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being present during a pill count

PLEASE!! someone PLEASE answer my question...i was not allowed during my pill count...is this normal protocol? i was told i should have been present!!  they didnt ALLOW me to be there!!! HELP ME PLEASE...i need to know as i have gathered alot of BAD INFO on my PCP and next step is to file a complaint with the office manager!
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547368 tn?1440541785
Hi Teresa,

I have never heard of such a thing! Of course you should be present for your "pill count". I never let my tablets out if my sight - even when I see my PMP.

I've had several, actually more - pill counts and they have always been done in my presence. In fact I count the tablets before I go to my PMP and I tell them how many tablets I have. Of course they count them and our "count" has always been the same.

I don't know if there is any law that says pill counts must be done in your presence but this sound pretty suspicious to me. I would not agree to having anyone take my opiates out of my sight. I would refuse in the future.

Other members may have different input - but regardless I would refuse to give over my meds. That's my opinion.

My Best,
~Tuck
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547368 tn?1440541785
Hi Carol,

Welcome to our Pain Management Forum. I am glad you found us and took the time to post our concern. We encourage all to begin a new thread and not post on another person's thread.

Phil is correct. Your physician is under no obligation to treat you - just as you are under no obligation to continue his employment. Yes I said that right. We do employ our medical providers. We pay them and determine if we'll continue to do so or not. Society and physicians often forget that fact.

In my home state every visit - and I mean every visit includes a pill count. It made me feel like a criminal. In the state I reside I must bring in my meds to be "viewed" by the PMP - every visit, no exceptions. If they look "off" I assume they would be counted. My PMP use to open my container and physically look at the pills. He no longer does that - I hope the trust is building.  

I don't think you have a choice - if you want to continue to see your current provider. I have heard other posters here say that they were terminated for not doing a pill count as requested. I recall were in another  town - or didn't have transportation. It didn't matter. Admittedly they both had contracts.

Have you tried talking to the person that called you and explain it would put your employment in jeopardy? I'd try that avenue.

I wish you the very best - and hope that you'll let us know how this turns out.

Best of Luck,
~Tuck
Helpful - 0
7721494 tn?1431627964
Carol,

How long have you been with this doctor?

Pill counts are unusual, and since this might cause you a good deal of problem at work, what are the consequences of refusing or rescheduling?

With HIPPA laws being as they are today, your doctor has no right to inform your employer why he wants to see you in the middle of the day.

I never revealed the fact that I used opioid analgesics to clients, colleagues, employers, employees, or other business associates during my career, unless they had reason to know, but I'm in an area where people are either provided privacy, or everyone knows all about neighbors because they are family -- it's a very different situation. I'm sure that people knew more about me than I realized!

No contract, no right to ask.

However, your doctor is under no obligation to treat. What would life be like for you if your doctor refused to treat?

This situation sounds like a perfect opportunity to talk things over with your doctor. These are hostile times for both your doctor and you in the treatment of pain.

I find it best to work together toward a common goal, instead of creating an adversarial relationship that is destined to fail.

Is that right? For me it is. You'll have to figure it out for yourself.

Maybe you'll share this ... would you fail a pill count?
Helpful - 0
Avatar universal
Out of the blue I've been called in for a pill count which would entail me having to take off a day of work.  I do not have any type of "contract" with my doctor and have no history of abuse whatsoever!  I'm told this is just a normal part of the world today.  I'm new at my job and don't feel it's fair to ask for an unplanned day off to make my doctor happy.  Can they do this without a contract?
Helpful - 0
547368 tn?1440541785
I agree a caring physician makes all the difference. I too was spoiled by having a kind, trusting PCP who managed my pain for years. I never abused or diverted my opiates. She knew it and never asked for a count or a UDS.

Sadly the climate has changed. Those good physicians are now terrified by the "eyes" and scrutiny of the DEA. I will leave this world suffering and in pain thanks to the DEA and their war on Chronic Pain Patients.

