algosdoc

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This is outstanding news. It is a long overdue change that will require family practitioners to practice is responsible opioid prescribing and to correct the ridiculous notion that hydrocodone is somehow less addictive.
 

101N

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More irony. This change was fought tooth and nail by the AAPM but supported by PROP.
 

algosdoc

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Prop wants to outlaw treatment of chronic pain with all opioids so they don't know when to stop....3 months max treatment.
 

Jcm800

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I read this as it is not a done a deal... Where does it read as of 1-25-13...

I think it's great news if it actually goes in effect
 

bedrock

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I read this as it is not a done a deal... Where does it read as of 1-25-13...

I think it's great news if it actually goes in effect
agreed, I don't think this is completely settled, but looks like it could go through.


I didn't understand the part about "now that it's scheduled II PA and NPs can't write it? I see PA/NPs writing schedule II drugs all the time.
 

101N

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I read this as it is not a done a deal... Where does it read as of 1-25-13...

I think it's great news if it actually goes in effect
It's not a done deal. But the vote was 19 to 10 so it would be hard for the FDA to keep a straight face while overturning the majority opinion of their advisory panel.
 

drusso

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It's not a done deal. But the vote was 19 to 10 so it would be hard for the FDA to keep a straight face while overturning the majority opinion of their advisory panel.
It will be a major cultural shift for primary care...especially those in rural areas. It's the right thing to do. I guess we'll all need to brush up on our REMS for hydrocodone...:cool:
 

painstop

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Here was one of the comments:

They wonder why Medicare is so expensive. I hv Painful disease called Chronic Fatigue Immune Dysfunction Syndrome. There isn't a sq inch that doesn't hurt. After 23 yrs of avoiding Pain Meds, It became horrendous. My Family Dr wouldn't help because DEA made it too scary & too ponderous. Sent me to Anesthesiologist at $395 for first visit; $270 ea time after. Wouldn't treat me unless I went to sleep specialist (thousands of $$s) & $250 rest of visits. Both demand monthly visits-sleep doc for nothing & pain doc just for a piece of paper. On top of that, I don't drive because of drugs & hv no one who can help. Now its going to get worse!!!!!! I'm 66 & miserable. All this does is give the DEA a reason to exist!! What am I to do now??????
 

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Ducttape

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agreed, I don't think this is completely settled, but looks like it could go through.


I didn't understand the part about "now that it's scheduled II PA and NPs can't write it? I see PA/NPs writing schedule II drugs all the time.
That can be state specific.

As is the Schedule... Regardless of Feds, hydrocodone will be schedule II soon for me, and tramadol Schedule IV...
 

algosdoc

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In my state, tramadol is unscheduled but carisoprodol is C-IV. NPs, PAs, nurse midwives, DPMs, DVM, DDS, DMD, clinical nurse specialists, all can write C-II and C-III. Soon CRNAs will be able to write C-II scripts if current legislation makes it through the state legislature.
 

Ttk371

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Ladies and Gentlemen,
What I am reading is scary. I have undergone three surgeries. They had salvaged the most that could be salvaged of my arm after a dislocation, detached biceps and plexitis. The surgeries have exceeded expectations: the prognoses were I would be able to raise my arm to 45 degrees, but I have achieved more - 55 degrees.
I am allergic to Ibuprofen and NSAIDS. We have tried Tramadol, I have experienced seizures and loss of sleep. Testosterone lab tests showed contraindications to Cortisol injections. Gabapentin has had only a fraction of effect that Hydrocodone APAP 5/500 delivers. We've tried stronger Hydrocodone, but I have eventually asked to keep that as reserve and stick with the minimum of 5 mg.. 6-12 ID units of 5/325 relieve me of all my pain, and I can live happy life then! We've been doing hepatic function tests once or twice a year, nothing abnormal.
Once I was advised to consult a pain specialist. The very fact of walking into his clinic has left an impression of visiting something akin to a prison visitation area. I was given the contract that would have deprived me of the choice to shop for the lowest price: nothing in the contract caps the doctor's fees nor the pharmacy charges.
Each visit to see my family doctor used to cost $75, and it just have gone up to $100. If my doctor gets deprived of the option to write in refills, my medical expenses will double or triple (I have no insurance.)
I won't be able to afford the S-II treatment - then what...? Disability and a public burden?
I have been living happy life. Why change that?
This is an online forum for medical students and professionals. I appeal before your wisdom to do everything possible to let YOU, not the government treat my pain!
 
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algosdoc

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It is all about harm reduction, and we have reached the tipping point where something needs to happen to bring about more responsible prescribing by physicians. The fact that hydrocodone can be refilled for years without ever the patient having to be seen by a physician is a tragedy. There are many reasons to make hydrocodone a schedule II drug regardless of the protestations of those that find free wheeling use of the drug convenient or physicians that find it easy to prescribe.
1. There is no evidence hydrocodone is any less addictive or potent than Schedule II opioids.
2. There is more hydrocodone prescribed in the US than any other drug in any class- 136,000,000 prescriptions a year. It is the most prescribed drug in the country by far, and the US uses well over 90% of all hydrocodone in the entire world. This is highly suggestive the ease of prescribing has resulted in such massive overuse.
3. Physicians have prescribed the drug in ways that are if not substandard care, are overt malpractice, without repercussions for decades. Surgeons will prescribe a one month supply with a refill, enabling patients to acquire large quantities of the drug unnecessarily and also encourage use of the drug through over prescribing. Such high dose use around the time of surgery leads to long term dependence on the drug, substance abuse, and addiction in many. PCPs call in refills without a thought. NPs prescribe it by the truck load as if it were candy.
4. The refillable nature of the drug leads to drug diversion. It is way too easy for a nurse in a clinic to call in their own supply or even the public to call in their own supply of the drug.

