Opiate Therapy Group: New Opiate Law in Washington State... What do you think?

1

Hi everyone.

At Gloria and others' request I am posting this discussion to the Opiate Therapy group. Perhaps some of us who are uncomfortable talking about taking pain medications (ME!) will feel that they can speak more candidly here...

I am writing this post in order to solicit thoughts and opinions on the further regulation of opiate pain medications. I have ATN and do take opiate pain killers in addition to two anti-seizure medications and a few more in order to manage my pain.

Yesterday I had a visit to an ARNP to discuss depression and anxiety. As we were reviewing my medication list she mentioned that she had heard talk of a new law regulating patients taking opiate medications. Here's what she said:

1. All patients will be required to sign a opiate pain medication contract. A contract such as this requires patients to abide by their prescription directions, to not seek outside sources of pain medication or sell pain medication, does not allow for early refills on pain medications, etc... I voluntarily signed one at my old GP's office but am not currently on one at my new GP. If you breach the contract your doctor holds the right to refuse medication. Many doctors require a contract in order to protect themselves from sanctions or reprimands in Washington State.

2. All patients taking opiate pain medications will be required to submit to random urine tests to assess whether or not the the level of opiates in their system are consistent with their current dosage level. If not, the doctor has the right to refuse medication.

3. There may also be reduced limits on what doctors can prescribe to non-cancer patients. In Washington the current limit is 100mg morphine equivalent.

4 This law DOES NOT apply to cancer patients at all (terminal or not).

5. This law DOES NOT apply to those seeking end-of-life care.

I have looked around on Google and haven't found mention of it yet so I will wait and see if this law does come to pass.

My two cents... I am sad that I will have to jump through hoops to take a medication which gives me pain relief. I feel that this is a step backward for all pain patients who use opiate pain medications to function and lead a normal life with reduced pain or no pain at all. I will submit to all of these regulations in order to continue to have reduced pain, though I will voice my disappointment and concern regarding the criminal treatment of those who have legitimate conditions which benefit from the use of these medications.

A law such as this, will easily open the door to similar restrictions in other states and that is a large part of the reason I am posting this information. If you would like to chime in on this discussion please do. I am interested in hearing your thoughts and observations. Best. Johanna

2

Hi Johanna,

I currently am taking Opiate therapy for my pain. I have read over the "new rules" that you have said were relayed to you. I go to a Pain Mgmnt clinic and I already had to sign an Opiate agreement, an agreement to only fill at one pharmacy, submit to random drug testing and sign an agreement to not seek Marijuana as a source of treatment for my pain. I currently live in California. I have not been told anything about limiting the dosages that can be prescribed. I do however have an appointment with my pain clinic next week and I will ask the PA if she has heard of anything like this going down in CA.

It would be a shame to see medication monitoring take a huge step backwards. I also have to jump thru hoops to get my pain meds. I have been to other doctors where it was worse then where I am at now but I never had to sign any agreements with them. For instance my last pain management doc didnt care if I smoked Marijuana at the same time as I took Opiates and he never made me sign any agreements but he has highly suspicious of me and made me feel as if I was a druggie. I hated going to him once a month because I always left feeling depressed. In the end my relationship with him ended very poorly. He cornered me in his office and accused me of being an addict when he had cut my pain meds in 1/2 the month prior to see how I would do??? Then when I called his office to tell him it wasnt enuf pain medication he told me I was allowed to go back to my original dose. Then on my next visit that was when he accused me of being an addict when he was the one who lowered my medication in 1/2 all at once. Of course I was in pain and having withdrawal symptoms I had been at the higher dose for 7 years. He said I had no reason to be short medication by 6 days when he was the one who authorized me to go back to my original dose. What an idiot!!

I feel badly for you. I hope no such law is passed in your state. It seems that you and have a lot of the same feelings about having to resort to taking pain meds to survive. I try very hard to tell myself it is there ignorance about chronic pain not mine.

I hope I have helped you a bit. I will ask about the rumblings on my next visit to the clinic and post here for you to read.
Laurie

3

Hi all.

Another interesting news story related to opiate prescriptions... Florida CVS pharmacies are refusing to fill opiod presciptions from specific doctors who they deem to be prescribing these medications too frequently or in a loose fashion. The concern is related to their liability as a pharmacy and related to the abuse of Oxycodone in particular.

Interesting stuff. The law here in WA State is the real deal and I have already been asked to sign a pain mgmt. contract and will have to have regular UA's, every 4-6 months (which, of course, I will have to pay for).

I do know that insurance companies do have limits on what dosage levels you can fill in a certain time period. My company does not cover my prescription if I have to fill early (I have had to do so once for vacation).

Well, that's all for today. Seems as if things will be tightening up for all of us and others who use opiods to manage pain. Unfortunate. Take care. Johanna

4

Hello, Johanna.

I have signed similar contracts with both of the Pain Management Clinics where I've been a patient.

However, I do not at all recall the mention of doctors having limits, or reducing the amount of what they can prescribe to non-cancer patients. This, indeed, would be a step back for those with chronic intractable pain at the levels that many ATN and TN patients experience.

There are already so many hoops to jump through just to be treated fairly, and without prejudice when dealing with doctors and pharmacies who we rely on for the medications which some of us have no choice to rely upon for any kind of quality of life whatsoever.

It seems that anyone who requires opiate medication to control their pain is treated as a potential "drug seeker". In the United States, even criminals are innocent until proven guilty! In my experience, too many of us are treated as "drug seekers" (well, of course we are seeking pain relief, so I find that phrase inappropriate at any rate), although there is no indication of illegal activity regarding our usage of medications which are meant to treat pain! I would go as far as far as to say, and I think we all know that, these drugs SAVE LIVES, if you catch my drift, without me becoming too melodramatic here.

It is encouraging that you've found nothing of the like on Google.

