Difficulties getting prescriptions refilled when regular doctor is out of the office

[k_lee02]

A little background. I have 4 herniated discs in my back. My back hurts bad enough but what really kills me is the compressed nerves that cause a constant burning, stabbing pain all the way down both of my legs. I am 31 years old. My back has hurt for 15 years, my legs for 10. I also have RA. I had a spinal cord stimulator implanted in October of 2013 and it hasn't helped anywhere near as much as I had hoped. The orthopedic surgeon that did the stimulator is very reluctant to do any kind of back surgery on me because I am so young.

I wear a 75mcg fentanyl patch that I change every 2 days. I also have percocet 10/325 that I can take up to 2 times a day as needed for breakthrough pain. I have been on both of these medications for 8 years now. I have only ever had the dosage of the fentanyl patch increased once and that was 3 years ago. The dosage/frequency of the percocet has not changed.

My primary care doctor is the one who writes my prescriptions. I don't call to request the refills unless I'm out or bill be running out over the weekend when his office is closed. He is very good about doing so. If the script is due to be refilled on the weekend he'll write it on Friday, he doesn't nitpick.

A couple of times a year I'll call for the refills and he will be out of the office. This is where I run into problems. I signed a pain contract agreeing to take the medication as prescribed, not to get medication from other doctors, not to take medication that wasn't prescribed, and agreeing to random urinalysis. The couple of times that I have been asked to take a urine test I have passed. This contract also states that if my doctor is out of town the on call doctor will refill the script. Some of the on call doctors will do it, no hassle. Others? Not so much.

This is my current situation. My last prescription for the fentanyl patches was written on May 22nd, the last several before that were written every 30 days. So, you'd think June 22nd would be the refill date but the month of May had 31 days. So I will actually run out on the 21st. The 22nd is a Monday so the date that I am running out (tomorrow) falls on a Sunday. The clinic is not open on weekends. I called on Friday to request the refill. The nurse says "We can't refill that, it's not due until the 22nd." I explained the calendar to her, she said she'd call back. When she did call back she said that it was only 1 day and that I would just have to wait.

I think I can handle waiting 1 day. I might get uncomfortable but I know it won't kill me. But it's the principal of the whole thing. I signed this contract saying that I would do what I was supposed to do and that I would be taken care of in return. This doctor and nurse knew darn well that I would be running out but they didn't really seem to care too much. Like I said, it does't happen often, usually when I have to deal with an on call doctor it's not a problem. However, since I have been taking these medications for several years this is something that I've come across a couple of times.

I am just wondering how many others experience this problem and if they have any ideas/advice for if it happens in the future. You would think that doctors and nurses would understand how a calendar works, after all, 7 months of the year do have 31 days in them.

[Tuckamore]

You're welcome. I think you have a great plan. I'm sure your PCP will admire you're patience and concern for him.

It still shouldn't have happened - and I agree I'd love to give these apathetic physicians chronic pain for long enough for them to understand.

Take Care,
~Tuck

[k_lee02]

I had considered making a formal complaint to the administration of the clinic but I decided against it. The main reason is that my PCP has always been good to me and I don't want to get him involved in something that could be an area of contention between colleagues. Also, with the amount of patients doctors are obligated to see each day I can see how it could be possible for them to get behind on charts and record keeping. On the off chance that my records aren't up to date or something like that I wouldn't want him to get into trouble if the administration decided to look into it.

I will talk to him about it though. I want him to be aware of the situation and I want to know what his input is. He may have a more trusted colleague that he could designate to handle my refills if he's out or something.

I would never wish chronic pain on anyone, not even my worst enemy. I do, however, wish that I could make some of these apathetic doctors feel what I feel for a little while.  A few days or a week so they could feel all of the ups and downs. Experience what it's like to have some blessed relief and then have it taken away. The medication doesn't take it completely away but it makes a big difference. That difference has become my lifeline. I'm still able to work, make dinner, spend time with my husband and son, drive my car and keep house.

Thanks again, all!

[Tuckamore]

I am so sorry! I glad you're going to discuss this with your PCP when he returns.  You're right - this is a climate of opioid-phobia! We have to chose every word we utter so cautiously for for being seen as a drug seeker - or an addict.

And so much for "continuity of care" !

Hang in - it's almost Wednesday - but this should never happen. That's the sorriest part of this story.

Please keep in to touch - and good luck.

