional: Personality change, sudden mood changes, low self-esteem, irritability, irresponsible behavior, poor judgment, depression, general lack of interest,
Family: Starting arguments, breaking rules, withdrawing from the family
School or Work: Decreased interest, negative attitude, many absences, truancy, visiting many doctors Social Problems: New anti-social friends, problems with the law, withdrawal from friends"

Wow, they are right! I have most of these same problems relating to meds--but they happen when I am not receiving the proper meds I need to allow me to minimally function. I am still in enormous pain, but without the meds, I would spend 75 per cent of my time in bed.

I have done med clear-outs (going off ALL meds) several times in my over 3 decades of constant pain. I needed to prove to myself (and drs) that I really needed the medication, and to see how I was--mentally, emotionally, socially, intellectually and spiritually--when I was totally clean of all meds.

Several times I did it for 6 mo to a year, and 6 years ago, just to be absolutely certain forever, I went off everything for 2 years. It was a complete and total nightmare. I hate being on opiods for many reasons, but one of the main ones is that you are dependant on drs who often treat patients who need these meds without fail, like they are second--or fifth--class citizens.

This last dr used to make phone calls during my office visits, not emergency calls, calls to his wife, his brother, some patients, but for the last 3 years, he made or received a minimum of 3 phone calls during my visits. He never said, "Excuse me, I have to make an important call."

I would be telling him how I was doing and he would just pick up the phone, in the middle of a sentence, and make a call. I would take books out of his bookcase and read them. I have run into this with other drs who wrote me scripts for the short acting narcotics--and small amounts, at that. They often acted like I was bothering them, needing to come in every month for my meds. One dr would come into the waiting room to fill out my script and hand it to me and tell ME to fill out my name and address, age, etc. For this 30 seconds out of his day, he was paid $94 every month.After 8 months of this, I stopped coming to see him, even though no one else would write the 100 percocets a month I got from him. I gave it up rather than have to deal with his disrespect.

My last visit with the dr who cut my meds by 33 per cent, he dropped the bombshell and had the nerve to make 2 calls and receive 2 calls.Finally I said, "Would you hang up the phone and let me get out of here." And this "man" is a neurologist AND a psychiatrist.

Sorry this is all over the place...back to the last cleanout of meds: I suffered so much. I was horrid to my family and friends, I was totally lost. But I felt I had to know how I would be when my system had completely readjusted to life with no meds at all.

Now I know how badly I need the medication, and I am lucky that I am positive nothing else---including vigorous exercise through gritted teeth--will ever work for me. It was a horror to go through, but it is wonderful to know that I gave every option a chance.

Thanks again, for all your great contributions.
Kotira