My children and husband have seen me, personally, suffer so badly when unable to obtain the medications which keep my pain at levels where I can maintain any quality of life that, even though I try to shield them from knowledge of how precarious my position is, that they are on pins and needles every time I have a Pain Management Appointment, even though I have someone who seems to be a knowledgeable and compassionate specialist who goes the extra mile to help me manage my pain effectively. Right now, it's working! I have my life back to a large degree! When I think of the anxiety that such a bill would cause my family, I get a bit emotional. Every evening before my youngest goes to bed, she prays that Mom will have the medicine that she needs to not hurt so bad! She has seen the change in me since I've received the correct medications to control my pain. I tried to be the mother, and wife that was needed before, but my pain made me withdrawn and unable to get out of bed or off the couch some days. Now, it's as if my family have been given their mother/wife back! It's been miraculous! The house stays nice. I volunteer to do things at their schools. I am able to cook more and to shop with them whenever they need something without constantly grabbing my face, and being almost at the point of tears from the pain, and unable to converse with them about what they are buying (I am recalling a school shopping trip that went very badly one time, because I was in severe Type II, TN pain).

Dare I say it? Cancer patients may know that, by one means or another, an end to their pain is in sight. Procedures have not proven to be extremely effective for Type II patients, especially! There is no remedy for many Type I patients!

Many of us, as it seems to be with you, and I know it is with me, have exhausted almost every means necessary to prevent having to take medication which the body become dependent upon (not addicted, in the case of most pain patients - the only thing they are addicted to in most cases is a pain free life)!

I would like to run this information past Dr. Patty Verdugo, a lady who runs a support group, and is a patient and advocate of those who suffer from chronic intractable pain and are unable to obtain the medication they need. I wonder if she knows anything about this "new law" regulating limits of medication allowed to be prescribed to anyone aside from cancer patients.

Thank you for sharing this information with us, albeit it is cause for concern, it is good to know what may be coming around the pike. TN and ATN patients who have to take opiate medication never asked to be placed in the position in life to have to worry about things such as this, but if this is true, about the limits, it greatly concerns us all!

Best wishes to you, my friend!

Stef

5

Hi Stef.

Thanks for your reply. Unfortunately, this law is going into effect on Jan. 1 of 2012. I also posted this discussion in the "General" section and a respondee posted a link to the new law. In WA State, the maximum morphine equivalent that a non-cancer patient can receive is 100 mg. (I may be incorrect on this number). My doctor talked with me about this limit last week, luckily, commenting that I am beneath it (I take a morphine equivalent of 65-70 mg). In terms of the maximum morphine equivalent I do believe that there is a guideline chart for physicians. I can find it for you as I looked it up in the past. The chart I read was on a gov't website and the max suggested limit for non-cancer patients was 120 mg morphine equivalent.

I also posted yesterday regarding a CNN news story regarding CVS pharmacies in Florida. Some CVS pharmacies are refusing to fill prescriptions written by certain doctors who they believe are over-prescribing opiate pain meds. In Florida, the news story mentioned, that the most abused medication is Oxycodone. Thus, CVS has this medicaiton tagged as part of their refusal rights. CVS has chosen to enact this policy for the sake of the their own liability. Whether or not this will lead to similar restrictions by other CVS pharmacies in other states or other large pharmacies in general remains to be seen.

I agree with your statement regarding cancer patients. I have been reluctant to voice my thoughts on this topic and am glad that you addressed it in your response; a thoughtful and semi non-partisan (no judgement intended) point of view. I also believe that in many cases LIVES ARE SAVED through the use of ANY medication which reduces pain. Fortunately, for those of us with ATN who fail other medications, stories like yours are a testament to the success of treatment with opiods. The fact that we have to fight for treatment, undergo false accusations, jump through hoops and keep our treatment a secret (my case), be measured against a stick meant for drug addicts is an additional stressful burden that we should not have to endure. Reading your story of motherhood, marriage and managing pain successfully gives me hope that I, too, will be able to do the same. Go back to work, be a better wife and a functional person. I don't have children and cannot possibly fathom how difficult it must be for you and your children to see you suffer.

I will post the link the WA State Law, Morphine Equivalent Chart and CNN Florida CVS pharmacy news story in another post. Please let me know what Dr. Verdugo has to say on this topic. Hope you're well! Take care. Johanna

Stef said:

Hello, Johanna.

I have signed similar contracts with both of the Pain Management Clinics where I've been a patient.

However, I do not at all recall the mention of doctors having limits, or reducing the amount of what they can prescribe to non-cancer patients. This, indeed, would be a step back for those with chronic intractable pain at the levels that many ATN and TN patients experience.

There are already so many hoops to jump through just to be treated fairly, and without prejudice when dealing with doctors and pharmacies who we rely on for the medications which some of us have no choice to rely upon for any kind of quality of life whatsoever.

It seems that anyone who requires opiate medication to control their pain is treated as a potential "drug seeker". In the United States, even criminals are innocent until proven guilty! In my experience, too many of us are treated as "drug seekers" (well, of course we are seeking pain relief, so I find that phrase inappropriate at any rate), although there is no indication of illegal activity regarding our usage of medications which are meant to treat pain! I would go as far as far as to say, and I think we all know that, these drugs SAVE LIVES, if you catch my drift, without me becoming too melodramatic here.

It is encouraging that you've found nothing of the like on Google.

My children and husband have seen me, personally, suffer so badly when unable to obtain the medications which keep my pain at levels where I can maintain any quality of life that, even though I try to shield them from knowledge of how precarious my position is, that they are on pins and needles every time I have a Pain Management Appointment, even though I have someone who seems to be a knowledgeable and compassionate specialist who goes the extra mile to help me manage my pain effectively. Right now, it's working! I have my life back to a large degree! When I think of the anxiety that such a bill would cause my family, I get a bit emotional. Every evening before my youngest goes to bed, she prays that Mom will have the medicine that she needs to not hurt so bad! She has seen the change in me since I've received the correct medications to control my pain. I tried to be the mother, and wife that was needed before, but my pain made me withdrawn and unable to get out of bed or off the couch some days. Now, it's as if my family have been given their mother/wife back! It's been miraculous! The house stays nice. I volunteer to do things at their schools. I am able to cook more and to shop with them whenever they need something without constantly grabbing my face, and being almost at the point of tears from the pain, and unable to converse with them about what they are buying (I am recalling a school shopping trip that went very badly one time, because I was in severe Type II, TN pain).

