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Pharmacist refused to fill.

Hey everyone I have been reading alot of your posts and I have been put into a situation I am not happy with.  Perhaps you can help me.  

Being a L5 replacement recipient and due to the damage to my spinal cord and nerve central prior to surgery i am in a lot of pain...moderate on the scale.  I take Opana ER40 3 times a day, Oxycontin40 2 times a day, Nucynta 75 2 times a day and Percocet 10's every 4-6 hours to control my pain.  My P/M doctor in the state I came from had given me a one month supply to make the transition during the move.  Well upon arrival at Fort Bliss I immediately did the protocol for obtaining a primary care physician to get into pain management asap.  I was seen by two doctors on post and the referral to pain management was made, much to my dismay the doctor I was referred to is no longer in this state due to malpractice, so I am on hold for P/M until a new doctor in P/M is found for me.  The way the P/M clinics here in El Paso are set up is i need a referral first then I must drop off my records for them to review prior to taking me on as a new patient and actually helping me.  

Well in the meantime my primary care doctor on the base here wrote me a two week supply script to tie me over.  Awesome I thought, I still have time as I watched my supplies dwindle.  Not at all the case.  The Army Pharmacy doctor decided that she isn't willing to risk her license on supplying me with a heavy narcotic the Opana ER 40.  Now what, I am out of my Opana, and not willing to go thru unnecessary withdrawals.  I have done the complete protocol and still not getting any help to get my medications filled.  They did on the other hand supply me with the OxyContin and Percocets, but they are not enough and certainly not helping with the withdrawals from the Opana.

Any suggestions on my next step?
20 Responses
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Avatar universal
Can you help me with a pm doctor. I sent you a message. Not sure if you got it or not.
Helpful - 0
Avatar universal
I'm glad they gave you something at least. I hope its able to at least help somewhat. I know what you mean about the bad reaction to Cymbalta, I can't tolerate and of the anti-depressant type meds, they make me manic. Lets hope that they will be able to get your pain back under control when you have your appointment in October. I have hear horror stories about the medical system for the military. Its a shame that people who serve this country tend to get substandard care. Would it be possible to find a PM in the private sector or are you forced to use the VA? Prayers to you.
Helpful - 0
Avatar universal
I had a reaction to Lyrica and to Cymbalta.  And the neurotin  really didn't seem to have any effect either way.  But good news they finally approved me for 60 Nucynta ER75 which is better than nothing and hoping it will be enough to get me to this P/M doctor.  Thanks for all your advice.
Helpful - 0
1326416 tn?1370927001
Someone who has been on opioids for a long time might require a higher dosage than a person who is "just starting out" with a pain medication regimen. I personally switch from one type to another periodically to help combat tolerance and to keep dosages down. Some people take high dosages because it's simply needed to control their pain. One need not be "concerned" about another persons dosage, that's between doctor and patient. The persons dosage wasn't at all excessive, and somebody was concerned that their dosage was very high? Nonsense. Everyone's different.
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Avatar universal
I agree that you're in a tough spot. I also agree that you've been taking WAY too much addictive medications in combinations I've never heard of any dr doing. As the wife of a retired 1st sgt, I know how hard it is to maneuver through the medical community on base. I don't completely understand your situation; are you waiting on surgery or have you already had it. I've had 5 disc surgeries myself and know how painful they can be. I'm not trying to be preachy because I once took a lot of addictive meds myself, but I think you're more afraid of the withdrawal than the pain. If that's the case, see if you can get into a Subuxone program if they won't help you any other way. I took Subutex for 5 years and it helps pain  a lot more than you think it will. Just a thought, no one can feel another's pain.
Helpful - 0
Avatar universal
Have you asked if maybe you can go back on the Lyrica or neurontin, it may help somewhat with the nerve pain. I know its not going to help your withdrawals but maybe lessen the nerve pain a bit? Check in when you get a chance, I'm sure your feeling like crap, but we do care so please check in, if only for some moral support. OK. Wishing you the best of luck!
Helpful - 0
1855076 tn?1337115303
What you're going through is so wrong and not fair.  Even if they didn't agree with what you were on and the doses, they should have allowed for a long, slow taper.  It is inhumane the way some people are treated.  (I've had a couple of experiences myself.)  I would suggest you check out the Substance Abuse Forum here as it is very helpful in ideas to help you minimize the withdrawals.  Any little thing you can do to help with the symptoms while you're going through them will help.  I tapered off a ton of meds and the suggestions from that forum were extremely helpful.  I won't say everyone there welcomed me as I was dependent versus addicted but there were a few who really went out of their way to help me.  And even if you don't want to post, you can read and figure out what things will help.

