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Meds cut in half unfair urine test and pill count

I had a pill count on Nov 5, 2014, I was out of state and my pills were separated, some in a 7 day planner at home and I had the bottle out of state.  I messaged my doctor on their site, and got not response of what to do, I messaged the doctor directly.  I got home a few days later and dropped my bottle on the pier and some fell between the cracks this was after hours and I messaged my doctor personally on his site, no response.  I had a prescription to be filled on Nov 28th, I filled it.and on Dec 29th I went in for my appointment.  My doctor said he didn't know about the messages and that didnt matter i ignored a pill count.  I did not Ignore it he ignored the message and I left messages at his office.  He stated that my last urine test showed low meds in system..I said I came in on Oct31st and I ran out of meds on Oct 27th and told the PA that at the time, he brushed it off at the time. He said we need to do something about that, IT WAS THEIR MISTAKE..I went in on Dec 29th and the doctor would hardly listen to me. he said when I come back on Jan 12 if test show fine no problem.  I went back on Jan 12th and he said he was cutting my meds in half the next prescription, he said the xrays and MRI's don't warant it.  I have been on pain management since 2008 his office but now new practice as of 8 months same offices.  The xrays of my back are not better than 2005 they are worse and so is my hip, my hip doctor said i would not be walking in 8 months.  My pain management doctor said that I need to do surgery or cut meds back.  It will be getting warmer in Feb and that is why.  That is forcing me to do surgery after that statement he said he was cutting my meds to half of what I am taking.  I stated that financially I can't afford to do surgery yet, and my 88 yr old Mom would have to look after me after surgery.  He said no matter my pain level he will not increase my meds. How do I fire him or look somewhere else, or what should I do.?  I was talked down to and felt like a second class citizen like I don't know what I am talking about, he said I have a 59 year old body and that is what happens deal with it. and he criticized my regular doctor for giving me too many med for my medical problems other than pain. I have never had any problem with the other doctors before he took over the practice since 2008 this guy took over in summer of 2014
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7721494 tn?1431627964
Find another doctor -- any doc who coerces a patient into surgery to treat pain is not qualified to practice pain medicine.

But you too need to get your act together -- the story about dropping pills on the dock isn't going to fly in any doctor's office.

It sounds as if you are continually running low on medication at the end of the month. I understand that you are under medicated, but taking more medication than directed is a bad idea and grounds for dismissal in any pain doctor's office.

The way to deal with ineffective medication is to keep a pain diary.

Now, what else are you doing to manage your pain? Pain management works best when multiple forms of therapy are used. Physical therapy and exercise are so very important. Counseling with a pain psychologist is essential to finding the best treatments and coping strategies. New coping strategies need to be found and developed. Alternative therapies should be attempted.

Your reluctance to try new treatment options is a signal to your doctor. You have to take an active role in your pain management.

Self-education is key. Learn everything you can about your various diseases. Also learn about how these diseases cause pain, and how that pain is best treated. Do you have neuropathic pain? Opioids are a poor medication choice for treating this kind of pain. GABA analogs are a much better choice. Discover and learn about treatment options and their outcomes and you can have an intelligent discussion with your doc instead of arguing about how much opioid pain meds you're taking or not taking.

I'll leave you with this thought -- Pain management is a game of inches -- For instance, if you live with regular level 6 pain, then opioid analgesia lower pain by only a point or two. Coping behaviors can lower pain another point. Exercise lowers pain yet another point. Collectively, that's a 4 point reduction in pain -- 66%  Now we're talking about a very tolerable level 2 pain.

When you can work together with your doctor, with mutual respect, you can achieve regular pain relief with a minimum of opioid tolerance and pseudo-addictive behaviors.

Still, I think this doc is making a wrong decision, but your behavior may have played a role in his decision. It is best for your long term pain management if you own part of the problem right now and learn from it.
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1 Comments
This is the best response.  I have used medicines at the lowest doses possible for 8 years and never have I called my doctor with some story about dropping my pills, leaving half here half there, my purse being stolen, etc.  I am very responsible with them and I know that if I lose them, it's my fault and I wouldn't expect my doctor to bail me out.  These doctors hear these excuses all day long and that's exactly what it is...an excuse.  You took more than you were prescribed.  You know it, they know it and that's why you're getting this response from them.  Work with your doctors and take your meds responsibly.   You aren't supposed to be prescribed enough to take the pain totally away.  That's too dangerous.  
Avatar universal
What's that old saying about beating a dead horse or something... or the other saying, can't get blood out of a turnip, or, my favorite... something about lipstick on a pig (but that one doesn't apply).

Anyway, if I were you, I'd get a copy of ALL my medical records, and simply find (heh heh "simply".... well, you know what I mean...), and simply find a fresh brand new Pain Doctor.

No matter what, no matter how much a-convincin' you do, there's always going to be the elephant in the room.

Just forget it. Wave the flag, find a new doc.

WHATEVER you do (and I personally HATE this situation), do NOT be forced into surgery.

That's the worst part of this whole d**n deal.... you're on Narcs, which DIRECTLY affect the mood/pleasure/deep-genetic-decision-making center in your brain... and I just know you're going to cave in and get surgery if you stick with this doc, just so you can get your meds.