Dare I say it? Cancer patients may know that, by one means or another, an end to their pain is in sight. Procedures have not proven to be extremely effective for Type II patients, especially! There is no remedy for many Type I patients!

Many of us, as it seems to be with you, and I know it is with me, have exhausted almost every means necessary to prevent having to take medication which the body become dependent upon (not addicted, in the case of most pain patients - the only thing they are addicted to in most cases is a pain free life)!

I would like to run this information past Dr. Patty Verdugo, a lady who runs a support group, and is a patient and advocate of those who suffer from chronic intractable pain and are unable to obtain the medication they need. I wonder if she knows anything about this "new law" regulating limits of medication allowed to be prescribed to anyone aside from cancer patients.

Thank you for sharing this information with us, albeit it is cause for concern, it is good to know what may be coming around the pike. TN and ATN patients who have to take opiate medication never asked to be placed in the position in life to have to worry about things such as this, but if this is true, about the limits, it greatly concerns us all!

Best wishes to you, my friend!

Stef

6

Here are the links I mentioned:

WA State Law (link is to the WA State legal code). Upon reading more this law addresses the difference between dependency and abuse. The law also addresses the lack of treatment of chronic pain due to the fear of disciplinary action by physicians. The law is designed to give physicians guidelines for treating chronic pain; attaining proper education to manage chronic pain, pain mgmt. contracts, patient monitoring through appts., assessments (including UA's) and then a new Commission which will evaulate physicians if they are deemed to not be following the guidelines of the new law.


http://apps.leg.wa.gov/wac/default.aspx?cite=246-919

http://www.medscape.com/resource/opioid/opioid-washington

Morphine Equiavalent Chart WA State: (I was mistaken on the suggested limit for non-cancer patients. It is 120 mg.)


http://www.agencymeddirectors.wa.gov/Files/DosingCalc.xls

News Story; Florida CVS Pharmacies & pain medications:

http://www.tampabay.com/news/health/cvs-tells-some-florida-doctors-it-wont-fill-their-prescriptions-for/1204032

Stef said:

Hello, Johanna.

I have signed similar contracts with both of the Pain Management Clinics where I've been a patient.

However, I do not at all recall the mention of doctors having limits, or reducing the amount of what they can prescribe to non-cancer patients. This, indeed, would be a step back for those with chronic intractable pain at the levels that many ATN and TN patients experience.

There are already so many hoops to jump through just to be treated fairly, and without prejudice when dealing with doctors and pharmacies who we rely on for the medications which some of us have no choice to rely upon for any kind of quality of life whatsoever.

It seems that anyone who requires opiate medication to control their pain is treated as a potential "drug seeker". In the United States, even criminals are innocent until proven guilty! In my experience, too many of us are treated as "drug seekers" (well, of course we are seeking pain relief, so I find that phrase inappropriate at any rate), although there is no indication of illegal activity regarding our usage of medications which are meant to treat pain! I would go as far as far as to say, and I think we all know that, these drugs SAVE LIVES, if you catch my drift, without me becoming too melodramatic here.

It is encouraging that you've found nothing of the like on Google.

My children and husband have seen me, personally, suffer so badly when unable to obtain the medications which keep my pain at levels where I can maintain any quality of life that, even though I try to shield them from knowledge of how precarious my position is, that they are on pins and needles every time I have a Pain Management Appointment, even though I have someone who seems to be a knowledgeable and compassionate specialist who goes the extra mile to help me manage my pain effectively. Right now, it's working! I have my life back to a large degree! When I think of the anxiety that such a bill would cause my family, I get a bit emotional. Every evening before my youngest goes to bed, she prays that Mom will have the medicine that she needs to not hurt so bad! She has seen the change in me since I've received the correct medications to control my pain. I tried to be the mother, and wife that was needed before, but my pain made me withdrawn and unable to get out of bed or off the couch some days. Now, it's as if my family have been given their mother/wife back! It's been miraculous! The house stays nice. I volunteer to do things at their schools. I am able to cook more and to shop with them whenever they need something without constantly grabbing my face, and being almost at the point of tears from the pain, and unable to converse with them about what they are buying (I am recalling a school shopping trip that went very badly one time, because I was in severe Type II, TN pain).

Dare I say it? Cancer patients may know that, by one means or another, an end to their pain is in sight. Procedures have not proven to be extremely effective for Type II patients, especially! There is no remedy for many Type I patients!

Many of us, as it seems to be with you, and I know it is with me, have exhausted almost every means necessary to prevent having to take medication which the body become dependent upon (not addicted, in the case of most pain patients - the only thing they are addicted to in most cases is a pain free life)!

I would like to run this information past Dr. Patty Verdugo, a lady who runs a support group, and is a patient and advocate of those who suffer from chronic intractable pain and are unable to obtain the medication they need. I wonder if she knows anything about this "new law" regulating limits of medication allowed to be prescribed to anyone aside from cancer patients.

Thank you for sharing this information with us, albeit it is cause for concern, it is good to know what may be coming around the pike. TN and ATN patients who have to take opiate medication never asked to be placed in the position in life to have to worry about things such as this, but if this is true, about the limits, it greatly concerns us all!

Best wishes to you, my friend!

Stef

7

Johanna,

I did some of my own digging last night. I found some literature on the subject, but not these specific links. Thank you for posting. I could open all but one, which is not system compatible.

