New Va Pain Medication Policy

[GuaymasJim]

My prescriptions are always screwed up in one way or another.  I have been prescribed Percocet/Percodan/morphine/demerol/hydrocodone etc for more than 40 years.  I take narcotics' "breaks/vacations" every 6 months to a year.  While this is a very miserable time for me, I was also advised to do it by someone (non-VA MD) whose opinion I respect and trust.  My body builds up less tolerance and the medications don't lose their effectiveness.

Years ago, I received percodan (oxycodone w/aspirin) in one quart milk box sized containers. I would receive literally thousands of these pills in a very short period of time. I prefer percodan to percocet but it is no longer on the VA formulary.  The non-VA MD advised taking opiates with apple juice (as opposed to any other fruit juice) because according to him, the oxycodone molecules attached to the sugar molecules and got into the blood stream much quicker.  I believe it works, but it might be the placebo effect.  Either way, that is the method i use.

I had to go to a class about opiates.  It was a power point presentation (using horribly out dated studies and other information) that could have easily been done online, but I had to travel 760 miles to attend.  Three weeks later, I had to return (another 760 mile trip) and sign a new "opiate contract" in the form of an "informed consent."

Some advice for all veterans:  STOP!!!! calling your medications "drugs"-use the term "medications."  Even unintentionally, the term "drugs" implies recreational use to many people including the DEA.  I grew up using the term "drug store" instead of pharmacy.  I don't use that term anymore either.  Study after study has shown that patients with chronic pain are very unlikely to abuse their medications, but there are too many DEA careers and outrageous agency funding at stake, so we are all labeled as "drug seekers" by the DEA to justify their existence.  I agree that abuse and diversion occurs, but since I don't do either, I don't feel that I should be punished with a reduced quality of life just because some criminals do.  A big VAOIG investigation was conducted in Tucson several years back because VA prescribed opiates were "on the street."  The results of the investigation showed that the diversion was being committed by employees the VA pharmacy mail out facility--NOT individual veterans.  The only "high" I have ever experienced from any medication was from Demerol. I received a massive dose, and it absolutely made me high!  Morphine, the VA pain medication of choice, has brutal side-effects for me.  It may well reduce pain, but it makes me feel like shit overall.

The most important advise (I can only speak specifically about Arizona, but I have read that other states are adopting the same policy) is NOT to have two "opiate contracts" in effect at the same time!  DON'T get pain medications from different providers at the same time!  Arizona has a data base of every narcotic prescription written in the state, and you WILL get flagged which will probably mean that you will be unable to get any future narcotic prescriptions from any provider.  It just isn't worth the risk!  If you feel you must get your narcotic medications from a private provider--MAKE DAMNED SURE YOU HAVE RESCINDED/CANCELED YOUR VA OPIATE CONTRACT IN WRITING BEFORE YOU HAVE EVEN ONE NON-VA OPIATE PRESCRIPTION FILLED!!!

Personally, I believe we are going to lose this battle and veterans are going to die as a direct result.  There are too many "moral judgments" being made a various levels of government.  Very few decision makers understand that chronic pain patients need opiate medications much the same way that diabetics need insulin.

[Vync]

 

The most important advise (I can only speak specifically about Arizona, but I have read that other states are adopting the same policy) is NOT to have two "opiate contracts" in effect at the same time!  DON'T get pain medications from different providers at the same time!  Arizona has a data base of every narcotic prescription written in the state, and you WILL get flagged which will probably mean that you will be unable to get any future narcotic prescriptions from any provider.  It just isn't worth the risk!  If you feel you must get your narcotic medications from a private provider--MAKE DAMNED SURE YOU HAVE RESCINDED/CANCELED YOUR VA OPIATE CONTRACT IN WRITING BEFORE YOU HAVE EVEN ONE NON-VA OPIATE PRESCRIPTION FILLED!!!

Excellent advice!

Do you know if the opiate contract is restricted to the physician or facility? For example, if Dr. Quack at the VAMC gives you the contract, are you limited to only that doc or just to doctors at the facility?