You have been/are on some hefty doses of meds.  I was as well.  It can be done.  I came off because I wanted to see if I could reset my tolerance and see if my pain was any different.  I was able to stay off them for a while, though I had pain.  The pain began to get bad again and caused my blood pressure to spike.  Despite putting me on two blood pressure meds, I couldn't get it down so my doctor convinced me it would be best to go back on them again.  I hope to wean off again if I can get my pressure under better control.  I don't want to be in a place that I'm at the mercy of a doctor, pill bottle or pharmacist or insurance company or the DEA for that matter.

You were given a rotten deal here.  You did what you were supposed to and you still wound up here.  It is just very, very wrong.
Helpful - 0
Avatar universal
I think I will go with a Neuro-STimulator for my next step.  The damage to my nerves in my spine and legs is so intense the pain can go from a simple numbness to shockwaves.  Regeneration of these damaged nerves is very lengthy and painful all at once.  I just want help to get through the pain is all.  Eventually I will be healthy enough to deal with the pain but to throw me out to the wolves so to say was very brutal on their part.
Helpful - 0
Avatar universal
My PCP told me day 1 I am not familiar with P/M and can offer you no help.  He is a General Practitioner only.
Helpful - 0
Avatar universal
In the past year I have tapered off from much larger doses of these meds and knocked out the Neurotins, Naprosyns, Naprelan, Celebrex, Lyrica and ReQuip  (short list off top of my head) that  they tried to give me to help with the pains I am having.  I have spoke with my Dr in GA about the Neuro-Stimulator as a option but wasn't willing to get one installed and make a 1700 mile trip to a strange doctor.  I am Glad that I decided to do that.  But upon this new P/M program I am looking for alternatives to my Pain.  Being in GA there were many factors that contributed to my pain..weather and dampness were the key factors.  I should have worked for the weather channel.  But any other suggestions you may have I would appreciate.  I wish I had a advocate to speak to my new doctor or to any doctor that could help me.

Thanks again.
Helpful - 0
Avatar universal
Just an update on my situation.  I was thrilled when they told me they had a specialty doctor coming in to help with the problem, well that was until I got to the appointment.  The so called specialist was a addiction specialist and more or less "Sorry to say your going cold turkey you are not getting your medications"   After a hour in the room talking with him I left with Doxepin and Phenergan to comfort and make it easier on me thru this tranistion.  So here is a breakdown of what I was forced to do, with no options and no relief for the main problem that I have and that is that I am in extreme Pain.

I went from taking:
Opana ER40 3 times a day to                          None
NucyntaCR275 3 times a day to                       None
Percocet 10       2 every 6 hours to                   1 every 6
Oxycontin40       1 at bed                                1 every 12 hours

The OxyContin is not what I wanted as it is more addictive than the Opana I was taking, but in reality the only relief i am getting.

The Pain levels are getting more intense and the depression and anxiety both are setting in to extreme measures.  I can't eat I have nausea.  And according to them I have only just began on the road to Withdrawals.

I am not at all happy with the system that the Government has set up for our soldiers who serve our country and their families to be forced into such brutal conditions and the lowering of self esteem making me feel as if I am a Pill seeker or Drug Addict (pill popper)  They should set up some sort of medical program for those who are in a pain management program to begin 4-6 months in advance of a move to get the proper medications and be pre-warned of how it is going to be when they arrive at their new duty station.  According to the law.  The Pain Management Clinic that you are in can't prescribe more than a 30 day supply of your narcotic pain meds to take with you.  They can't give you prescriptions to fill at your new locations because they are only licensed in the state in which they practice.  In my case I also went from one area in the country  to another which meant that my insurance switched to a new location so I couldn't use the Network to find a new doctor or to preplan for a Pain Management Doctor in the area I just moved to.  Once I got here I followed protocol and called for a appointment, went to it with a new provider, asked for referals and was given prescriptions that only cover 1/2 of the medications and 1/2 the original doseage amounts I was on less than 30 days ago.  From being  monitored by a reputable Pain Management Doctor to "your on your own-- Kick the Habit--your **** outta luck" situation.  The wait time from the day I left the state I moved from to arriving at our new base, set up house, making the required appointments, getting the referrals, searching for a P/M Clinic and making the appointment is from July 17- Oct. 16 and that is only an initial appointment.  Thats not to say he will agree with the current program I am on much less the medications but also it is stated by the appointment clerk that no prescriptions are given on the first appointment and it can take up to 30 - 45 days to get placed with the care specialist the new P/M doctor feels you are suited to.  So if your in a P/M program currently and about to get PCS'd or moving to another state with the Armed Services this is something you may want to check into, as I personally don't want to wish the Pain and Anquish I am going through right now on anyone....and my downhill ride is only just beginning.