This is an emotionally charged subject for me. My primary goal in life, right now, is to be a good mother. Pain relief is key, for me, in achieving this goal. So, when things like this come into question, it evokes the "Mama Bear" in me, not to mention the scores of friends I have who are chronic pain patients and my concern for their wellbeing, as well as the doctors who ARE interested in treating real pain with opiates, if they are required.

If I am reading these correctly, physicians with the authority to do so, are not limited in their ability to prescribe.

The article regarding CVS is alarming! I think there is a growing problem throughout the pharmaceutical industry. They want to pick and choose what drugs they dispense. I call ahead to make sure that the pharmacies I use keep the medicines I am prescribed stocked. Some must order them.

But, needless to say, although I am looking to change pharmacies this month, this article alone assures me of one pharmacy which will NOT be getting my business. This is very important information, which I would like to share with the group. I feel I should warn the other members of this group that CVS has made the decision to discriminate against those who are prescribed a certain medication. It is like the one doctor said, it is a business decision. However, they are a large chain who can afford to lose business, I suppose.

CVS is the only store which stocks the shampoo I use at a reasonable price, but speaking strictly for myself, even if it is in Florida, I have no patience with any entity which chooses to make life more complicated for chronic pain patients.

Best wishes, and thank you for providing these links. I hope you do not mind that I copy one to the main message board of this group.

Your friend,

Stef


Johanna Smith said:

Here are the links I mentioned:

WA State Law (link is to the WA State legal code). Upon reading more this law addresses the difference between dependency and abuse. The law also addresses the lack of treatment of chronic pain due to the fear of disciplinary action by physicians. The law is designed to give physicians guidelines for treating chronic pain; attaining proper education to manage chronic pain, pain mgmt. contracts, patient monitoring through appts., assessments (including UA's) and then a new Commission which will evaulate physicians if they are deemed to not be following the guidelines of the new law.


http://apps.leg.wa.gov/wac/default.aspx?cite=246-919

http://www.medscape.com/resource/opioid/opioid-washington

Morphine Equiavalent Chart WA State: (I was mistaken on the suggested limit for non-cancer patients. It is 120 mg.)


http://www.agencymeddirectors.wa.gov/Files/DosingCalc.xls

News Story; Florida CVS Pharmacies & pain medications:

http://www.tampabay.com/news/health/cvs-tells-some-florida-doctors-...

Stef said:

Hello, Johanna.

I have signed similar contracts with both of the Pain Management Clinics where I've been a patient.

However, I do not at all recall the mention of doctors having limits, or reducing the amount of what they can prescribe to non-cancer patients. This, indeed, would be a step back for those with chronic intractable pain at the levels that many ATN and TN patients experience.

There are already so many hoops to jump through just to be treated fairly, and without prejudice when dealing with doctors and pharmacies who we rely on for the medications which some of us have no choice to rely upon for any kind of quality of life whatsoever.

It seems that anyone who requires opiate medication to control their pain is treated as a potential "drug seeker". In the United States, even criminals are innocent until proven guilty! In my experience, too many of us are treated as "drug seekers" (well, of course we are seeking pain relief, so I find that phrase inappropriate at any rate), although there is no indication of illegal activity regarding our usage of medications which are meant to treat pain! I would go as far as far as to say, and I think we all know that, these drugs SAVE LIVES, if you catch my drift, without me becoming too melodramatic here.

It is encouraging that you've found nothing of the like on Google.

My children and husband have seen me, personally, suffer so badly when unable to obtain the medications which keep my pain at levels where I can maintain any quality of life that, even though I try to shield them from knowledge of how precarious my position is, that they are on pins and needles every time I have a Pain Management Appointment, even though I have someone who seems to be a knowledgeable and compassionate specialist who goes the extra mile to help me manage my pain effectively. Right now, it's working! I have my life back to a large degree! When I think of the anxiety that such a bill would cause my family, I get a bit emotional. Every evening before my youngest goes to bed, she prays that Mom will have the medicine that she needs to not hurt so bad! She has seen the change in me since I've received the correct medications to control my pain. I tried to be the mother, and wife that was needed before, but my pain made me withdrawn and unable to get out of bed or off the couch some days. Now, it's as if my family have been given their mother/wife back! It's been miraculous! The house stays nice. I volunteer to do things at their schools. I am able to cook more and to shop with them whenever they need something without constantly grabbing my face, and being almost at the point of tears from the pain, and unable to converse with them about what they are buying (I am recalling a school shopping trip that went very badly one time, because I was in severe Type II, TN pain).

Dare I say it? Cancer patients may know that, by one means or another, an end to their pain is in sight. Procedures have not proven to be extremely effective for Type II patients, especially! There is no remedy for many Type I patients!

Many of us, as it seems to be with you, and I know it is with me, have exhausted almost every means necessary to prevent having to take medication which the body become dependent upon (not addicted, in the case of most pain patients - the only thing they are addicted to in most cases is a pain free life)!

I would like to run this information past Dr. Patty Verdugo, a lady who runs a support group, and is a patient and advocate of those who suffer from chronic intractable pain and are unable to obtain the medication they need. I wonder if she knows anything about this "new law" regulating limits of medication allowed to be prescribed to anyone aside from cancer patients.

Thank you for sharing this information with us, albeit it is cause for concern, it is good to know what may be coming around the pike. TN and ATN patients who have to take opiate medication never asked to be placed in the position in life to have to worry about things such as this, but if this is true, about the limits, it greatly concerns us all!

Best wishes to you, my friend!

Stef

8

Stef-

I'm glad you're posting the CVS story. I posted it here as a reply to my original discussion and also as a reply to this same discussion that I posted in the "General" discussions. Thanks. I don't live where there is any mainstream pharmacy available. There is one privately owned, small pharmacy on the island which I live on and I can't imagine if they chose to do the same as CVS.