It's a pet peeve of mine also.

Thanks for the input - and welcome back to our community.

~Tuck
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710547 tn?1295446030
My accumulation of controlled drugs was known by my PCP, and he was supportive. He knew it wasn't approved of officially, but with Medicaid, it's so hard to get a doctor at times and as it turned out, had I not had the extras due to weaning myself off a while back of a high dose to a low dose - I would have been facing - Not only cold turkey wd, but severe debilitating pain. I have NEVER sold, given, or misused a drug. They're kept in a locked safe, and are used responsibly. It's so aggravating to feel the control of the government on our ability to manage our Healthcare with the advice and counsel of our trusted physicians.

This is quite a pet peeve of mine! The truth must be told, however, to keep everyone aware. I, personally, have never had a pill count. The last palliative care dr I had used to drill me every time on exactly how many I had taken. I wasn't used to it and it really bothered me. I was spoiled for many years by a caring dr who had faith and trust in me - a beautiful thing!
Helpful - 0
547368 tn?1440541785
It's sad that not one agency will make these PMP follow the rules. The DEA should have made at least a comment to the PMP about his improper procedures. It's we CP patients that have to tow the mark.

Nurseob - thanks for your input - and yes, most of us know what should happen - but that doesn't mean it happens.  As a nurse myself I see a lot of things that aren't done according to protocol - and some borderline illegal. It also depends on how you pain contract reads. My former one read only that the pill count would be done in my presence - it didn't say there had to be a witness in addition to the staff member "counting."  These PMP call the shots.

Theresa -  I'm sorry you had to pay $50 for your records. I'm not surprised there are "things" missing from your medical records - or that it's filled with miscommunications. I think most patients would be surprised to learn what is or is not in their records. I'll say it again - I encourage everyone to ask for a copy of their medical records every 3-6 months. As I said earlier, I've never had to pay for a copy.

Thanks for the update. It's very much appreciated. Please keep in touch.

Good Luck My Friend,
~Tuck
Helpful - 0
Avatar universal
Sorry I'm so late to your post, but I most definitely agree that you should be allowed to be present at any and all pill counts that you have.  You should NEVER let them out of your sight!

I returned some Fentanyl patches to my Dr. that I no longer needed because I had tapered down from 100 mcg's to 75 mcg's and I wanted to get rid of them so I took them to him.  They INSISTED that I be present when they destroyed them. They brought them into my exam room and cut them up in my presence and then BOTH the nurse and I had to sign the paper showing how many were destroyed and how they destroyed them.  That's the same way that they should be doing your pill counts.

i'm assuming you passed the pill count.  I hope you did anyway.  NEXT time don't let them out of your sight!!!

Best of luck.  I'm glad everything worked out for you.

Good luck.........Sherry  :)
Helpful - 0
Avatar universal
Yes you do have the right to be present when your meds are counted.
I am a nurse and there are suppose to be several witnesses and it has to be documented and signed.
They are your meds and it is for your legal right and staff's counting them that you have all people see it and agree on the count.
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Avatar universal
thanks Tuck! i went as far as the DEA and all and they said that BOTH the dr and the patient should be present during a PILL COUNT for the safety and protection of BOTH parties! thanks so much! and as far as any thing ...my ex dr dont follow the rules of making "certain" things to become part of my records...i just pd 50 bucks for my records and youd have no clue as to what wasnt there..things i knew shoulda been ...and communication mistakes...on his part....all the Drs that were currently employed by him at his practice have left since my 1st post here...now hes all alone and begging for patients!
Helpful - 0
547368 tn?1440541785
What hey did to you was more than unfair - I think it was illegal at the very least they didn't follow their part of the contract. No one can take your opiates out of your sight. Sadly they do have the right to call a pill count whenever they so desire.