No, I'm not picking on you... it's just a fact -- opiates trigger an ever-so-deep center of the brain, and unless you have the discipline of a deity, it is difficult NOT to 'give in' and have procedures done, just so you can get more meds.

That's what I'm afraid of. The "get surgery or else" thing that's going on.

Please, run the other way.

(of course, if surgery is medically necessary, then by all means get surgery.... but from reading your post, my deepest hunch says you really need to think this one through).
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Avatar universal
darn-in... Phil beat me to it (I was typing as fast as I could LOL)
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7721494 tn?1431627964
You've got to get up pretty early in the morning to get the jump on old Phil....
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Avatar universal
Allrighty then... I'm moving the hands on my alarm clock up an hour
:-)
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Avatar universal
my pain is from bone on bone with the hip no socket, back is d disc disease and various disc protrusions and compressions.  I also have Rheumatoid Arthritis, I did not ignore the pill count, I was out of state, I have never had trouble with any doctor since starting this pain management in 2008, a lot of patients are having various issues with this office
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Avatar universal
I am not seeking more pain medications for surgery, I can't afford the surgery now and don't want to be forced into any surgery that is going to be a financial burden on me, and forced my mom into looking after me, and she is 88 years old. The places they can send me to for rehab after the surgery to recover handle old people and are short staffed, and all that i have heard of in the area are not good.  My doctors don't want me to go to any of these places and want for me to recover at home.  The comments to my regular physician was not warranted by this doctor, nor my attire comments by him saying I need to dress more appropriately..I had on shorts t shirt, tennis shoes, socks it was 58 degrees outside, does he not know the meds taken raise my level of temperature..and for the lack of meds in my system, 3- 4 days without meds because of their appointment schedule is not my fault..
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Avatar universal
yeah i should not have told the truth about the pills dropping on the pier i reached for my phone and one bottle fell out, the other bottle of different pain med was in other pocked intact.  I was out of state when the doctor office called me, and was several days before i got home to the rest of the pills in the 7 day planner. I put them in my pocket one on left and one on right and things happened..I didn't know that being truthful would hurt my results but the doctor never responded to my messages directly to him on what to do when out of state with pills at home too.
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7721494 tn?1431627964
That's a lot of things coming together into one big screw-up, but with controlled medications, doctors cannot accept stories like this.

I can imagine that you could straighten out being out of town with hotel receipts, travel receipts, or whatever. But being short on your monthly count is like saying "my dog ate my homework."

Excuses like this just don't work. I've seen patients in their 60s and 70s dismissed from a practice because of a false positive or negative urine screen. No questions asked, no weaning. They receive a "you're dismissed" letter from their doctor's office, maybe with a farewell of "don't let the door hit you in the behind on your way out."

These are difficult times in pain management. You really have no idea, do you? The heat is on prescribers and dispensaries, buth. The DEA can't stop illegal drug trafficking, so to save their empire (and budget), they're now prosecuting physicians at a rate unprecedented since the Harrison Act -- over 1000 prosecuted last year alone.

We who are prescribed chronic opioid therapy (COT) and practioners who write our Rx have enemies everywhere. Regulators, the press, parents of children who've died of opioid poisoning, and even doctors who are supposed to be compassionate are are against COT. Just visit the website of Physicians for Responsible Prescribing of Opioids (PROPS) and read their "educational material." Many of their board of directors publish multiple reports annually that often misrepresent the facts to bring others around to their views.

http://www.supportprop.org/index.html

Chronic painers need to protect their docs who endorse COT and all practitioners who are compassionate in their treatment of chronic pain. This means keeping our urine clean, cooperating with treatment guidelines, and not showing up with excuses like this. Pain patients have to be beyond reproach and add disprove with our behavior the statistics of groups like PROPs who claim COT causes addiction.

No doubt, the pendulum will swing back toward a reasonable approach to treating the estimated 100,000,000 people in pain, and the 35,000,000 who live with chronic pain. But until then, we have to live with the propaganda against COT.

Do you know that we are the only patient population who has to take regular urine screens, who has to agree to one-sided controlled substance agreements before we will be treated, who have to submit to humiliating pill counts and demeaning treatment at the pharmacy.

Complete candor and honesty is essential whenever one is dealing with a physician prescribing controlled substances. Impeccable behavior is a must to protect your rights as a patient, your doctor's rights to treat, and the rights of every other chronic painer maintained with COT.

Someday all this will change, but excuses won't help. God forbid I would lose half of my medication some month, but if I did, I'd rather endure two weeks of the misery of opioid withdrawal than jeopardize my doctor and my access to vital pain medication. The stakes are too just high.
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Avatar universal
should i fire him and go somewhere else? and when do i do this and how
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Avatar universal
I have no doubt Philnoir can help you with this. But, in the end it will be your decision to make. Finding a pain specialist in the first place can be very challenging. I'm going through this myself right now. Finding a second specialist can be even harder. Maybe it depends on where you live and how many specialists are in your area. Do your research. In my opinion this is very important. I'm not sure if you should find another Dr before you fire your current one or not. If you do that and have problems finding another Dr you may find yourself without any medication for awhile. That would not be a good thing. Can I ask if you're working with your primary Dr too? If so, maybe you can talk to them about wanting to find another pain specialist and they may be able to help you with that.
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Avatar universal
Please don't jump all over me for saying this, but there is one more option that may work if you are on a mild-enough prescription: Quit all opiates and be DONE with this s**t. Then, you NEVER have to deal with doctors, urine, pharmacists, dirty looks, etc., again.