For me, I find this to be and incredibly controversial topic with patients, doctors, pharmacies and legislatures pitted against one another. It is a basic right to be able to recieve medical treatment (in my opinion) regardless of what that treatment might be. I feel rage when I think of all of the people who abuse these medications which has led to the reluctance of doctors to prescribe them and the guilty before proven innocent mentality that you mentioned in one of your above posts. When I go to the doctor I feel anxious every time as I am always wondering if that will be the day that my doctor will say "I can't prescribe these medicines anymore to anyone." Luckily, my doctor, at the moment, trusts me whole-heartedly and I am very thankful for that.

As to the morphine-equivalent limits... Upon further reading they're guidelines in most cases. 120 mg is the guideline for non-cancer patients. If a non-cancer patient is to take more then they are referred to a pain mgmt. specialist by their GP.

That said, my doctor has twice mentioned that I am "under the limit." This lead to my assumption that WA State had codified the above morphine-equivalent guidelines. So, I am going to ask her what law or guideline she is referring to. I'm not worried about asking her as I am not asking for medication just curiousity and concern if there is such a regulation vs. a guideline.

I, too, feel the same as you; protective, concerned and emotional on this topic. Your goal to be the best mother you can be is profound (not really the right word but I don't have words to describe it very well). Having found a pain medication that works for you, brings you relief and enables you to be an active part of your family must be a godsend. In my case, having the ability to take a break-through pain med when I need it is hugely important. It keeps me from going down the proverbial rabbit-hole all of the time. Taking a long-acting pain med in conjunction with my anti-seizure meds has also given me more relief. I do respond to seizure meds and am hoping that Tegretol will help. However, Tegretol has horrible side effects, much worse than the very first time I took a pain medicine. I am willing to do what ever it takes, medicine-wise at the moment, to get relief and get some of my life back.

Please let me know what you hear from your medical contact on this issue. If I see more articles related to this topic I will post them. A suggestion for your shampoo.... www.drugstore.com (i think). Really cheap. I'll send you the link if you want it. This discussion and dialogue is very important for all of us to be aware of and I hope that my posting this discussion (and you and others replying to it) is helping to bring a little awareness to all of us in the Opiate Therapy group.

Take care. Johanna

Stef said:

Johanna,

I did some of my own digging last night. I found some literature on the subject, but not these specific links. Thank you for posting. I could open all but one, which is not system compatible.

This is an emotionally charged subject for me. My primary goal in life, right now, is to be a good mother. Pain relief is key, for me, in achieving this goal. So, when things like this come into question, it evokes the "Mama Bear" in me, not to mention the scores of friends I have who are chronic pain patients and my concern for their wellbeing, as well as the doctors who ARE interested in treating real pain with opiates, if they are required.

If I am reading these correctly, physicians with the authority to do so, are not limited in their ability to prescribe.

The article regarding CVS is alarming! I think there is a growing problem throughout the pharmaceutical industry. They want to pick and choose what drugs they dispense. I call ahead to make sure that the pharmacies I use keep the medicines I am prescribed stocked. Some must order them.

But, needless to say, although I am looking to change pharmacies this month, this article alone assures me of one pharmacy which will NOT be getting my business. This is very important information, which I would like to share with the group. I feel I should warn the other members of this group that CVS has made the decision to discriminate against those who are prescribed a certain medication. It is like the one doctor said, it is a business decision. However, they are a large chain who can afford to lose business, I suppose.

CVS is the only store which stocks the shampoo I use at a reasonable price, but speaking strictly for myself, even if it is in Florida, I have no patience with any entity which chooses to make life more complicated for chronic pain patients.

Best wishes, and thank you for providing these links. I hope you do not mind that I copy one to the main message board of this group.

Your friend,

Stef


Johanna Smith said:

Here are the links I mentioned:

WA State Law (link is to the WA State legal code). Upon reading more this law addresses the difference between dependency and abuse. The law also addresses the lack of treatment of chronic pain due to the fear of disciplinary action by physicians. The law is designed to give physicians guidelines for treating chronic pain; attaining proper education to manage chronic pain, pain mgmt. contracts, patient monitoring through appts., assessments (including UA's) and then a new Commission which will evaulate physicians if they are deemed to not be following the guidelines of the new law.


http://apps.leg.wa.gov/wac/default.aspx?cite=246-919

http://www.medscape.com/resource/opioid/opioid-washington

Morphine Equiavalent Chart WA State: (I was mistaken on the suggested limit for non-cancer patients. It is 120 mg.)


http://www.agencymeddirectors.wa.gov/Files/DosingCalc.xls

News Story; Florida CVS Pharmacies & pain medications:

http://www.tampabay.com/news/health/cvs-tells-some-florida-doctors-...

Stef said:

Hello, Johanna.

I have signed similar contracts with both of the Pain Management Clinics where I've been a patient.

However, I do not at all recall the mention of doctors having limits, or reducing the amount of what they can prescribe to non-cancer patients. This, indeed, would be a step back for those with chronic intractable pain at the levels that many ATN and TN patients experience.

There are already so many hoops to jump through just to be treated fairly, and without prejudice when dealing with doctors and pharmacies who we rely on for the medications which some of us have no choice to rely upon for any kind of quality of life whatsoever.

It seems that anyone who requires opiate medication to control their pain is treated as a potential "drug seeker". In the United States, even criminals are innocent until proven guilty! In my experience, too many of us are treated as "drug seekers" (well, of course we are seeking pain relief, so I find that phrase inappropriate at any rate), although there is no indication of illegal activity regarding our usage of medications which are meant to treat pain! I would go as far as far as to say, and I think we all know that, these drugs SAVE LIVES, if you catch my drift, without me becoming too melodramatic here.

It is encouraging that you've found nothing of the like on Google.

