Tales from the dark side

[ghost dog]

Guys, tell me if I'm getting bit repetitive here. I just thought I would share a story from my clinic today.

I get a consult request from an (ex) pain doctor :"please take over scripting for a reasonable patient of mine who was previously addicted to Oxycontin and is now on the Fentanyl patch. I have recently lost my opioid license."

This consult screams bogus (i.e. how is this a reasonable pt to be on Fentanyl if they were addicted to Oxycontin ??), so I call this guy. It turns out the patient is taking 500 mcg (yes 500) of Fentanyl Q 2days.

I have absolutely no intention of seeing this person, but ask him if he does patch counts : a big pause "Uh, no. I trust him".

Really, you trust an Oxycontin addict? Unfriggin believable.

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[jsaul]

Guys, tell me if I'm getting bit repetitive here. I just thought I would share a story from my clinic today.

I get a consult request from an (ex) pain doctor :"please take over scripting for a reasonable patient of mine who was previously addicted to Oxycontin and is now on the Fentanyl patch. I have recently lost my opioid license."

This consult screams bogus (i.e. how is this a reasonable pt to be on Fentanyl if they were addicted to Oxycontin ??), so I call this guy. It turns out the patient is taking 500 mcg (yes 500) of Fentanyl Q 2days.

I have absolutely no intention of seeing this person, but ask him if he does patch counts : a big pause "Uh, no. I trust him".

Really, you trust an Oxycontin addict? Unfriggin believable.

so if this pain doctor lost his "opioid" license then what does he do. Is he giving all his patients this same note and sends them to other doctors. was his dea number taken away? did he get arrested for presribing narc for no legit medical purpose by the dea. Otherwise how is the DEA number taken away.

 

[mille125]

Guys, tell me if I'm getting bit repetitive here. I just thought I would share a story from my clinic today.

I get a consult request from an (ex) pain doctor :"please take over scripting for a reasonable patient of mine who was previously addicted to Oxycontin and is now on the Fentanyl patch. I have recently lost my opioid license."

This consult screams bogus (i.e. how is this a reasonable pt to be on Fentanyl if they were addicted to Oxycontin ??), so I call this guy. It turns out the patient is taking 500 mcg (yes 500) of Fentanyl Q 2days.

I have absolutely no intention of seeing this person, but ask him if he does patch counts : a big pause "Uh, no. I trust him".

Really, you trust an Oxycontin addict? Unfriggin believable.

This one would not even get through my door. We would kindly instruct the patient to see an addictionologist or check in to inpatient rehab. We would consider seeing him after this is done.


You do not need to accept every consult that is sent to you.

 

[lonelobo]

This one would not even get through my door. We would kindly instruct the patient to see an addictionologist or check in to inpatient rehab. We would consider seeing him after this is done.


You do not need to accept every consult that is sent to you.

2nd that

 

[Doctodd]

really?.....there is a separate opioid license?

 

[Aether2000]

We wouldn't see him regardless of if he completed rehab. Once an addict, always an addict.

 

[Mattchiavelli]

Sooo.... basically continue the plan of care that got this other practitioner to lose his DEA number. Riiiight.

 

[lobelsteve]

We wouldn't see him regardless of if he completed rehab. Once an addict, always an addict.

Happy to see the patient for all of their non-narcotic pain care.
Procedures, TENS, PT, psychology, etc.
Meds include Pamelor, Cymbalta, Keppra, or Neurontin. Flector, Voltaren gel, etc.

 

[mille125]

We wouldn't see him regardless of if he completed rehab. Once an addict, always an addict.

yes, but he might be more receptive to non-opioid therapies after he is detoxed...i have seen it on a limited basis which is why i give them a chance..

 

[Aether2000]

That does make sense. The reason we don't permit them into our practice is the whine factor. Everything was sooooo much better when they were on narcotics, they whine. "Why not give me just a few for pain after the procedure?". "Doc that procedure made me much much worse- it is your job to treat the pain caused by your procedure". And so on......
But you are less jaded than am I and perhaps have had some good outcomes with procedures in ex-addicts or recent addicts.

 

[Jcm800]

That does make sense. The reason we don't permit them into our practice is the whine factor. Everything was sooooo much better when they were on narcotics, they whine. "Why not give me just a few for pain after the procedure?". "Doc that procedure made me much much worse- it is your job to treat the pain caused by your procedure". And so on......
But you are less jaded than am I and perhaps have had some good outcomes with procedures in ex-addicts or recent addicts.

i am equally jaded. but its the "please shut the **** up factor" as i refer to it...

this prescription drug thing is outta control in indiana...

 

[Aether2000]

I don't know whether or not to be happy that Indiana is not alone in this problem.... You should hang out on some of the patient internet forums....some people are on 600 mcg fentanyl patches or 1000mg oxycontin a day.....