[ourdoc]

I had a new PCP do the same thing to me, passing the buck with pain meds, but using a method I learned as a medic was easily able to change their mind.  Any time a doctor pulls this kind of crap, ask them what the "standard of medical care" is for this medical situation.  Doctors know if they refuse to follow the standard of medical care, it can cost them their liscense to practice medicine in all 50 states.

Sometimes they will ignore it, and that's when you do need to file a complaint with your state medical board.  At the very least the doctor will get a warning that if it occurs again they will be in front of the medical board.

The VA can make all the "policies" they want, but they do not get to decide the license requirements, those are set by the medical community.

It goes right along with the other thing to remind them, didn't you take an oath to "first, do no harm" and don't you realize by doing this you ARE doing harm?

If a doctor says no to either of these things, from that point on as is my legal right, I will refuse to see them as they are not a REAL physician and I flat out tell them so.  I also remind them I have the right to read and dispute and hold them accountable for everything written in my health records.  Many will try to put disparaging remarks like you are a drug addict instead of medication dependent, there is a HUGE difference.  Not seeing them again is also followed by a legal complaint to the medical board.

So far I've only had one VA doctor refuse.  3 months later she lost her liscense to practice and because of that was terminated.  She had made those kind of remarks in my record, which were also part of her termination.  They weren't happy at that point as they had to read every patients records she had written in, to remove these kinds of remarks.  The VA doesn't really care about them either, they are also just a number and paycheck.  

Stand up for your rights, and don't be afraid to let the doctors know that you know just what your rights are, and that includes questioning their treatment.  Don't let them bully you.

Eventually you can find good doctors in the VA.  I would not trade my VA PCP right now for any other doctor, in or out of the VA.

[Vync]

I had a new PCP do the same thing to me, passing the buck with pain meds, but using a method I learned as a medic was easily able to change their mind.  Any time a doctor pulls this kind of crap, ask them what the "standard of medical care" is for this medical situation.  Doctors know if they refuse to follow the standard of medical care, it can cost them their liscense to practice medicine in all 50 states.

Sometimes they will ignore it, and that's when you do need to file a complaint with your state medical board.  At the very least the doctor will get a warning that if it occurs again they will be in front of the medical board.

The VA can make all the "policies" they want, but they do not get to decide the license requirements, those are set by the medical community.

It goes right along with the other thing to remind them, didn't you take an oath to "first, do no harm" and don't you realize by doing this you ARE doing harm?

If a doctor says no to either of these things, from that point on as is my legal right, I will refuse to see them as they are not a REAL physician and I flat out tell them so.  I also remind them I have the right to read and dispute and hold them accountable for everything written in my health records.  Many will try to put disparaging remarks like you are a drug addict instead of medication dependent, there is a HUGE difference.  Not seeing them again is also followed by a legal complaint to the medical board.

So far I've only had one VA doctor refuse.  3 months later she lost her liscense to practice and because of that was terminated.  She had made those kind of remarks in my record, which were also part of her termination.  They weren't happy at that point as they had to read every patients records she had written in, to remove these kinds of remarks.  The VA doesn't really care about them either, they are also just a number and paycheck.  

Stand up for your rights, and don't be afraid to let the doctors know that you know just what your rights are, and that includes questioning their treatment.  Don't let them bully you.

Eventually you can find good doctors in the VA.  I would not trade my VA PCP right now for any other doctor, in or out of the VA.

Ourdoc,
That is great advice.

[GuaymasJim]

Vync,  I am not sure about your facility/provider question.  I do know that all VA prescriptions go through a review process at the VA pharmacy before they are released to the patient.  If you were to have two different VA providers prescribing two opiates at the same time, I am certain that the pharmacy would contact the providers to reconcile the prescriptions.  Since non-VA prescriptions have to be rewritten by VA providers, I believe the same review process would be followed.  I have a contact in the VA pharmacy and will ask her your question and get back to you.

[ourdoc]

The way I handle this is any doctor that I see that wants to prescribe me any medication, narcocotic or not, I ask them to directly contact my VA PCP with the request for them to write the script. Believe it or not most doctors love it when patients say this as it shows they are trying to safely use medication by them only being prescribed by one doctor.  It also gives them the second opinion on the medication being prescribed and how it may react with your other meds.