It is time to put a halt to the prescribing of a potent opioid narcotic for every bruise, bump, and scrape. It is time for surgeons to stop creating chronic pain patients through injudicious prescribing. It is time for patients to grow up and accept a little pain....life is not pain free, and everyone in the rest of the world with the exception of the US patients seems to know this and accept it.
 

Ttk371

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Dear algosdoc,
I trust that you have data to quote to support your statements 1 through 3. I beg to differ on #4, The refillable nature of the drug leads to drug diversion. It is way too easy for a nurse in a clinic to call in their own supply or even the public to call in their own supply of the drug.
That's either a misdemeanor or a crime, and it's not the physicians' job (neither there's anything patients like I can do) to deal with that particular issue. Most importantly, am I supposed to be a collateral damage?
If you say that "little pain" is endurable without pharmaceutical treatment, can you take on a fraction of my pain, please? I wish so much I could be a good looking, athletic man who needs no medication! But any sightly torso is beyond my reach.
I have transferred out of surgeon's care into help by a family physician about four weeks after the last surgery. I have asked for psychology order last fall, and have consulted to determine presence or absence of dependency ("not probable.")
How would you address the matter of those additional $600-$1000 a year I would have to scrap for if up-scheduling goes into effect?
How would you address the matter of approximately five hours every month I would have to take as time off for additional, purely bureaucratic physician visits?
Thank you.
 

Ducttape

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We do not provide medical advice on this forum.

you should talk to your doctor about your care.


(ps a local doctor lost his license and ability to do his lifes work because his office staff misused one blank prescription without his knowledge. According to the DEA statement, it IS his job.)
 

Ttk371

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Dear Ducttape,
To dispel any possible misunderstanding, I am not seeking any medical advice here. I doubt that would be ethical or even legal.
One of my questions, which may be interpreted rhetorically, addresses the possibly overlooked economical disadvantage.
Sincere regards.
 

knoxdoc

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I was talking to a PA at our local VA who said that the VA (systemically) will no longer be prescribing oxycodone for chronic non-cancer pain. Any truth to that? Maybe Hyperalgesia or Clubdeac could chime in.
 

algosdoc

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Unfortunately the medical care system does not work for free. Monitoring of potent opioids is critically important, regardless of your characterization of this as simply bureaucratic...
And your experience of lack of substance abuse being promoted by acute use is contrary to many of our experiences. You are barking up the wrong tree here....if you want a solution to your financial or social problems you will not find it here.
 

algosdoc

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They can write a one time per year script for a 30 day supply of a C II However there is a bill being debated in the legislature right now that would allow further liberalization of prescribing.
 

clubdeac

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To answer ur question knoxdoc, there has been no talk at my VA of stopping oxy scripts for chronic pain. If I hear of something different i will let you all know
 

knoxdoc

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To answer ur question knoxdoc, there has been no talk at my VA of stopping oxy scripts for chronic pain. If I hear of something different i will let you all know
Thanks Deac. Sounded too good to be true.
 

Ttk371

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Dear Ducttape,
The example of a doctor losing his license over a misused blank prescription has shaken me. Isn't the board staffed well enough to tell right from wrong?
My heart goes out to side with that doctor and to pray for his well being. I see a case of a devoted professional whose career has been damaged by what appears to be gross lack of prosecutional discretion.
 

Jcm800

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Dear Ducttape,
The example of a doctor losing his license over a misused blank prescription has shaken me. Isn't the board staffed well enough to tell right from wrong?
My heart goes out to side with that doctor and to pray for his well being. I see a case of a devoted professional whose career has been damaged by what appears to be gross lack of prosecutional discretion.
dude, go away...
 

primadonna22274

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DEA schedule prescriptive privileges are regulated at the state level.
As a PA, I can write Sch II-V in Pennsylvania and I could in Oregon after about 2003. I cannot write Sch II in SC, only III-V. SC NPs also lack Sch II privileges.
It's complicated.
 

ampaphb

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It's not a done deal. But the vote was 19 to 10 so it would be hard for the FDA to keep a straight face while overturning the majority opinion of their advisory panel.
Although I recognize you have your own agenda, your comment is inaccurate. The FDA has disagreed with its advisory panel on many occasions.
 
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ampaphb

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Unless they also take a way my ability to write "do not fill until" scripts, this is a matter of form over substance
 

Ducttape

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Unless they also take a way my ability to write "do not fill until" scripts, this is a matter of form over substance
not legal in my state.

but, initially i was perturbed, but now i do not have an issue with the lack of this "ability".

this is purely a convenience for the patient, and frankly in the past there have been cases of patients "abusing" this convenience, garnering more prescriptions for themselves and/or decreasing their risk of being "caught" misusing drugs.