Thanks for all your help and comments.
Helpful - 0
1855076 tn?1337115303
I'm in agreement with tapering and also with the nurse who mentioned the combination of meds you are on is very strange and dangerous.  I've never known anyone to have more than one extended release med and one breakthrough narcotic.  I was on a ton of meds a few years back and even though my doctor thought it was okay, I knew it wasn't.  I tapered off a boatload and lowered my tolerance.  Pain management is just that, management.  It's not pain free.  Also look into hyperalgesia.  It is caused when the narcotics actually start increasing your pain.  Even though you are not an addict, look to the substance abuse forum for suggestions on helping with withdrawals.  It helped me tremendously when I was tapering (on my own, not the best way to do it.)  Is the Nucynta ER or IR?  I feel bad for the position you're in.
Helpful - 0
Avatar universal
I agree.Do not wait until you are out of medication.Start tapering NOW. As I'm sure you know,withdrawal is brutal and the local ER's are usually not sympathetic to withdrawal. Talk frankly to your primary care physician and get his/her help.Many pain management doctors no longer accept new patients,as they risk their licenses even when following the law.People who haven't needed pain management simply do not understand it.
Helpful - 0
Avatar universal
As a chronic pain patient,I understand your pain. I am also taking opioids for pain management and am grateful for the P/M specialist I see in Las Cruces, however, as an RN, I am concerned about the types and dosages of the medications that you are taking.While each of them alone,taken as ordered,may be safe,the combination of like medications can,and has been,deadly,even for patients accustomed to opioids. This is why the pharmacist has declined your prescription. Recent changes in FDA law give pharmacists the right and the obligation to deny prescriptions that they feel are excessive or inappropriate. The new guidelines also allow legal prosecution of pharmacists who fill these prescriptions, as well as the doctor who wrote them. They are not wanting to torture you,but to save your life. I recognize that you need pain management but please work with your physician to decrease the dosages and number of medications you require. You should never use more than ONE extended relief opioid and ONE immediate release opioid in combination. I wish you the best and hope you are able to find relief. You may want to add a TENS unit...it works wonders for me.
Helpful - 0
Avatar universal
Oh, one other thing. I just wanted to say thank you for your husbands service and your support to him. God bless both of you!
Helpful - 0
Avatar universal
Hi there, I'm very sorry to hear about your situation. I have some suggestions, unfortunately, none of them are really all that good.

First would be to call the clinic you have an appointment with in October and ask to be put on the cancellation list. Then I would start tapering what little meds you have left. You will still have withdrawals but having something in your system will be better than nothing at all. Get some Imodium, it will help tremendously. The ER/ your PCP can prescribe clonodine that will also help with withdrawals.

Unfortunately, you are probably going to have a hard time finding another doctor that will keep you on your current levels of meds, so chances are you would have to detox/taper down regardless. The only other thing I could suggest is try to get into an inpatient detox program at your local hospital.

Its not going to be pleasant, but eventually you will start to feel better. I wish you the best of luck and feel free to come here for continued support, we're here for you.
Helpful - 0
Avatar universal
As to the withdrawals they referred me to the ER which they can do no more for me than the on post clinics can.
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Avatar universal
They finally found a P/M clinic for me but my appointment is Oct 16th and i have like a 10 days supply of my last 2 remaining medications.  Not to mention the main 2 which I am already out of.
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Avatar universal
What does your PCP say about what to do with the withdrawals?
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Avatar universal
The scenario worsens.  I have been to 3 P/M  clinics here in El Paso none will take me on as a new patient.  Seems there has been a investigation into mismanagement of prescriptions and the doctors here are scared to take on new patients.  Now I have an appointment with a Doctor lined up but not until Oct. 16th.   6 weeks without any type of pain management program or detox care.  What should I do???
Need advice please??
Helpful - 0
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