CVS refusing to fill opioid when patient is also on a benzo

[myrandom2003]

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Over the last 2-3 weeks, I have had CVS pharmacies in my area, Indiana, refusing to fill pain medications when a patient is on benzos.
The medications I prescribe 99% of the time is T#3, Tramadol, or belbuca/butrans. On occasion it is a 7-day norco rx. This is not just for new RX, but also for patients with pre-existing RX.

Pharmacist refuses to fill even if I call, so I stopped calling.
Now patients are calling my office to re-send RX elsewhere.

Anyone else dealing with this? What have you done?
This is getting annoying.

 

[Ferrismonk]

Over the last 2-3 weeks, I have had CVS pharmacies in my area, Indiana, refusing to fill pain medications when a patient is on benzos.
The medications I prescribe 99% of the time is T#3, Tramadol, or belbuca/butrans. On occasion it is a 7-day norco rx. This is not just for new RX, but also for patients with pre-existing RX.

Pharmacist refuses to fill even if I call, so I stopped calling.
Now patients are calling my office to re-send RX elsewhere.

Anyone else dealing with this? What have you done?
This is getting annoying.

I don't encounter this anymore, but I would tell those patients to transfer all their scripts to another pharmacy.

 

[myrandom2003]

I don't encounter this anymore, but I would tell those patients to transfer all their scripts to another pharmacy.

That still requires me having to resend rx somewhere else.

 

[Orin]

In my EMR, I often will write in the instructions to pharmacist about being aware of risky co-prescribing per the PMP so they understand that there's a physician using their medical judgement and accepting the risk/liability.

I still get refusals, as you can't make a professional do something they don't want to do.

 

[Ferrismonk]

In my EMR, I often will write in the instructions to pharmacist about being aware of risky co-prescribing per the PMP so they understand that there's a physician using their medical judgement and accepting the risk/liability.

I still get refusals, as you can't make a professional do something they don't want to do.

I tried this and still get refusals. I talked to pharmacists and still get refusals. I co-prescribed narcan and still got refusals.

I would even offer for the pharmacist, as a valued professional who is also involved in the care of our mutual patient, to come to the patient's next office visit to discuss the best plan of care. The pharmacists always decline my offer. I document this.

Only thing you can do is send Rx elsewhere, or if still allowed, give a paper script and let the patient figure out who will fill it.

 

[painfree23]

Why are so many of you writing opiates for those on benzos?

 

[myrandom2003]

At least in my instance, they fill 30 tabs or 60 tabs in the last 90 days. I’m not concerned about it enough to limit my tramadol rx.

 

[Agast]

Zolpidem is also a benzodiazepine, I don’t think it’s the same level as being on xanax. If a patient is having their benzo managed by a psychiatrist I am more amenable to allowing them to have pain medication, with the assumption an expert made the assessment that it is absolutely needed and an SSRI would not suffice.

For my older patients, I counsel them to start weaning to see if they actually still need it. I also talk to them about risk of developing dementia

Risk of Dementia in Long-Term Benzodiazepine Users: Evidence from a Meta-Analysis of Observational Studies - PMC

There is conflicting evidence in the literature on the association between benzodiazepines (BDZs) and the risk of dementia. This meta-analysis aimed to determine the relationship between the long-term usage of BDZs and the risk of dementia. The ...

www.ncbi.nlm.nih.gov

 

[Ferrismonk]

Why are so many of you writing opiates for those on benzos?

Legacy patients in a multi-provider group where we share patients. It's been discussed and I only fill on rare occasions.

 

[lobelsteve]

Zolpidem is also a benzodiazepine, I don’t think it’s the same level as being on xanax. If a patient is having their benzo managed by a psychiatrist I am more amenable to allowing them to have pain medication, with the assumption an expert made the assessment that it is absolutely needed and an SSRI would not suffice.

For my older patients, I counsel them to start weaning to see if they actually still need it. I also talk to them about risk of developing dementia

Risk of Dementia in Long-Term Benzodiazepine Users: Evidence from a Meta-Analysis of Observational Studies - PMC

There is conflicting evidence in the literature on the association between benzodiazepines (BDZs) and the risk of dementia. This meta-analysis aimed to determine the relationship between the long-term usage of BDZs and the risk of dementia. The ...

www.ncbi.nlm.nih.gov

WRONG. FACTUALLY incorrect.

Zolpidem

A publicly available article also appearing in PubMed about Zolpidem

www.statpearls.com

 

[painfree23]

WRONG. FACTUALLY incorrect.

Zolpidem

A publicly available article also appearing in PubMed about Zolpidem

www.statpearls.com

From ur link - “Overall, zolpidem is not recommended for the general population as a first-line treatment because of its high potential for abuse.” ..so essentially a benzo

 

[lobelsteve]

From ur link - “Overall, zolpidem is not recommended for the general population as a first-line treatment because of its high potential for abuse.” ..so essentially a benzo

A knife can be used to stab someone. A safety pin can also stab someone. So basically, a safety pin is a knife.

 

[painfree23]

A knife can be used to stab someone. A safety pin can also stab someone. So basically, a safety pin is a knife.

A knife has a “high potential of abuse” , a safety pin doesn’t

 

[Ducttape]

A knife can be used to stab someone. A safety pin can also stab someone. So basically, a safety pin is a knife.

the ability to use an object for unintended purpose doesnt technically "make it" that same object.

i doubt anyone would consider a pencil or wood sliver to be equivalent to a stilleto...
well, unless you are a vampire and that wood sliver goes through your heart (since it is nearing Halloween)


back to the point - whether it is a benzo or non-benzo (technically correct), zolpidem is a Controlled Substance with abuse potential, and significant interactions can occur with opioid medications.

 

[lobelsteve]

Ambien has abuse potential like Ultram or gabapentin.
Xanax has abuse potential like opiates and alcohol and illicits.

I vote for BZD to be schedule 2.

 

[deleted875186]

Ambien has abuse potential like Ultram or gabapentin.
Xanax has abuse potential like opiates and alcohol and illicits.

I vote for BZD to be schedule 2.

And honestly there are a lot of psychiatrists that are filling out too many benzos.