 

[Mister Mxyzptlk]

600 mcg fentanyl patches

AKA, the "Duragesic Vest".


I just got a referral because the FP was "uncomfortable" prescribing ONE vicodin per day.

 

[Jitter Bug]

Followed by in rare cases the Duragesic leisure suit.

 

[Jcm800]

I don't know whether or not to be happy that Indiana is not alone in this problem.... You should hang out on some of the patient internet forums....some people are on 600 mcg fentanyl patches or 1000mg oxycontin a day.....

my biggest issue is, i dont think these patients are TAKING these meds...

they may GET oxycontin 1000 mg a day, and they take SOME, but i am pretty confident the majority is not taken by the patient...it is taken by someone, in some form, for some payment...

 

[painchas]

Pill counts at random times will solve that question very fast. If not there or out of town too bad. Great way to thin out the med management side when needed. Truely needy patients will make it happen and be spot on on the counts.
Regards.

 

[ghost dog]

I don't know whether or not to be happy that Indiana is not alone in this problem.... You should hang out on some of the patient internet forums....some people are on 600 mcg fentanyl patches or 1000mg oxycontin a day.....

Thes "doctors" who prescribe such idiotic doses of narcs deserve a lot worse than having their DEA # / opioid license revoked.

They make is all look like a bunch of incompetent fools. It really grinds my gears.

I have one patient right now I outright refuse to script the Fentanyl patch: her last "clinician" decided to ramp her up to 200 mcg Q 3days. Not too over the moon ridonculous until she tells me that her pain remains "9 - 10 / 10." And she has FM, a HX of cocaine abuse, adolescent abuse, and untreated l(likely bipolar d/o - but refuses to see psych). A real train wreck.

I'd really like to find this past MD and give them a pimp slap.

 

[Jcm800]

Thes "doctors" who prescribe such idiotic doses of narcs deserve a lot worse than having their DEA # / opioid license revoked.

They make is all look like a bunch of incompetent fools. It really grinds my gears.

I have one patient right now I outright refuse to script the Fentanyl patch: her last "clinician" decided to ramp her up to 200 mcg Q 3days. Not too over the moon ridonculous until she tells me that her pain remains "9 - 10 / 10." And she has FM, a HX of cocaine abuse, adolescent abuse, and untreated l(likely bipolar d/o - but refuses to see psych). A real train wreck.

I'd really like to find this past MD and give them a pimp slap.

i have a thousand patients i outright refuse to write their narcs...
why do people feel compelled to feed the monster?

 

[painMD24]

I just saw a patient this week who stated she had spine surgery in MD 20 years ago, moved to North Carolina and has driven back to Maryland every three months for her fix of duragesic 75mcg, hydrocodone 10mg, valium 5mg tid and adderall.....q 3 months for 20 years! Surgeon's office mysteriously closed several weeks ago and her primary in North Carolina referred her to me so I could "give her pain meds so she won't go into withdrawal."

I'm new to the forum here and realize some of you would not have seen this patient at all, but I did and of course did not prescribe opiate, but sent back some non opiate recs with other treatment options to her primary. Asked my MA to request the Maryland surgeon's notes......only to find out yesterday the mysterious closure of the surgeon's office was done by the DEA!

 

[powermd]

I just saw a patient this week who stated she had spine surgery in MD 20 years ago, moved to North Carolina and has driven back to Maryland every three months for her fix of duragesic 75mcg, hydrocodone 10mg, valium 5mg tid and adderall.....q 3 months for 20 years! Surgeon's office mysteriously closed several weeks ago and her primary in North Carolina referred her to me so I could "give her pain meds so she won't go into withdrawal."

I'm new to the forum here and realize some of you would not have seen this patient at all, but I did and of course did not prescribe opiate, but sent back some non opiate recs with other treatment options to her primary. Asked my MA to request the Maryland surgeon's notes......only to find out yesterday the mysterious closure of the surgeon's office was done by the DEA!

I think I know this patient! Or one that is very similar.... She used to drive 5 hours from NC to Southern Maryland to visit my old practice for therapeutic facet blocks (*snicker*) under MAC, and refills on her meds. She may have had a pump though.. don't remember exactly. I'm glad I didn't develop strabismus given how many times a day my eyes would roll with all the nutty addicted patients in that practice. TG I'm non-narcotic all the way now.

 

[101N]

That does make sense. The reason we don't permit them into our practice is the whine factor. Everything was sooooo much better when they were on narcotics, they whine. "Why not give me just a few for pain after the procedure?". "Doc that procedure made me much much worse- it is your job to treat the pain caused by your procedure". And so on......
But you are less jaded than am I and perhaps have had some good outcomes with procedures in ex-addicts or recent addicts.

This mirrors my experience as well. You can never over-estimate the manipulation factor with addicts. That said, I'd see the patient to reinforce the message: You don't need, and wont ever receive opioids from me.