Cross-covering prescription refills

Narcotic seeker/abusers typically call in the middle of the night with their renal colic. I guess it is to try to throw us off balance. Very nervy, but fortunately, we have ERs and non-contrast CT scans.

“Just say No” .. works for me..

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-Jay Yew, MD
http://www.UroCanswer.com

No, I think chronic narcotic therapy is a logical treatment option for some patients.

I think every patient who is on chronic narcotic therapy plans actually keeps track of their meds.

If I won’t refill someone’s lipitor at midnight, then I certainly won’t refill someone’s oxycontin either.

If you take 3 pills a day and you have 6 left, you have enough for 2 days. It’s not that hard to figure out.

And yes, I assume everyone who calls the on-call doctor in the middle of the night to ask for refill of chronic pain meds is either diverting or drug seeking.

People using these medications properly don’t run out of them at 2 AM, they don’t call the answering service muliple times, they don’t ask who is on call before wanting to talk to the doctor, and they don’t call on Friday at 5:15 PM.

Arrogance? Arrogance is assumming that I exist solely to call in prescritpions at odd hours for someone I’ve never seen.

ERs are open 24 hours a day. Acute pain that is so severe it requires narcotics should be evaluated by an someone who is expert at treating emergencies.

Chronic pain so severe it requires narcotics should be periodically evaluated in an office/clinic setting. If I expect all my other patients to get labs and a physical exam every x months and to call during the daytime for their meds, I expect my chronic pain pts to do the same.

Why is treating these patients just like they are normal people such a horrible, arrogant thing?

Just asking.

or until doctors actually start practicing medicine again. I can see not supplying the drug addicts but when you resort to talking to and treating everyone, including those who clearly have REAL chronic pain issues, that have been documented by REAL tests, like seekers then you are not doing your jobs.

It is much easier to treat everyone the same, than to take the time to sort through it all and make real decisions about patients on indiv. basis. Why not just advertise that you don’t treat pain, “so do not come to me for medical issues that cause pains?” I guess that would be an honest approach but also one that makes you look silly and incompetent.

I am a PA student who is researching how to handle “Drug Seekers(ing)”, in a professional and well informed manner, and I have fallen upon this blog. I have to say that I really appreciate the heated, as well as perfect, example of the positions stated here. As a soon-to-be mid level clinician I too care about patients. I also care about myself and the career and family that I have worked so hard for. Therefore, I can completely agree 100% with the no weekends, no evenings, no substitute clinician, etcetera rule. I will validate the obviously frustrated person, a.k.a 7:34am (by the way this is too early in the day to be so upset), in that there are real chronic pain conditions. However, the fact remains that if there is someone with a chronic condition, who has a prescribed narcotic for said pain, then they are well aware of what they need to take to manage the pain and how many pills are left in that bottle. Therefore, it is truly very rare for someone with a chronic pain condition to have the need to appear in the ER at say 2 am (or 7:34 am) with a request for narcotics unless they are a true drug seeker. The rules are made to protect everyone involved. Physicians do really care about their pts and do their best to keep them comfortable whenever possible. As for 7:34am assuming that clinicians don’t practice medicine anymore and should run “real” tests to differentiate a drug seeker from someone with a legitimate complaint is an making unfair accusation. First and foremost, there is/are no test(s) that can be performed, on someone with say chronic shoulder pain, that’s gong to come back with a result that says, “hey doc, this pt is telling the truth!” The opposite is true of 7:34′s claim, in that clinicians ARE practicing medicine by protecting the pt. Pain until the primary care physician opens their office in the morning is better than death from a potential OD. I’m a young adult and drug seeking is so common in my age group that I regret to say that I have seen it with my own two eyes again and again. I’ve seen adderoll and oxycontin, as well as others, abused resulting in severe side effects including death. So, if you’re angry about these rules, and you have a legitimate chronic pain issue, please take a step back and understand why these rules exist and then take the time to be responsible about your own care and count your pills and remain well informed. -Nicole

i say this hurts people like my self who have real pain documented by my doc and when i get pain after hour my b/p goes up to 239 over 205 and is only relieves when i am given a dilaudid shot e r dr refuse to treat me. I had a minor stoke waiting to be seen because of my b/p. I had to take a ambulance to another hospital just to be seen and treated. Again I go back there and I am not treated deliberatly ,Whats a person to do in this case ,, I s this fair treatment,,I am filing my own law suit this as we speak .. Any advice or help would be appreciated jkeempc@yahoo.com

7:34 makes good points! I have 2 great examples that show it quite well. I am a CNA in a hospital setting, and one day I had a patient that suffered from chronic pain and had for 22 years. In my report I was told matter-of-factly by the other CNA that she was a drug seeker. For reasons made clear in my second example, when I read a bit of her history and talked with her a bit I was outraged! For not only had the CNA told me this assumed lie but so had the RN. Then the next night a different CNA told me the same thing! I won’t go into the details of her condition for HIPAA reasons but it was a chronic disease that is certainly known to cause chronic, severe pain. But through both nights I worked with her she was practically ignored when it came to pain treatment.
My second example is in my own life. I was severely injured in a car accident 2 years ago which resulted in a LeForte 111 fracture (if you dont know what it is, look it up, but trust me it ain’t fun), a nearly amputated finger and of course severe pain. I had to get several titanium implants, along with other reconstructive surgeries including a nose job, a nasal implant, and a chin and cheek implant. I suffer daily from pain, and it flares up occasionally out of nowhere to the point its almost unbearable. But because of the public view and the view of doctors on pain meds I was only able to find a doctor that would treat my pain last month. It took me two years to get treated for what is an obviously painful condition! I somewhat respect the view of not refilling prescriptions on weekends, holidays, or after hours, though I would say there are exceptions. But seriously many doctors need to recognize that chronic pain is as much a disease as the flu or cancer, and should be treated as such. Not treating it leads to the exact opposite of what medicine stands for! Your patients will have a decreased quality of life, be more prone to depression and drug abuse, and their personal lives will suffer because of it: relationships with friends and family will become strained, their personalities will become less pronounced. In fact I personally spent about 6 months where I just slept and ate and had no social life at all, simply because I was in so much pain I didnt want to go anywhere or do anything. I do want to acknowledge that their are good doctors out there. My doctor is a prime example I simply told her what had happened to me, and its very simple to check on the accuracy of what I said as it is very well documented by my surgeon, and she asked what has worked for me in the past and thats what she gave me. Sorry its so long I tend to ramble, but I guess all I want people to take out of this is that people that truly suffer from pain are being neglected on a large scale by healthcare providers, and this needs to change. The standard of care and the quality of care in chronic pain patients needs to be brought up to a medically acceptable level not just shrugged off because some people fake it. There are many doctors who truly care and treat patients that are suffering like that, but all doctors should care, that is what they are their for.