My children and husband have seen me, personally, suffer so badly when unable to obtain the medications which keep my pain at levels where I can maintain any quality of life that, even though I try to shield them from knowledge of how precarious my position is, that they are on pins and needles every time I have a Pain Management Appointment, even though I have someone who seems to be a knowledgeable and compassionate specialist who goes the extra mile to help me manage my pain effectively. Right now, it's working! I have my life back to a large degree! When I think of the anxiety that such a bill would cause my family, I get a bit emotional. Every evening before my youngest goes to bed, she prays that Mom will have the medicine that she needs to not hurt so bad! She has seen the change in me since I've received the correct medications to control my pain. I tried to be the mother, and wife that was needed before, but my pain made me withdrawn and unable to get out of bed or off the couch some days. Now, it's as if my family have been given their mother/wife back! It's been miraculous! The house stays nice. I volunteer to do things at their schools. I am able to cook more and to shop with them whenever they need something without constantly grabbing my face, and being almost at the point of tears from the pain, and unable to converse with them about what they are buying (I am recalling a school shopping trip that went very badly one time, because I was in severe Type II, TN pain).

Dare I say it? Cancer patients may know that, by one means or another, an end to their pain is in sight. Procedures have not proven to be extremely effective for Type II patients, especially! There is no remedy for many Type I patients!

Many of us, as it seems to be with you, and I know it is with me, have exhausted almost every means necessary to prevent having to take medication which the body become dependent upon (not addicted, in the case of most pain patients - the only thing they are addicted to in most cases is a pain free life)!

I would like to run this information past Dr. Patty Verdugo, a lady who runs a support group, and is a patient and advocate of those who suffer from chronic intractable pain and are unable to obtain the medication they need. I wonder if she knows anything about this "new law" regulating limits of medication allowed to be prescribed to anyone aside from cancer patients.

Thank you for sharing this information with us, albeit it is cause for concern, it is good to know what may be coming around the pike. TN and ATN patients who have to take opiate medication never asked to be placed in the position in life to have to worry about things such as this, but if this is true, about the limits, it greatly concerns us all!

Best wishes to you, my friend!

Stef

9

Sadly, Johanna, because I wanted to protect our members here, I made "Opiate Therapy Group" a private group. Members must be considered by Administrators of the group.

Things should not have to be this way. The thing is, though, that even letting people on the web know that any of us are prescribed pain medication (and some give their real name and locations) on the web is a bad idea! The type of addict, the illicit user, is even more appalling to me than the healthcare profession who judges the chronic pain patient and assumes that we all are that type of person. But, that is the first reason.

The second reason why it's a "closed group" is to protect our members from discrimination within our own group! I have not known much of this to happen, but I NEVER want to take that chance with any of my friends here. My friends here are already in pain and having to fight, many times, a system which are in constant fear may fail them due to it's own prejudices.

I wish we were drawing attention to the problem, but we're private. Our posts are not supposed to pop up on the main feed. If we are, something has gone wrong.

It's not that I believe ANYONE here should have ANYTHING to have to hide. It is society's ignorance of role that opiate/opoid based medications play in the lives of the chronic pain patient who may require them to live some semblance of a normal life, as I do.

Some people may wonder why they must be approved to join. Ultimately, it's for their own protection.

I am not soliciting, or telling anyone to join this site, but if anyone here would like to publicly advocate for fairer treatment of those who use pain meds, Chronic Intractable Pain and You, is another Ning based website where one can join. Dr. Patty has been a long time advocate of what she calls, "real medicine for real pain". I am a member, just to show my support, and have signed their petitions, but hold no administrative duties, and do not have time to be a very active member there.

I am so glad that you have a good relationship with the person who provides the medicines which help you through day in/day out. I feel I have that too, for now. I feel blessed beyond measure! A year ago, I was trying to keep a positive attitude, but was in chronic intractable pain, and constantly fought feelings of hopelessness. Now, I keep kids for extra money, am thinking of going back to work, and am loving every moment of being the best mom and wife I can be! I have an educated Pain Management Therapist, and God, to thank.

If there comes a time that you require a referral to Pain Management, you can still see your Primary Care Physician. The only difference is that your PM Physician will be in charge of managing your pain. I feel very comforted by the fact that this new law does not extend to Pain Management docs, if I am understanding it correctly! Yay!!!

I hope everyone is having a blessed Christmas season!


Johanna Smith said:

Stef-

I'm glad you're posting the CVS story. I posted it here as a reply to my original discussion and also as a reply to this same discussion that I posted in the "General" discussions. Thanks. I don't live where there is any mainstream pharmacy available. There is one privately owned, small pharmacy on the island which I live on and I can't imagine if they chose to do the same as CVS.

For me, I find this to be and incredibly controversial topic with patients, doctors, pharmacies and legislatures pitted against one another. It is a basic right to be able to recieve medical treatment (in my opinion) regardless of what that treatment might be. I feel rage when I think of all of the people who abuse these medications which has led to the reluctance of doctors to prescribe them and the guilty before proven innocent mentality that you mentioned in one of your above posts. When I go to the doctor I feel anxious every time as I am always wondering if that will be the day that my doctor will say "I can't prescribe these medicines anymore to anyone." Luckily, my doctor, at the moment, trusts me whole-heartedly and I am very thankful for that.

As to the morphine-equivalent limits... Upon further reading they're guidelines in most cases. 120 mg is the guideline for non-cancer patients. If a non-cancer patient is to take more then they are referred to a pain mgmt. specialist by their GP.

That said, my doctor has twice mentioned that I am "under the limit." This lead to my assumption that WA State had codified the above morphine-equivalent guidelines. So, I am going to ask her what law or guideline she is referring to. I'm not worried about asking her as I am not asking for medication just curiousity and concern if there is such a regulation vs. a guideline.

I, too, feel the same as you; protective, concerned and emotional on this topic. Your goal to be the best mother you can be is profound (not really the right word but I don't have words to describe it very well). Having found a pain medication that works for you, brings you relief and enables you to be an active part of your family must be a godsend. In my case, having the ability to take a break-through pain med when I need it is hugely important. It keeps me from going down the proverbial rabbit-hole all of the time. Taking a long-acting pain med in conjunction with my anti-seizure meds has also given me more relief. I do respond to seizure meds and am hoping that Tegretol will help. However, Tegretol has horrible side effects, much worse than the very first time I took a pain medicine. I am willing to do what ever it takes, medicine-wise at the moment, to get relief and get some of my life back.

