ptsd Can My Pcp Abruptly Stop My Pain Management Meds?

[justrluk]

Even as recently as my last visit (last week) it wasn't mentioned...

[Charli]

They are supposed to wean you off but YES they can do it.

I was told that there is a push from the top to wean any vet without cancer off their pain meds. I just had mine reduced by 50% and my quality of life is gone. I called my elected officials and there wasn't much to be done. So I'm trying to find a doctor on the outside to give me my meds. I've told my PCP that I will NOT live like this and so they sent me to the shrink. The shrink asked me if I was going to hurt myself and I said I think you people are doing a great job hurting me and they gave me the speal that they're caring about me. HUHHHHHHH! this much care might kill me.

We had better circle the wagons and start writing every elected official we can or we're all going to lose our pain meds.. I was also told that doctors that do not wean patients off the meds will get lots of pressure to do so.

[Charli]

Every veteran on narcotics (what a nasty word I prefer opioid therapy) has to sign a narcotic contract in order to get pain meds.

[Charli]

All I can say is that about 10 years ago I asked the VA pain management clinic for celebrex or vioxx and they gave me morphine instead. Since that time I have been on morphine, methadone, oxycodone, and fentanyl. Now oxycodone is considered the number one drug that is abused in Florida with hydrocodone a close second. I used to get 180 oxycodone a month. Now I just get 120. I feel like the VA is putting a target on my back. I have been on the contract for years and never violated it. If I am addicted the VA was the drug pusher that made it all possible.

You're not addicted, You're dependent. Addiction is a complex physical and mental result of misuse of pain meds. An addict will do anything for a fix a dependent patient will not. There is a push from the top to wean all of us off our pain meds if we don't have cancer. Quality of life apparetnly doesn't count. I'm putting my affairs in order just in case I can't find a pain management doctor outside the VAMC system. Personally I'm sick of the DEA and some idiots in DC inflicting their BS on me.

[stuart7491]

i recently violated my pain mgt contract by having to vist a local er after a fall i had to pay for the visit since it is not life threating and meds. the current meds would not touch the pain i was in. so being honest i mentioned this and then received a letter stating i would no longer get them because i rec'd from someone else. from what i have read the va was required to provide me a copy of pain management contract. they nevwer did and no documentation in visit that says they did, they gave me other stuff as is in the record, but not that,to they violated. also had rerceived pain med from other va drs. nothing said, but have also had a another dr write, but pharmacy would not fill because of agreement. can i appeal this decision. i also have appt with shrink, canhe write for at least the methadone, i could get by with just them, the oxy 10mg 4x a day really did't do that much. i don't mean to sound demanding but appt with both pcp and pshyc are in 3 weeks any help or direction pointing very much appreciated

[GuaymasJim]

There is quite a lot of information missing from your post that really makes a difference on how to approach this. The VA is getting a massive amount of pressure from DEA to reduce opiate prescriptions because they have become the #1 abused drug in the US. The VA usual opiate contract is similar to civilian contracts except it is much stricter.

Those of us who have been receiving these medications for decades have seen the cycle go from handing them out like popcorn to restricting them to the last hours of a terminal cancer patient's last day. With the news filled with daily reports of "prescription drug abuse/overdoses," this cycle is going to very long and difficult. The VA is looking for any excuse they can find to reduce the amount of opiates they are dispensing--any excuse! You unfortunately have given them several.

The following is neither legal nor medical advice, but I hope it helps a vet understand some of the ramifications of using opiates generally and specifically how the VA now deals with their use.

If you were prescribed opiates at your local ER, did you inform the local ER personnel about the fact that you were already on opiate therapy and under contract? Was the opiate prescription written by the local ER filled at the VA pharmacy? Did you inform them you were already on opiate therapy and under contract with the VA? I haven't seen (nor want to see) your contract, but I would be in violation of mine is I had to answer "NO" to any of those questions.

"so being honest i mentioned this" How (written or verbal) and to whom (Primary VA/private provider, pharmacist, intake nurse); and when (the next day, next appointment, next refill time, when confronted with the violation)? Again, I haven't seen (nor want to see) your contract, but mine requires a bonified and documentable emergency detailed in the medical records of the emergency as well as notification ASAP to my VA provider. The additional opiates would be figured into my consumption and my normal prescription would be adjusted accordingly if needed.

Yes, the VA is required to give you a copy of the contract at the signing. If they said they gave you a copy, the law usually sides (presumption of regularity) with them much like when they say they have sent notice of a C&P exam or the annual TDUI questionnaire when they really have no way of knowing whether or not they did actually send the forms. I am certain that you will not be able to obtain restoration of your opiate therapy based on whether or not you received a copy of the contract. You obviously knew your were under contract with or without a copy as you read and understood the requirements when you signed it (Hopefully!).

"have also had a another dr write," If the "another dr" who wrote the additional prescription was not covered by your contract, then I can almost guarantee that the VA will view that as even another violation.

What "but pharmacy would not fill because of agreement?" If it was the VA pharmacy, even the attempt to have it filled was probably noted and reported as another violation.

"also had rerceived pain med from other va drs. nothing said" Those other VA providers are aware of the contract as it will pop up on the VA computer screen when they attempt to enter an opiate prescription. Your PCP was also automatically notified and had to sign off on it. The VA pharmacy is supposed to act as a gate keeper by keeping track of multiple opiate prescriptions so they see the contract also.

Your best bet is to discuss this in detail with both your PCP and mental healthcare provider. It will probably be an uphill battle but be honest and straight forward and you may get back under contract. If "the oxy 10mg 4x a day really didn't do that much" and the methadone is helpful TELL YOUR PROVIDERS. If you are new to this type of therapy, you might not realize that with regard to opiates, more is not necessarily better in fact it may be much worse. Also, it you use more than is necessary or more often than is necessary, the medication may stop helping at all. Another important point, it is common for patients on long term opiate therapy to experience an increase in pain intensity not only the original pain but pain caused by different conditions. Finally, one of the biggest dangers of using opiates is that they are usually combined with acetaminophen (Tylenol) which is extremely harmful to the liver. The strict daily allowable limit of opiates is more a limit on acetaminophen than the actual opiate. I certainly hope that your providers, VA and private, explained all of this to you when they wrote the prescriptions and especially when you and your provider signed the contract. It it wasn't discussed, then I highly recommend that you bring it up the next time you have the opportunity.

Except for the occasional jerk, I believe most providers do really want to help patients, but, with DEA's opiate policy, their jobs are truly on the line. The determination of the proper use of opiates, or any other medication for that matter, legitimately belongs to the FDA, the doctor, and the patient, but so far no one has made me king so we have to deal with what we have--draconian non-medically determined DEA restrictions and regulations on opiates.

You should be gradually weaned from almost any medication rather than just immediately cut off. I cannot tell from your post whether or not you still have enough medications to last until your next appointment, but if you are experiencing withdrawal symptoms, report them to your provider immediately! Common withdrawal symptoms are: severe discomfort, including diarrhea, abdominal pain and cramping, vomiting, runny nose, eye tearing, yawning, sweating, agitation, restlessness, twitching and tremors, back and bone pain, and intense craving for the drug.

IF THESE SYMPTOMS ARE SEVERE--GO TO THE ER!

If you do get back under contract for opiates, you are going to be labeled as a potential abuser and even more strictly monitored.

So, my advice is to adhere strictly to the terms of the contract and if a situation arises where there is ANY question, ASK your VA provider, first if possible, AND DOCUMENT EVERYTHING! Having said that, I would not personally allow my health to deteriorate any further just because of an unreasonable bureaucrat and/or bureaucratic policy-but that's just me.