DEA, schedule II privileges

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ctts

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This post may raise some eyebrows, but I was considering the opioid patients that I have inherited (mostly abandoned by PCP or moved from out of state), and how much I would rather not be prescribing opioids...have any of you have considered, or perhaps know of a colleague, who has renewed a DEA license, without requesting privileges to prescribed schedule II drugs? That is, to voluntarily relinquish privileges to prescribe schedule II drugs?

My thinking is, when patients ask for opioids, I cannot say technically that I "cannot" prescribe opioids, as I can legally do so, it is just that I do not want to or do not recommend it. But, if I do not have DEA prescribing privileges for schedule II drugs, then I can truly say that I cannot, and then it is not even a matter up for debate.

I would have some concerns/guilt about the few patients I have that I think are actually very responsible with their meds and actually seem to benefit... Anyway, not saying I would actually consider this, but it is a thought that comes to mind from time to time.

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It raises eyebrows that you are in deep trouble to other physicians and hospital admin.
 
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Sometimes people need opioids. I'd hate to be in a position where I, as a pain doctor, couldn't provide a patient with the care that they desperately need within my scope of practice. Are you going to tell the 45 year old with end stage metastatic breast cancer that she should just take gabapentin and tylenol?
 
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This post may raise some eyebrows, but I was considering the opioid patients that I have inherited (mostly abandoned by PCP or moved from out of state), and how much I would rather not be prescribing opioids...have any of you have considered, or perhaps know of a colleague, who has renewed a DEA license, without requesting privileges to prescribed schedule II drugs? That is, to voluntarily relinquish privileges to prescribe schedule II drugs?

My thinking is, when patients ask for opioids, I cannot say technically that I "cannot" prescribe opioids, as I can legally do so, it is just that I do not want to or do not recommend it. But, if I do not have DEA prescribing privileges for schedule II drugs, then I can truly say that I cannot, and then it is not even a matter up for debate.

I would have some concerns/guilt about the few patients I have that I think are actually very responsible with their meds and actually seem to benefit... Anyway, not saying I would actually consider this, but it is a thought that comes to mind from time to time.
Stop being a p@ssy. The biggest and hardest part of the job can be saying, NO.

But it gets easier and easier the more you do it. I say no in my sleep.

If you like being professional, don't laugh at them when doing so. Or you can tell them: "That's not how I treat pain." Then redirect to what you can do. If they retort 2x more about how they need the narcs or what will I do....tell them "That's not how I treat pain." Then say you can detox and you would be glad to refer.

I have been doing this for 13 years and current gig. See my online reviews. It prevents others from coming in. Double win. I am now telling a bunch of 80-90 year olds who were on 4-5 Percs and 4 Xannies per day the same thing. (Doc retired) Never too old to grow up and see psych for the benzo taper, and wean with what you got on the opiates.
 
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it would raise the issue of abandonment for the patients you are currently prescribing for.

I second steve's comments and add one more - have a pre-printed list of other "opioid" prescribers and say that he can contact these other doctors to see what they will prescribe. what you tell them is what your office will or will not do.

it is not inappropriate to list a suboxone provider, or if the list includes previously opened (but now shut down because of DEA action) on that list....
 
This post may raise some eyebrows, but I was considering the opioid patients that I have inherited (mostly abandoned by PCP or moved from out of state), and how much I would rather not be prescribing opioids...have any of you have considered, or perhaps know of a colleague, who has renewed a DEA license, without requesting privileges to prescribed schedule II drugs? That is, to voluntarily relinquish privileges to prescribe schedule II drugs?

My thinking is, when patients ask for opioids, I cannot say technically that I "cannot" prescribe opioids, as I can legally do so, it is just that I do not want to or do not recommend it. But, if I do not have DEA prescribing privileges for schedule II drugs, then I can truly say that I cannot, and then it is not even a matter up for debate.

I would have some concerns/guilt about the few patients I have that I think are actually very responsible with their meds and actually seem to benefit... Anyway, not saying I would actually consider this, but it is a thought that comes to mind from time to time.

If you want an interventional only practice, why not? You could just help the few you mentioned find a new doctor, and then you have no emotional skin in the game. If you can make this happen and still have a job, kudos to you.
 
I typically say I am not a prescriber of opioids... if someone is coming from someone who was prescribing I will offer a referral to addiction management and document it. I have several patients including one young man with metastatic bone cancer who I prescribe moderate doses to. I wouldn’t be able to sleep telling people like that I couldn’t help when I can. And that will as others say raise red flags that you were/are in trouble. Technically speaking it could be done.
 
You do you boo.
Many pcps have no problem saying go here because I am not allowed to prescribe X medicine.

What are you going to RX when one of your procedures has a bad temporary outcome or your vb fracture guy comes in barely able to move?

Cbd and tramadol can only go so far.
 
This post may raise some eyebrows, but I was considering the opioid patients that I have inherited (mostly abandoned by PCP or moved from out of state), and how much I would rather not be prescribing opioids...have any of you have considered, or perhaps know of a colleague, who has renewed a DEA license, without requesting privileges to prescribed schedule II drugs? That is, to voluntarily relinquish privileges to prescribe schedule II drugs?

My thinking is, when patients ask for opioids, I cannot say technically that I "cannot" prescribe opioids, as I can legally do so, it is just that I do not want to or do not recommend it. But, if I do not have DEA prescribing privileges for schedule II drugs, then I can truly say that I cannot, and then it is not even a matter up for debate.

I would have some concerns/guilt about the few patients I have that I think are actually very responsible with their meds and actually seem to benefit... Anyway, not saying I would actually consider this, but it is a thought that comes to mind from time to time.