~Tuck

[k_lee02]

After getting through Sunday okay for the most part I called the office again on Monday. My doctor was still out (will be until Wednesday). The nurse called me back a few hours later and told me that the on call doctor didn't feel comfortable filling it! I couldn't believe my ears. I told her that I had put my last patch on on Friday and that it should have been changed on Sunday. I'm guessing this on call doctor must have been a resident or a new doctor because I didn't recognize the name. Also, they see from my chart that I'm young and I'm sure that that doesn't help. If they cared to look any further they could see my MRIs, diagnoses, treatments, and all of that other stuff.  There are about 15 doctors in this clinic. She said I would have to follow up with my PCP. I was so angry but you really have to watch what you say to these people in this current climate of opioid-phobia.  Anything you say can be misinterpreted as 'drug seeking behavior'. I know that my PCP won't be happy that they refused to fill it.

I've been biding my time with my Percocet. My legs are extremely restless and they hurt so bad. My husband's brother lost his job, then his car got re-possessed and he got evicted from his apartment. We moved him in with us for the time being. Yesterday I had to get all the stuff out of our spare bedroom, we've been using it as storage. Today I had to work and it was very busy. I manage a restaurant/banquet facility. We also cater. There were 2 banquets in house and a catering job off site.

One more day. Actually, a little more than half a day. I can do it.

Thank you all for your kind words of encouragement, advice and stories. I hope you are all having realatively pain-free days (or as pain-free as they can get, anyway).

[abbeyjustcuz2924]

part b of comment......sorry!!


Sorry for rambling, as I said, I'm new and it's my first post and I have so much to say as I truly am starting to feel real fear about what will I do without this medication? I truly can not walk without it, I must crawl on all 4's as the pain is so great without it that I can not stand straight up. And this leads me to my question as this situation has made me think of this: is there a law that states how/when a doctor can just stop giving a patient their pain prescription? Can they just literally take you off one day, or do they have to ween you off or do they have to give you so much time to find another doctor? Is there such a stipulation like a "grandfather clause" once you have been on it for so long?

Like so many others I fear the word discretion as discretion does not change my injuries or pain that I deal with 24/7, as you all well know, it never stops. I find myself with great amounts of fear as I see how this clinic is changing and changing in how patients on this type of medication are being treated so differently than other patients in the last few years. As for another PCP, from what I have researched, this is one of the only clinics left that takes on pain patients in this area and private doctors are not taking on any new pain patients. I feel so stereotyped because of the "bad apples" who as one posted mentioned will just find another vice for themselves such as heroin.

Is anyone aware of what the actual laws are on this subject. Every time I try to research this subject, I don't find anything but garbled answers. I don't know if I'm searching wrong or there truly are no straightforward answers? As I said, I am in northeast Pennsylvania and am looking for any laws on the subject whether federal or state laws as I truly do find myself feeling more and more fear on the subject and now the actions of the clinic yesterday and today have just added to the concern/questions I have that it seems no one wishes to answer. I am currently 39 years old and that gives me fear as well as I may have many years left and how do I live them without this medication that has saved my life in it's treatment of pain?

Best of luck to all of you with all that you deal with each and every day. I hope to become an active member of this community and thank all of you for the posts you make here.

[abbeyjustcuz2924]

I am new to this community (but not new to the troubles/concerns/emotional distress the "system" has brought to our lives especially these last few years), but  from what I have read so far it is a great community with some very insightful advice. I am glad that I have found it. To give some history of myself, I was in a car accident which was caused by a teenager while driving and talking on a cell phone before society realized what a problem that is. I was at a stop light at a 4 way intersection when he rear ended me at about 60mph (speed limit of 40mph) and that drove me into the active part of the intersection where I was hit on both sides of the car. The seatbelt used such force to pull me back into the seat (thank God it did) that the seat broke and drove itself into my lower and mid spine (along with the other injuries like 142 stitches to close the wound on my forehead that reaches from one eye to the next....but the spinal damage was the worst of it). I had 3 surgeries to try and correct the damage to no avail. The 2nd surgery actually led to an emergency 3rd as the drill from the 2nd surgery nicked my spinal cord and therefore I was leaking cerebral fluid for 3 days before it was found). That was 1997 through 1999. Needless to say, I have been on pain meds since 1999. Like you, I have only increased in dosage once in all of those years and in the beginning I actually had them decrease it as I felt like it was too much as I was "in space" somewhere. (I must say here at the time of the accident my 1 year old son and 2 year old daughter were in the car as well but their car seats worked so well that neither of them received so much as one scratch...just a lot of crying from the terror of 3 cars striking us and some nightmares afterword...but today they are 19 and 20 years old and both have degrees and good employment...thank God...I hope I don't offend anyone by saying the "G" word as I don't mean any and will try to change my language accordingly.)