Once you become established with your new physician - and you know thing will be better with her - I'd write a letter to the physician that did the pill count without you being present. I'd make it very factual and well written - but I would be sure what they did - and I would say they violated the contract.  I say something like after 7 years of being her patient - you abided by the contract, always passed the drug screens and pill counts that you expected the be treated with the respect that you extended -etc.

The reason?? Any letter that you write and address to the physician becomes a part of your medical record - if they follow the rules. I may even send it certified or at least tractable. You want that a part of your record so down the road it's know why you left her practice.

You have every right to be PO. I'll be interested to hear how well you like your new Physician. Be cautions about belittling your current physician. Say positive things about her too - if asked just state the facts.

Again, please keep in touch.
Helpful - 0
Avatar universal
the office called and i was 2 and a half hours away....and not going to be back in my town for 3 days due to my apt being painted...i then was told... "you have 24 hours to get here with ALL your bottles of medicines" so on friday i had to rush back to my town go in to my dr office and was not allowed to be present...IM REALLY PO!!
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Avatar universal
youre right....the opiate agreement thing that i signed states that i am to be present during any pill counts!
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Avatar universal
thanks tuckamore...but i wasnt allowed to be present and im now very ticked off! i had been looking for a new primary since last year and ive found one..i see her for the first time on aug 18th! i cant wait...i just hope im not douing the wrong thing ..ive been with the one now for about 7 yrs...i know it can be hard to make a change...but i do feel it will benefit me in the long run...and yes...everyone ive talked to about this says yes i should have been present!
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Avatar universal
Hi Teresa --

I'm just curious on how they initiated the pill count? Do they simply call you up one day and tell you to come in for a count? Or is it done during a scheduled appointment that happens to be in the middle of the current prescription cycle?
I'm just trying to make myself more knowledgeable about this stuff, especially since it looks like I'll be needing pain management for quite some time.

Thxs
Helpful - 0
Avatar universal
Thank goodness you had some extra of your pain meds during that time. It just shocks me how out of control all of this is. It seems that most of us have little to no control over our pain.
I'm so sorry that you and Tuck get such high BP during flare ups and when you're without your meds. You're right, it is dangerous but the DEA doesn't care.
Big hugs to both of you.
Helpful - 0
547368 tn?1440541785
I think we all have a few extra. My PMP was "counting" my meds wrong. He doesn't actually count them table by table he just "eyeballs" them really well, tips the bottle to see that they all look alike.

Anyway a few months ago he said to me, "Tuck I think you should have a few extra but you've been having way too many in your bottle." I reminded him again that he wasn't looking on the fill date on the bottle. Most of his patients fill their meds on the day of their appt or shortly after. I was a "new" patient and all my meds were changed - so I went through 10 days of a taper off my previous meds before I filled his RX. He knew that - but just forgot. He does allow me for flares - meaning I may take one extra on a day and then take less on another. Much depends on the PMP. My PMP in another state counted each tablet and you better not be off by even one. You weren't dismissed but you were warned.

So yes in normal situations we can apparently have a "few" ahead - but anything more than that may bring us huge trouble.

You're right fntn. I don't have your medical issues but during a flare with hypertensive meds my B/P will still rise, often it'll be 170 or 180 over 110 - or 120. When my pain is controlled well I don't even require hypertensive agents. What a world we chronic pain patients in live today.
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Avatar universal
No, I didn't but it's insane to not allow a patient to have a safety allotment. I had an insurance issue at one point and my doctor was on vacation. So my prescription ran out before I was able to get in for another appointment. I wasn't a problem for me since I had extras.