Please let me know what you hear from your medical contact on this issue. If I see more articles related to this topic I will post them. A suggestion for your shampoo.... www.drugstore.com (i think). Really cheap. I'll send you the link if you want it. This discussion and dialogue is very important for all of us to be aware of and I hope that my posting this discussion (and you and others replying to it) is helping to bring a little awareness to all of us in the Opiate Therapy group.

Take care. Johanna

Stef said:

Johanna,

I did some of my own digging last night. I found some literature on the subject, but not these specific links. Thank you for posting. I could open all but one, which is not system compatible.

This is an emotionally charged subject for me. My primary goal in life, right now, is to be a good mother. Pain relief is key, for me, in achieving this goal. So, when things like this come into question, it evokes the "Mama Bear" in me, not to mention the scores of friends I have who are chronic pain patients and my concern for their wellbeing, as well as the doctors who ARE interested in treating real pain with opiates, if they are required.

If I am reading these correctly, physicians with the authority to do so, are not limited in their ability to prescribe.

The article regarding CVS is alarming! I think there is a growing problem throughout the pharmaceutical industry. They want to pick and choose what drugs they dispense. I call ahead to make sure that the pharmacies I use keep the medicines I am prescribed stocked. Some must order them.

But, needless to say, although I am looking to change pharmacies this month, this article alone assures me of one pharmacy which will NOT be getting my business. This is very important information, which I would like to share with the group. I feel I should warn the other members of this group that CVS has made the decision to discriminate against those who are prescribed a certain medication. It is like the one doctor said, it is a business decision. However, they are a large chain who can afford to lose business, I suppose.

CVS is the only store which stocks the shampoo I use at a reasonable price, but speaking strictly for myself, even if it is in Florida, I have no patience with any entity which chooses to make life more complicated for chronic pain patients.

Best wishes, and thank you for providing these links. I hope you do not mind that I copy one to the main message board of this group.

Your friend,

Stef


Johanna Smith said:

Here are the links I mentioned:

WA State Law (link is to the WA State legal code). Upon reading more this law addresses the difference between dependency and abuse. The law also addresses the lack of treatment of chronic pain due to the fear of disciplinary action by physicians. The law is designed to give physicians guidelines for treating chronic pain; attaining proper education to manage chronic pain, pain mgmt. contracts, patient monitoring through appts., assessments (including UA's) and then a new Commission which will evaulate physicians if they are deemed to not be following the guidelines of the new law.


http://apps.leg.wa.gov/wac/default.aspx?cite=246-919

http://www.medscape.com/resource/opioid/opioid-washington

Morphine Equiavalent Chart WA State: (I was mistaken on the suggested limit for non-cancer patients. It is 120 mg.)


http://www.agencymeddirectors.wa.gov/Files/DosingCalc.xls

News Story; Florida CVS Pharmacies & pain medications:

http://www.tampabay.com/news/health/cvs-tells-some-florida-doctors-...

Stef said:

Hello, Johanna.

I have signed similar contracts with both of the Pain Management Clinics where I've been a patient.

However, I do not at all recall the mention of doctors having limits, or reducing the amount of what they can prescribe to non-cancer patients. This, indeed, would be a step back for those with chronic intractable pain at the levels that many ATN and TN patients experience.

There are already so many hoops to jump through just to be treated fairly, and without prejudice when dealing with doctors and pharmacies who we rely on for the medications which some of us have no choice to rely upon for any kind of quality of life whatsoever.

It seems that anyone who requires opiate medication to control their pain is treated as a potential "drug seeker". In the United States, even criminals are innocent until proven guilty! In my experience, too many of us are treated as "drug seekers" (well, of course we are seeking pain relief, so I find that phrase inappropriate at any rate), although there is no indication of illegal activity regarding our usage of medications which are meant to treat pain! I would go as far as far as to say, and I think we all know that, these drugs SAVE LIVES, if you catch my drift, without me becoming too melodramatic here.

It is encouraging that you've found nothing of the like on Google.

My children and husband have seen me, personally, suffer so badly when unable to obtain the medications which keep my pain at levels where I can maintain any quality of life that, even though I try to shield them from knowledge of how precarious my position is, that they are on pins and needles every time I have a Pain Management Appointment, even though I have someone who seems to be a knowledgeable and compassionate specialist who goes the extra mile to help me manage my pain effectively. Right now, it's working! I have my life back to a large degree! When I think of the anxiety that such a bill would cause my family, I get a bit emotional. Every evening before my youngest goes to bed, she prays that Mom will have the medicine that she needs to not hurt so bad! She has seen the change in me since I've received the correct medications to control my pain. I tried to be the mother, and wife that was needed before, but my pain made me withdrawn and unable to get out of bed or off the couch some days. Now, it's as if my family have been given their mother/wife back! It's been miraculous! The house stays nice. I volunteer to do things at their schools. I am able to cook more and to shop with them whenever they need something without constantly grabbing my face, and being almost at the point of tears from the pain, and unable to converse with them about what they are buying (I am recalling a school shopping trip that went very badly one time, because I was in severe Type II, TN pain).

Dare I say it? Cancer patients may know that, by one means or another, an end to their pain is in sight. Procedures have not proven to be extremely effective for Type II patients, especially! There is no remedy for many Type I patients!

Many of us, as it seems to be with you, and I know it is with me, have exhausted almost every means necessary to prevent having to take medication which the body become dependent upon (not addicted, in the case of most pain patients - the only thing they are addicted to in most cases is a pain free life)!

I would like to run this information past Dr. Patty Verdugo, a lady who runs a support group, and is a patient and advocate of those who suffer from chronic intractable pain and are unable to obtain the medication they need. I wonder if she knows anything about this "new law" regulating limits of medication allowed to be prescribed to anyone aside from cancer patients.