I am in northeast, Pennsylvania and see my PCP who is a doctor in a major clinic in the area where there are at least 5 other doctors along with many PA's. I have also signed this medication agreement contract and have had many urinalysis over the last 5 years and have passed every one whether a "surprise" or not.

I run into the exact same problem when my PCP is out of the office (and sometimes he is out for 5-10 business days at a time). They always have a dr. that is supposed to cover for him but those dr.'s seem to do it in "their own good time" and I say this as this clinic has a policy of when one is to even call for their Rx. Their policy is that you can not call it in until the day that it is due (which I completely see why), but yes, what about weekends/holidays? My PCP is usually very good with recognizing those times and we deal with it, but when he is out it is a nightmare. As a matter of fact my medication was due on Sunday (which they can clearly see), so I thought, ok, I better wait until Monday to call as I don't wish to push 2 days early. I called my Rx refill in yesterday morning when they opened and was told my PCP is out on vacation until next Wednesday, but someone will be covering for him. As of today at 1pm my Rx is still not done. When I phoned to ask what I should do as I have been out since Sunday evening, they told me to wait until 4pm and see if it's done by then (my situation is very similar to yours as I receive one medication as the "main" medication and the other is for breakthrough pain and this refill is for the breakthrough Rx.)
Sometimes I think that they don't care as it is a breakthrough medication, but don't they realize this has been the cycle for the last 9 years? Yes, I have the main medication so I don't receive the "sickness" that 16 years of pain meds will give to you even though you take it just as given you, but the pain becomes so intolerable in between.
I have noticed great changes in the last few years such as the front desk used to have the refill with them until you picked it up and now it is locked in a cabinet at the nurses station behind a locked door and when the nurse finally comes out with it you have to show them your id even if they've known you for years. I also have noticed that some nurses treat patients picking up these Rx's very differently than other patients (as in very badly){Just for an example, a nurse called my home one day about 2 days after a urinalysis ordered by a covering doctor, which I gladly took. During this call she spoke to me in such an indignant voice and said "why do you have restoril and syrax, I hope i'm saying those correctly, in your system?" I was stunned and asked if it could be my pill for nerve damage? She said no and then just before hanging up on me, she said she would notify my dr. of my actions! I was beside myself...how could this be in my system? Along with oh my God, what is in my body that I don't know of? I was so upset that I called my pharmacist and he told me to calm down all is fine. He told me you are on valium at night and some people metabolize valium in a way where these 2 "things" will come up in your system. He then asked me who told me such a thing that something was wrong with that and was shocked to hear it was a nurse. I directly called the clinic back, told them of what the pharmacist had just told me and then I heard nothing more until I saw my dr the next week. He apologized to me and said that he had nothing to do with that phone call as he knows why those 2 "things" showed up in my system and would expect them to be there. He apologized and said it would not happen again...but the difference in treatment by the nurses to patients such as myself can be plainly seen.)
I have spoken to my PCP about this a few times and he has complained to administration right in front of me as when he returned he saw that his covering dr. took far to long to authorize the Rx....but still it continues when he is away.

I know we must be patient but as many of the posts have said, they have no idea what we go through without it whether new studies on using this medication agrees with using it or not or whether the DEA agrees with it or not. I have always said that if one places a Rx bottle with a pain medication in front of someone such as a DEA agent that just had something in their life happen that causes their body terrific pain, but then tell them this bottle is here as this is available but you can not have it, so you must not open this bottle and take anything from within it. I would venture to say that it would take no more than a few hours (depending on pain level) for them to grab the bottle and take a pill and then thank "the universe" that it exists and is available to people who need it (and I won't even go into if it is a member of their family whom they love such as mom, wife, dad, etc.).

using a 2nd post as a part b as this one "exceeded the 8000 character limit"

[Tuckamore]

I have had the same issue in WI. Sadly not all clinic doctors viewed writing opiate prescriptions as  "continuity of care."  I thought it should be just seen as such but my physician's colleagues told me different. It depends on each PCP.

I'm talking PCPs and not PMPs - that may be the difference. In WI not all PCPs will even write opiate prescriptions any more.

