It can be a problem when the many of the refill requests are for controlled substances.
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- Treating chronic pain with narcotics and avoiding the risk of addiction
- Medication refills
- Vicodin ES #180, 1 tab q4hrs prn pain x 4 refills
- Dangers of herbal medicines
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{ 14 comments }
This becomes a nonproblem when you refuse all controlled substances covering on the weekend.
When you cover for another physician you make sure they should tell their patients not to call about refills on the weekend, no exceptions, no sob stories.
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.
All my patients on long-term schedule 2 drugs know that there will be no refills on weekends by me or by covering docs and that they need to keep up with it. As for vacations, which the original blog is covering, I know that my covering doc doesn’t like to do schedule 2’s and so I keep track, know who is supposed to run out before I go, and take care of it ahead of time. It doesn’t require fancy computer software, just a date file for schedule 2 drugs. If the system fails and they run out, they have to come in and see him or talk someone else into bridging them.
“Just say No” .. works for me..
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-Jay Yew, MD
http://www.UroCanswer.com
Do you guys think every patient on pain medication is just a drug seeker? because it sounds like you do. Do you not know there are real medical conditions that cause chronic pain, and that your attitudes keep people suffering and not asking for relief because they don’t want to be labeled a seeker?
Your indifference to treatment of pain makes one wonder if you aren’t sending legitimate patients to the street because of your failure to treat real conditions.
Do you ever worry that you are letting down your patients? Or does your arrogance not allow you to even care?
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.
It is not unreasonable for someone whose doctor is on the hook for prison time–not just malpractice, not just license forfieture, but prison time–in providing them with scripts for oxycontin or adderall, to keep regular appointments and keep up with their meds. I tell patients maintained on these meds that these conditions can only be managed with close collaboration with a doctor who feels comfortable with it, and that they are not going to be able to find people to supply them on weekends or holidays, will be labeled drug seekers and blown off. That is just the fact of life and until the federal narcotics control laws are changed and Americans regain their 19th century liberty to abuse their receptors as they see fit, it isn’t going to change.
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.
Add me to the list of docs who just say no to weekend/after hours refills.
And contrary to moron 7:34 AM I also care about my patients.
But addicts lie. That’s their job. I’ve had them lie about kidney stones (you see that all the time). I’ve had them lie about having cancer. I’ve had them lie about having HIV. Who would lie about having AIDS? Seen it with my own eyes. I’ve had them lie about who their doctor is. So you’re Dr. Smith, covering Dr. Jones, and patient says he’s Jones’ patient. You send a report of the phone call to Jones, he says he has no such patient. That’s why we have such rules. I’ve had them screw up, thinking I’m Dr. Jones, but they call me (Smith), saying he’s Smith’s patient. I’m looking at my own patient roster, in a solo practice, I KNOW my patients. Called that clown a liar and told him if he ever called again, I’d call the police. I’ve done that as well, when they’ve forged my name on prescriptions, I prosecute.
I’ve also had the police call with a drug OD with my name on the prescription bottle. Suicide.
So ALL the doctors I work with……frankly all the doctors I know…..all agree, and set strict rules from the outset. NO NARCOTIC REFILLS AFTER-HOURS OR ON WEEKENDS. ***NO EXCEPTIONS**
And with all that, I am known as one of the more liberal docs when it comes to prescribing opiates for pain.
Of course moron 7:34 is not a physician, has never made a decision more important than McDonald’s or Burger King for lunch.
A physician recognizes medicines have risks and benefits. And the patient needs to be able to count to ten or whatever number of pills is needed to get through a weekend. Probably that excludes 7:34 right off the bat.
In the rare (and I do mean rare) case the patient is legitimate AND has a legitimate reason for being out of meds, there is always the ER.
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
7:34 has it spot on. Rather than treating patients who seek help in a safe environment, we deny them adequate assistance and they seek help where they can find it, often illegally. Anyone who thinks an ED is the answer hasn’t had to sit in one for hours only to be given Toradol (not indicated to treat and worse than useless for severe pain) and been referred to their primary care provider for follow up. Many people do not have primary care providers and if they do, it can take days or weeks to get in to see them. Not helpful when one is hurting NOW. Nicole, 7:34 is NOT too early to be upset if one has been up all night in a great deal of pain. I pity your future patients if you aren’t capable of understanding that. Also, the individual referring to 7:34 as “moron” is a prime example of what’s gone wrong with the practice of medicine. They need to find a different occupation, preferably one involving inanimate objects. The labels some individuals pin on patients, i.e., “drug seeker”, “moron”, etc., are frequently inaccurate and ALWAYS negatively influence how we care for them even if we convince ourselves otherwise.
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
Wow I just read all this about not prescribing narcotics after hours. Do you really think this will solve anything? No you’ll send your patient into the streets looking for the narcotic that they are so use to taking because you, the doctor, prescribed it to them in the FIRST PLACE! Don’t tell me you docs don’t know which patients are drug seeking and which aren’t! You continue to treat these patients and continue to prescribe the narcotics also, so don’t hold yourself up too high on the pedestal docs!! You know you make a good penny off of these people, especially the doctors who claim to have physical therapy for accidents, workmans comp, etc. I cried to my doctor a few times about being addicted to vicodin, only to be given a script and told to only take so many a day, Well, then when I left and ate all the pills within the first two days and called for a refill, boom, there it was at the pharmacy another full bottle of the original amount, quantity and strength. So ONE PILL, that is all it takes can start this addiction, we as addicts are NOT proud but very shamed into feeling as if we are nothing more than scum for getting addicted to these pills BUT in retrospect, if I hadn’t ever gone to a doctor in the first place for my pain, I would never had been given a vicodin, percocet, etc. and wouldn’t be sitting here typing this and be so mad! How dare you have an attitude towards patients that call you off hours, how many times have we as patients sat in your office waiting for hours on end just to be seen? We pay for health insurance and we should have the right to be prescribed what we need when we see fit not when you see fit. There are MANY LEGITIMATE reasons for calling a doctor in the middle of the night for a pain pill. Sitting in an ER is absolutely ridiculous when all of a sudden your tooth starts, you lost the filling or the cavity you’ve been scared to get fixed finally actes up. Or your back starts, etc. why don’t you as a doctor go sit in the ER with an issue and see how long it takes to be seen before you finally get some pain relief, they send you home with a script and tell you to follow up w/your family doctor, seems to me, a waste of time and good place to start weeding out the middle people. Oh, I’ve said enough, it is just attitudes like this that make me sick over doctors who think they are mightier than though!
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.
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