Obviously, some chronic pain patients are on considerable dosages of methadone, morphine, hydromorphone, and high-dose contins, for chronic, unrelenting severe pain, and absolutely need medication to function. For those, the discovery of the poppy is a blessing -- and -- the pain relief is worth (several times over) the hoops that we have to jump through to sustain our protocol.

However, I've noticed it gets revealed that some folks are on *really small amounts* of hydrocodone a day "to take the edge off," their mild to moderate pain, yet they go through incredible hassle to maintain this status quo.

I get that hydrocodone is 'nice' (it does provide mild pain relief, and does provide the oft-demonized euphoria which also mitigates our pain perception)... but the truth is, many *many* peoples' lives would be bettered by simply quitting. (Many people in unbelievable pain have happy, active, and contented lives on a couple Advil a day.) This frees up resources -- not only will the doctors have more time to focus on those that are in severe, incapacitating pain, but the pain patient gets their life back! On many cases, our bodies *are* capable of producing enough endorphins to make it through the day (how many stories do we hear about, "the truck was on top of me, and I didn't feel a thing").

Again, in case we skipped over this post's intro, my intention is not to anger those who are on large, and necessary doses of pain medication -- no, rather, this post is just a comment to 'consider' for those who aren't really in that much pain... and maybe even for those that *are* in that much pain, but would have a healthier, free-er life without the PM rigamorole...
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Avatar universal
i tried to cut my meds in half this week to try and the pain was soooo intense and could not sleep at night for pain i am on 20 mg oxycodone 40 mg opana. i don't really want to be on anything and like you said f### all this urine test and pill counts that is so degrading. and you feel like a criminal and this doctor is controlling your life...I am sick of it.I might go to my regular doctor and talk...she knows me well
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Avatar universal
this particular doctor has given out incorrect urine tests one girl went directly to her regular doctor and had one done within the hour and it proved correctly. Some have gotten lawyers i have heard..I just don't want him to black ball me..or anything I guess i will cancel my contract after talking to other doctors in the area and my med doctor after they say they can take me..pain management doctors ..and see if my regular doctor can prescribe something she is further away but understands stuff.
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Avatar universal
From your posts, it almost sounds like if you *remain* with your current Pain Doctor, eventually your "number will come up," and it will be 'your turn' to get the Wrong Result.

I like your idea about approaching your doctor. Actually, approaching your doctor on the basis you mentioned: on a "preemptive basis!"

"Hey doc, all these other people at XYZWhatever pain clinic end up with False Urine Results, and eventually I'm going to be the one with the Bad Result."

-and -- if your State allows this:

"...so Doc, I would be willing to even take LESS opiate, just so I could stick with you, and be under your care because I trust you fully."

There. What do you think of that? (heh heh it's YOUR idea, really... I just re-phrased it, so you'll know that I understand what/where you're coming from).
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Avatar universal
i recently had my very first pill count...at my primary care doc...i wasnt allowed to be present during the count..they wanted EVERYTHING i take.. in the bottles,not just the norco...should i have been present?
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3 Comments
I know again, this is an old post, but for new people who are reading them, YES YES YES, you have the ABSOLUTE RIGHT to be present for pill counts. First of all, those are LEGALLY YOUR meds. Your script and YOU and/or YOUR insurance paid for them which makes them YOUR property. Being that you are responsible for the count, if they are short, the doctor will discharge you as a patient, you absolutely should be there for the count. That is the same thing as, me being a nurse, say I work a shift and while I go off shift I let the oncoming nurse count my narcotics BY HERSELF! Since I am the one responsible for the drug count, what's to stop her from taking some and then saying the count is short? NOTHING. Don't EVER just hand your meds over for them to count. They cannot make you do it. You are doing nothing wrong by being present for the count.
I trust no one so would require I be present.  It's unlikely they'd mess with your pills but again, I trust no one.  Diversion can happen anywhere  and any time.  How often do people get asked to do pill counts?
The frequency of pill counts can vary. Some doctors require them monthly, others may be quarterly or sending-annually, some may be random, or not at all.
In some cases, they are required if there is basis to suspect abuse/misuse, or there is questionable urine test results that triggers the random pill counts. Some doctors will require them from a new patient they don’t know well, or there is a history of doctor switching. It’s important to understand that they can also be required for no reason, as a result of random selection as well.
Any patient in pain management usually signs a contract where these policies are stated that the patient can be required to come in for a random count, and failure to show up within a set time frame is an automatic failure and can result in immediate dismissal from that doctors care, so it’s important that patients discuss the contracts and rules with the doctor before signing the contracts.
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