Discussing this problem with your physician is the best approach.

~Tuck

[philnoir]

I've never had a situation where my doctor goes on vacation and doesn't have a covering doctor to manage his patients while he's gone.

And those doctors have never refused what's called "continuity of care" meaning, the same prescriptions my doctor wrote last month.

Now, if I'm expecting to change my medication with the covering doc, that's something else. I don't expect that.

So, if the docs who are covering aren't offering continuity of care, tell your doctor. He needs to know, and find other docs who will do their job.

Doctors are no different than mechanics -- you have good ones and bad ones. Sometimes, when our docs don't do a good job for us, we need to replace them.

Yes, it's a big hassle, but well worth it in the end.

And frank, open communication with your doctor is very important. Doc, I'm not happy with this -- when you go away I can't get my Rx filled, and you know what that means to me. So, will you please talk with Dr. So and So, or how about you write me another month of Rx that I can pick up in 30 days, so that I don't have this problem with Dr. X?

Rational people can come up with solutions to problems. If your doctor is not rational, find another now -- you'll be glad that you did.

Best wishes.

[Tuckamore]

Hi k_lee,

Welcome to the Pain Management Forum. I apologize for the poster that was rude. They are not a member of our community - indeed they've only posted once - they do not represent the other members in this kind and supportive community.

Before I continue I want to say, thank you Purrm3. You have offered some good suggestions.

Now back to you L-lee - fellow ! Wisconsinite. The clinic nurse would not have felt that way had it been her or a loved one that was in pain. I've had the same experience. My PMP (now in FL) sees patients on 2 days a month - at his leisure. Usually it's a 29-30 day internals but it has been 31. He posts a note on his large chalk board saying things like, "Next appointment in 31 days. Plan your meds accordingly."

Geez! If you take your meds as prescribed and according to the contract that you signed you're out on the 30th day! One can juggle meds so I have an extra day, by taking less! That means several days of missing a dose -  that means even more pain to deal with. No fair - but we are powerless to challenge these PMP.

Because of the rural areas in WI - PMP are even harder to come by than in other areas of the USA. PCP often follow and prescribe for their chronic pain patients. I actually prefer that as they usually know you best. Your PCP may be willing to leave a dated script for you at his office when he is out - of has time off.

The reluctance of your PCP colleagues to write your RXs is due to the new laws - Laws that say a chronic pain patient should be seen every month and if not than a proper and lengthy documentation must be made on the at least quarterly visits. This leaves his/her colleagues in a quandary. They have not seen you - nor do they know if your PCP has done the proper medical documentation. They risk losing their license if protocol is/has not been followed. I'm sure that law has some considered for those colleagues - but they don't or won't take the chance.

This is a sad, sad situation. The government has clamped down hard, and often unfairly on physicians that write opiate RXs. The rampant abuse and diversion of opiates has been the focus of the DEA and other government agencies since 2010. The numbers are down in deaths related to prescription opiates - but abusers always find drugs to abuse. Heroin deaths and abuse is at an all time high - so they just found another drug. The laws designed to address the abusers ends up effectiving the innocent - we legitimate chronic pain patients.

Until laws are changed (if ever) you and I are at the mercy of the few PCP or PMP that will treat and prescribe for us. We'll see more and more of concerns/problems like you have posted here.

Hang in there! We'll get through this - and talk with your PCP to see if he can help you with this on-going issue.

I'll look forward to hearing from you again - and your hearing your updates. I hope you'll become an active member of our community.  Best of luck.

Take Care,
~Tuck

[purrm3]

Wow, thought tgat comment was very rude! She was asking for other who have experienced the same problem not advise or judgement reaction on her experience.  
I have also run into that problem when my pcp was writing my scripts for pain medication.  When they would call me back and say its only one day, i would usually try this rebuttal that usually helped. " I dont mind pucking up a script that has the a future date on it. Being that i have taken this medication for many years i would hope that the Dr who has to write this script would understand that even one day can make a huge difference in my pain management and emotional status."
I am sorry that u have to go through this with the on call Dr. I know it's a pain.  I would also talk to ur Dr and ask that he leave specific instructions on the refilling of ur meds from the other Dr's.  Most dont mind doing that. That way u can refill ur medication with, hopefully, a smaller hassle.
Wishing u the best of luck.  

[penny_wizs]

You proudly say how your doctor "doesn't nitpick."

Now, it's your turn not to "nitpick."

KEEP YOUR MOUTH SHUT!