prescription crisis

[randomdoc1]

Found this article and found it interesting. In part, I don't feel sorry for these chains. I'm frustrated plenty of times by their sloppy record keeping on prescriptions and how easily some of the individual pharmacies allow early benzo refills while my office gets millions of calls for "refills" for medications like SSRIs when there is already a prescription on file and they let my patients run out cold turkey because the system is too flawed or staff are too lazy to check all the prescriptions on file. But another question it raised is this, when will or can patients be also held accountable for entering themselves into the crises they find themselves in? Often times it is patients seeking this out. Our office gets so many calls because "doctors won't refill these medications I need." Then they find someone who gives them what they want, when they get in trouble, it's "that terrible doctor." I sure wish at times there was a way patients can be held responsible for this. I know I've said this so many times, but over 75% of the calls for this office for prospective patients are for daily benzos and/or stims. Many already on opiates and with other comorbidities. Soon as we say we're not doing that, they go looking else where. Yes, providers should not prescribe recklessly, pharmacies should do their due diligence, but patients really should be held accountable too. Ok, done with my rant now.

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[VA Hopeful Dr]

Found this article and found it interesting. In part, I don't feel sorry for these chains. I'm frustrated plenty of times by their sloppy record keeping on prescriptions and how easily some of the individual pharmacies allow early benzo refills while my office gets millions of calls for "refills" for medications like SSRIs when there is already a prescription on file and they let my patients run out cold turkey because the system is too flawed or staff are too lazy to check all the prescriptions on file. But another question it raised is this, when will or can patients be also held accountable for entering themselves into the crises they find themselves in? Often times it is patients seeking this out. Our office gets so many calls because "doctors won't refill these medications I need." Then they find someone who gives them what they want, when they get in trouble, it's "that terrible doctor." I sure wish at times there was a way patients can be held responsible for this. I know I've said this so many times, but over 75% of the calls for this office for prospective patients are for daily benzos and/or stims. Many already on opiates and with other comorbidities. Soon as we say we're not doing that, they go looking else where. Yes, providers should not prescribe recklessly, pharmacies should do their due diligence, but patients really should be held accountable too. Ok, done with my rant now.

My office doesn't accept refill requests from pharmacies.

I write for enough medication to last until I want to see the patient back. If they run out its because they didn't listen when I said when I wanted them back. For non-controlled I make them schedule an appointment and then call in enough to get them to that appointment plus 1 week. For controlled non-benzos I don't refill without a visit. For benzos I'll do that once and then tell them I won't do it again. If it happens again I will (don't want to cause withdrawal) but then at their visit we start titrating off of them.

If patients go elsewhere because you won't continue their prescriptions, that's 100% a win for you. We're seeing a slow but steady culture shift among physicians against prescribing lots of controlled meds especially if they are already on other controlled medications. Its already better than it was 10 years ago. We'll get to a decent place, it just takes time.

 

[randomdoc1]

oops, realized I forgot the post the actual article lol

Ohio judge rules Walmart, CVS, and Walgreens must pay a combined $650.6 million for damages related to opioid crisis

Walmart, CVS, and Walgreens must pay a combined $650.6 million to two Ohio counties for damages related to the opioid crisis, a federal judge ruled Wednesday.

www.cnn.com

 

[whopper]

I write up to 6 months worth of medication for a non-controlled substance if that substance has been found to be safe for the patient. If they want more they have to reschedule. If the person forgets to reschedule we get them in ASAP and give enough for the meeting. If they forget the meeting I pretty much terminate the patient, while providing one last prescription for 1 more month of medication.

Why? Cause you will get bozos who keep trying to harass you month after month after month while not showing up to their appointments. End the dysfunctional relationship. Of course I'm willing to consider extenuating circumstances.

If it's a controlled substance, I've set up myself in a good position and don't mean this in a selfish way. With the exception of less than 5 patients out of over 1000 I don't prescribe any benzos in a manner where they will have withdrawal. So they can't argue they'll have withdrawal. The very few are trustworthy patients which is why I was willing to give them that level of trust. If a patient was on a decent amount of benzos, missed an appointment, I'd likely terminate them on the spot and given them a very limited supply while offering referrals.

If patients go elsewhere because you won't continue their prescriptions, that's 100% a win for you. We're seeing a slow but steady culture shift among physicians against prescribing lots of controlled meds especially if they are already on other controlled medications. Its already better than it was 10 years ago. We'll get to a decent place, it just takes time.

EXACTLY. I have seen some very rare instances where patients do need controlled substances such as a benzos (and I'm not including ADHD medications). E.g. they have a bona-fide sleep disorder where a benzo is the only treatment, but this is very rare. Only cases I've seen were treatment resistant cases where the patient did the due diligence and tried several other meds. I had one guy and the only med that worked on him was Lamotrigine but it didn't work better over 200 mg daily so we kept him at 200 mg daily. SAM-E plateaued at 1500 mg daily, so we kept him at that but he still bad anxiety only partially treated. I gave him Clonazepam, it worked (4 SSRIS, 3 SNRIs, Buspirone, and a slew of antipsychotics tried with no benefit). After being on Clonazepam about 2 mg daily for 6 months his anxiety further lowered and we weaned him down to less than 0.5 mg used about 2-3x weekly, then 2-3x monthly.

So after about 6 months of me feeling good about his case, he falls through the floor of a condemned building, developed PTSD after he broke his hip and his anxiety is now worse than ever before. CRAP.

 

[forchinet121]

My office doesn't accept refill requests from pharmacies.

I write for enough medication to last until I want to see the patient back. If they run out its because they didn't listen when I said when I wanted them back. For non-controlled I make them schedule an appointment and then call in enough to get them to that appointment plus 1 week. For controlled non-benzos I don't refill without a visit. For benzos I'll do that once and then tell them I won't do it again. If it happens again I will (don't want to cause withdrawal) but then at their visit we start titrating off of them.

If patients go elsewhere because you won't continue their prescriptions, that's 100% a win for you. We're seeing a slow but steady culture shift among physicians against prescribing lots of controlled meds especially if they are already on other controlled medications. Its already better than it was 10 years ago. We'll get to a decent place, it just takes time.

You can also tell them to go to the ED if you’re actually concerned about withdrawal, don’t feel forced into writing scripts

 

[VA Hopeful Dr]

You can also tell them to go to the ED if you’re actually concerned about withdrawal, don’t feel forced into writing scripts

Eh, I can get people in within 10 days at the worse (usually less than 7). And extra week of this before a visit seems much more fair for both the patient and the already overwhelmed ED.