But in the DEA's fantasy world, I would have been in trouble. When my pain hits without medication, my blood pressure rises quite a bit, Not so good for someone dealing with decompensated ESLD with portal hypertension, it can cause uncontrolled bleeds and death. That's ok thought, so long as they think they're winning their little war on drugs.
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Avatar universal
You've told me about your Dr before and he sounds like a really good and caring one.
I was just so shocked to hear that it's illegal to have any extra of your own pain medications. Like I always say, I learn something new almost every time I come to this forum. Have you ever heard of this before?
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Avatar universal
My PMP knows that I have extra, I let him know every time I see him. But he has me doing a holiday every week, so that's why I end up with leftovers. Basically one day a week, I stop taking all meds for a day, sometimes two, kinda a reset. It's painful of course since I have serious bone degeneration issues. Strange that I don't ever seem to suffer from withdrawal symptoms. I've gone as long as two full dsys without any opioids or any other kind of pain meds. And I am on a very large dosage. Guess I'm lucky.
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Avatar universal
My gosh! It's illegal to have extra medication? You're so right Tuck. What if we have a snow storm and can't get out for a few days, or some kind of natural disaster? What if some chronic pain patients don't need their full prescription one month and have some left over? Are they supposed to take the pills back to their Drs?
This whole thing is completely ridiculous. I'm so worried about my sister because her RA specialist will no longer be prescribing pain meds after Sept. She did send all of her patients a list of 3 pain Drs.
When my sister has an RA flare up she may take more of her meds for a few days and require less the rest of the month. What if she sees the pain Dr right after an RA flare up and she's short on her meds? I hope her new Dr will understand how RA works.
Every time I come to this forum I read more stories about how badly chronic pain patients are being treated.
To the original poster. I would never let my meds out of sight. I don't see how they can get away with this. You should have every right to be there for every single pill count.
Helpful - 0
547368 tn?1440541785
Pill Counts are done based on all the opiate medications you have been prescribed for the month - for example - if on January 1st you were prescribed 60 hydrocodone (Vicodin) that are ordered to take 2 tablet a day. Now say on January 15th they want to do a Pill Count it will be of that Hydrocodone. You should have half of the "pills" in your bottle - depending on the time of day lets say you should have 31 pills in your bottle. The staff of your prescribing practitioner "count" the pills  and you only have 22 or you have 40 - your count is "off" and there will be questions.

If you have too little they may think you've diverted some of your medication. If there is too many they may think the same (you're saving them to sell) - or that you don't require 60 tablets a month.

If you are prescribed more than one controlled substance per month you will be required to bring in all of the tablets for this monthly count. Most providers do this count every month - at your regularly scheduled appointment.  

It's illegal to "accumulate" scheduled (controlled substances). If the DEA or your PMP discovers you are accumulating controlled substances you may very well face charges - federal charges.

I know - it doesn't seem right. We all feel more comfortable with a few extras to get us through an emergency situation - like if we lose our PMP or we are in an area where a hurricane can strike - we may be forced to miss our appt and may not even be able to see our PMP for days or weeks. There are all types of possibilities - still it's illegal to accumulate these medications.  

Hope that explained Pill Count to you.

Best Wishes,
~Tuck
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Avatar universal
I've never had a pill count. Do they only count the pills based on your current prescription period or do they want to count all the pills that may have accumulated over the past year or so? I have all those stored as well, but I have thrown some out after the expiration date had pasted.
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547368 tn?1440541785
Hi Again,

I've done some searching to see if I can find legal information on "pill counts" - I've found multiple examples of the proper way to conduct pill counts. They are all about the same. Here's one example that reflects all the others:

Pill Count Procedure
Staff Duties
One staff person will be assigned to:
1.Bring the patient to a private area of the clinic;
2.Ensure that a staff person is present to witness this procedure;
3.Request that the patient submit their medication to be counted and/or
examined;
4.Receive the medication from the patient;
5.Count the medication on a clean (germfree) flat object using sterile gloves or equipment.
6.Examine the color, shape and imprint of the tablet to insure the medication is the same as prescribed.  

Etc - And it goes on

In a facility (like a hospital and long term facility) drug counts are done at the end of each shift with the nurse ending the shift and the nurse beginning the shift. The count must be correct and both nurse must be present. -  So not allowing you to be present just doesn't make good sense.

~Tuck
Helpful - 0
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