New Va Pain Medication Policy

[rootbeer22]

Folks;

It's the same ole story...a few break the rules..and the many suffers and is affected by this situation. I was severly injured and really understand the many aspects of pain management. The Local Facility Patient Advocate can help with these kinds of issues. That said, if a vet does not follow the "pain contract" then the VA is going to be tough on them...for a lot of the right reasons. That said, it should be between the doctor and their patients and when non-doctors start setting policy...everyone suffers..

Edited November 18, 2014 by rootbeer22

[jeffperry1134]

I take sertraline along with a few other depression meds and it has helped a little.

[Carolyn Reed]

Fellow vets. I too have fallen victim to the VA's extreme policy regarding prescription narcotics. I have a bad knee. Two years ago I was seen in the ortho clinic in Little Rock. At that time I was told by the doctor that the knee would need to be replaced but that I did not currently meet the VA's criteria for knee replacement. I was told that I needed to be a lot closer to 70 than I am. At that time I was 58. The doctor said that they could do an intermediate surgery to help relieve the pain but that he was not willing to do that because it would put me at surgical risk twice, since the knee is definitely going to need to be replaced. For pain relief he started me on injections of steroids alternating with injections of something call Synvisk, probably spelled wrong. Every single time I have gone to the injection clinic the ANPs who administer the injections have to stick me twice. These are painful injections in a already painful knee. I am essential incapacitated by this knee and unable to maintain my home in a sanitary and safe manner.

I asked to be prescribed two or three 7.5 mg of hydrocodone to take two days a week. Just enough to enable me to stand long enough to wash dishes and do some basic housework. I was denied. I volunteered to be on a pain contract. Denied. I offered to pick the pills up at the VA pharmacy on the days I planned to do housework. Denied. I have sought for the ortho doctors to re-evaluate the knee for possible surgery and even though I do have an appointment with ortho, the nurse assures me that there is absolutely no plan for surgery.

So they won't fix the knee and they won't give me a small number of a mild narcotic to allow me to have a quality life. All I have is pain and that is all I have to look forward to. I am now 60 and I know the game well enough to know that if I live to be 70 at that time they will tell me that I am not a candidate for knee replacement because my general health is not good enough to allow the surgery. In the meantime, I am expected to live in constant pain that even interferes with my ability to sleep.

I am not suicidal and I sure don't want to give the impression that I am, but the thought of living for years and years with this level of pain is almost unbearable. And I now have a better understanding of why so many vets choose to end their lives. It is very hard to be mentally healthy when you are in constant pain.

I was told that the real issue is that the FDA has revised their rules and that narcotics can now be prescribed for no more than 30 days. The doctor must see you to refill the script. The primary care doctors at the VA simply do not have the time to see that many vets each month. So, to comply with FDA regulations the VA here in Arkansas has decided to completely stop writing scripts for narcotics. This is not what the FDA intended when the revised their guidelines. They intended doctors to responsibly monitor the drugs they prescribed. Within the VA system that simply is not an option. The doctors here really need to see you no more than twice a year or they are overloaded.

Having been in the VA system for a long time, I know that the VA was the greatest offender in overprescribing narcotics. Years ago I asked to be taken off the 180 Davacet they were prescribing me each month. At that time my primary care doc handed me a book of all they pain meds and asked me to choose what I wanted to take. Because I think Tylenol is dangerous, I choose tramadol, which I have taken sparingly over the last few years. But now that I need something stronger or I need surgery on my knee, I am totally out of luck. The VA has become an environment totally void of compassion and I feel that they have infantized me by not allowing me any say in my healthcare decisions.

The one question that just keeps puzzling me is this...Why do they always ask you to rate your level of pain on a scale of 1 to 10 if they know ahead of time that they are not going to treat the pain no matter what you tell them? Any ideas?

[63SIERRA]

sertraline is an anti depressant. its ZOLOFT

[Pete53]

After 25 years my new Primary Doc does not feel comfortable writing scripts for xanax and hydrocodone, So she stopped with no consultation or warning. Fortunately I have learned to deal with VA and my Medicare Doc wrote the scripts. Except for insulin I am pretty much out of the VA clutches.

I feel that Veterans deserve the same choices that everyone else has. Why are we held captive to bad medicine?

[ourdoc]

Title 21 Code of Federal Regulations

PART 1306 — PRESCRIPTIONS

CONTROLLED SUBSTANCES LISTED IN SCHEDULE II

§1306.12 Refilling prescriptions; issuance of multiple prescriptions.

(a) The refilling of a prescription for a controlled substance listed in Schedule II is prohibited.

(b)(1) An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided the following conditions are met:

(i) Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice;

(ii) The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription;

(iii) The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse;

(iv) The issuance of multiple prescriptions as described in this section is permissible under the applicable state laws; and

(v) The individual practitioner complies fully with all other applicable requirements under the Act and these regulations as well as any additional requirements under state law.

(2) Nothing in this paragraph (b) shall be construed as mandating or encouraging individual practitioners to issue multiple prescriptions or to see their patients only once every 90 days when prescribing Schedule II controlled substances. Rather, individual practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so.

This is the current law, right from the DEA page at http://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_12.htm. The problem is the VA has their own policies that do not match the law.