Sounds like you are in a tough situation-- I'm assuming these people aren't taking 1-2 Norco a day for you to even consider what you are saying.

I inherited a large volume of chronic pain patients on Fentanyl, Methadone, Oxy from a pain doc when I started myself, and I know the pressure of trying to meet their demands, spare the surrounding/referring physicians from having to deal with these patients, and try to sleep at night.

I learned the hard way, that these patients lead to problems for you and your staff in many ways (pharmacy, ER, government, insurance, and on and on).

They also seem to multiply the longer you keep them around.

These days are different though and it is much easier to say no. They watch the news, the CDC has guidelines, your hands are tied.

You would love to write them whatever they want, but you can't. If they know someone who can, you would be happy to provide a referral.

I wouldn't be a dick about it, because these are the patients to kill you in the parking lot (I had to cancel my day once because of a threat).

But be FIRM
 
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it would raise the issue of abandonment for the patients you are currently prescribing for.

I second steve's comments and add one more - have a pre-printed list of other "opioid" prescribers and say that he can contact these other doctors to see what they will prescribe. what you tell them is what your office will or will not do.

it is not inappropriate to list a suboxone provider, or if the list includes previously opened (but now shut down because of DEA action) on that list....

Had a guy sent to me for eval this AM from PCP in our office. OD on percs/oxycontin 7/2020 with leftover meds from dental visits. Got some suboxone from a family member. Needs more of it. Happy to get referral for AddPsych and has plan to get on it then taper over time with CBT. Also had ankle pain and wanted injections and new orthotics. Sen referral to my Foot/Ankle surgeon. What can appear the toughest on paper can be the easiest patient you will see all day.
 
Yes, I had a lady who had “wants fentanyl” as basically her CC. Family doc, playing at being a pain doc, was prescribing and left the state. Discussed that she was still hurting on fentanyl and she didn’t want injections or surgery so why not get off the fentanyl. She enthusiastically agreed and I am helping her wean off. She had only been on fentanyl a year and didn’t really want to be.
 
If you are an employee of a Big Box shops you may run afoul of your contract with them, as the contract or your hospital privilege's may require you to maintain full DEA schedule prescriptive authority.

But if neither of those are issues or you are in your own private practice, then you can certainly down regulate your DEA prescribing level. There are Psychiatrists who do that in part to do exactly what you are getting at, to clearly say, "sorry, I can't and won't be able to prescribing any substances of XYZ rating."

As some above alluded to, you'll likely want to transfer the care of those you are already prescribing for well in advance before you down regulate.

The next issue is understanding the DEA schedules and what it would take to get it back in case you wanted to reverse this.
 
I don't understand why you want to make this as complicated and limiting your DEA license when all you need to do is say "no."

You can accomplish the same objective with zero additional time investment. Just say "no."

If you want to make life even better, educate your new patient coordinator to say the following TWICE during consultation scheduling:
1. CTTS does not prescribe controlled substances such as opioids, narcotics, or sedatives.

THen, repeat this statement with any appointment confirmation emails or phone calls

Then, when your MA rooms the patient, have the MA repeat this statement.

They've now heard the message 4 times. Which means they listened to it maybe one time.

If it turns out you DO want to Rx controlled substances for an exceptional case or malignant pain, you can always do so.
 
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“No pain medicine? I thought this was a pain clinic” lol... if I had a dollar
 
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Phone call 3 days after first visit, of which 15 minutes was spent on in-depth discussion of opioids risks/taper and additional 15 minutes discussing PT/possible procedures which they have declined:

"Patient states nothing is working, asking for refill of oxycodone/norco/Tylenol#4"
 
Phone call 3 days after first visit, of which 15 minutes was spent on in-depth discussion of opioids risks/taper and additional 15 minutes discussing PT/possible procedures which they have declined:

"Patient states nothing is working, asking for refill of oxycodone/norco/Tylenol#4"
You talked to this patient on the phone for 30 min?

im in georgia, come mop my floors.
 
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You talked to this patient on the phone for 30 min?

im in georgia, come mop my floors.
Haha no I meant 30 minutes at the first visit. Probably 25 minutes too long still.

I try to avoid any phone calls that can wait till the next visit.
 
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Stop being a p@ssy. The biggest and hardest part of the job can be saying, NO.
I don't understand why you want to make this as complicated and limiting your DEA license when all you need to do is say "no."
This.

Seriously OP. Are you 12? If you don't agree with the treatment plan, change it. No need to lie, no need to limit yourself.
 
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no.....steve sent me a patient on oxycontin 80 tid and oxycodone 15 q4 years ago and i was able to wean her down thx to my dea permit. No no no.
 
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no.....steve sent me a patient on oxycontin 80 tid and oxycodone 15 q4 years ago and i was able to wean her down thx to my dea permit. No no no.
PM me, I wanna see this....

Still seeing the married couple from you. He is off opiates and has Nevro, she is at 90meq and no better.
 
PM me, I wanna see this....

Still seeing the married couple from you. He is off opiates and has Nevro, she is at 90meq and no better.

i was joking....partially. She's only on oxyir 15mg bid now for neck and back fusion/transitional syndrome
 
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i was joking....partially. She's only on oxyir 15mg bid now for neck and back fusion/transitional syndrome
Love it! I really do have a couple from Steve. They are great, not on opioids. He got back to tennis at age 80 after an ESI fixed his stenosis for 18 months. She's still scared to death of needles. Debatable whether that is Steve's fault.
 
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