Thank you for sharing this information with us, albeit it is cause for concern, it is good to know what may be coming around the pike. TN and ATN patients who have to take opiate medication never asked to be placed in the position in life to have to worry about things such as this, but if this is true, about the limits, it greatly concerns us all!

Best wishes to you, my friend!

Stef

10

Thanks Stef. I am grateful for a place to post that is private in regards to my treatment with pain medication. I joined this group for the reason that I wanted to be able to talk more candidly about my experiences and to share more openly. I, unfortunately, do hide that I take pain medications from many people who know me. I live in a very tiny place with a low population where it is very easy to have your anonymity compromised. I, like you, don't think we should have to hide our treatment methods/means. I am a bit naive when it comes to the world wide web sometimes so I don't always remember that what I am sharing in the general LwTn community may be "world-wide."

I will definitely look in to the website you suggested. Thanks for providing the information.

LwTN has given me a place to open up a bit in terms of having ATN, pain, sadness, treatment and much more. I can honestly say I have met some fantastic people here, like you, who have increased my knowledge and who have provided compassion, kindness and understanding.

Thank you! Wishing you a good holiday! Johanna



Stef said:

Sadly, Johanna, because I wanted to protect our members here, I made "Opiate Therapy Group" a private group. Members must be considered by Administrators of the group.

Things should not have to be this way. The thing is, though, that even letting people on the web know that any of us are prescribed pain medication (and some give their real name and locations) on the web is a bad idea! The type of addict, the illicit user, is even more appalling to me than the healthcare profession who judges the chronic pain patient and assumes that we all are that type of person. But, that is the first reason.

The second reason why it's a "closed group" is to protect our members from discrimination within our own group! I have not known much of this to happen, but I NEVER want to take that chance with any of my friends here. My friends here are already in pain and having to fight, many times, a system which are in constant fear may fail them due to it's own prejudices.

I wish we were drawing attention to the problem, but we're private. Our posts are not supposed to pop up on the main feed. If we are, something has gone wrong.

It's not that I believe ANYONE here should have ANYTHING to have to hide. It is society's ignorance of role that opiate/opoid based medications play in the lives of the chronic pain patient who may require them to live some semblance of a normal life, as I do.

Some people may wonder why they must be approved to join. Ultimately, it's for their own protection.

I am not soliciting, or telling anyone to join this site, but if anyone here would like to publicly advocate for fairer treatment of those who use pain meds, Chronic Intractable Pain and You, is another Ning based website where one can join. Dr. Patty has been a long time advocate of what she calls, "real medicine for real pain". I am a member, just to show my support, and have signed their petitions, but hold no administrative duties, and do not have time to be a very active member there.

I am so glad that you have a good relationship with the person who provides the medicines which help you through day in/day out. I feel I have that too, for now. I feel blessed beyond measure! A year ago, I was trying to keep a positive attitude, but was in chronic intractable pain, and constantly fought feelings of hopelessness. Now, I keep kids for extra money, am thinking of going back to work, and am loving every moment of being the best mom and wife I can be! I have an educated Pain Management Therapist, and God, to thank.

If there comes a time that you require a referral to Pain Management, you can still see your Primary Care Physician. The only difference is that your PM Physician will be in charge of managing your pain. I feel very comforted by the fact that this new law does not extend to Pain Management docs, if I am understanding it correctly! Yay!!!

I hope everyone is having a blessed Christmas season!


Johanna Smith said:

Stef-

I'm glad you're posting the CVS story. I posted it here as a reply to my original discussion and also as a reply to this same discussion that I posted in the "General" discussions. Thanks. I don't live where there is any mainstream pharmacy available. There is one privately owned, small pharmacy on the island which I live on and I can't imagine if they chose to do the same as CVS.

For me, I find this to be and incredibly controversial topic with patients, doctors, pharmacies and legislatures pitted against one another. It is a basic right to be able to recieve medical treatment (in my opinion) regardless of what that treatment might be. I feel rage when I think of all of the people who abuse these medications which has led to the reluctance of doctors to prescribe them and the guilty before proven innocent mentality that you mentioned in one of your above posts. When I go to the doctor I feel anxious every time as I am always wondering if that will be the day that my doctor will say "I can't prescribe these medicines anymore to anyone." Luckily, my doctor, at the moment, trusts me whole-heartedly and I am very thankful for that.

As to the morphine-equivalent limits... Upon further reading they're guidelines in most cases. 120 mg is the guideline for non-cancer patients. If a non-cancer patient is to take more then they are referred to a pain mgmt. specialist by their GP.

That said, my doctor has twice mentioned that I am "under the limit." This lead to my assumption that WA State had codified the above morphine-equivalent guidelines. So, I am going to ask her what law or guideline she is referring to. I'm not worried about asking her as I am not asking for medication just curiousity and concern if there is such a regulation vs. a guideline.

I, too, feel the same as you; protective, concerned and emotional on this topic. Your goal to be the best mother you can be is profound (not really the right word but I don't have words to describe it very well). Having found a pain medication that works for you, brings you relief and enables you to be an active part of your family must be a godsend. In my case, having the ability to take a break-through pain med when I need it is hugely important. It keeps me from going down the proverbial rabbit-hole all of the time. Taking a long-acting pain med in conjunction with my anti-seizure meds has also given me more relief. I do respond to seizure meds and am hoping that Tegretol will help. However, Tegretol has horrible side effects, much worse than the very first time I took a pain medicine. I am willing to do what ever it takes, medicine-wise at the moment, to get relief and get some of my life back.

Please let me know what you hear from your medical contact on this issue. If I see more articles related to this topic I will post them. A suggestion for your shampoo.... www.drugstore.com (i think). Really cheap. I'll send you the link if you want it. This discussion and dialogue is very important for all of us to be aware of and I hope that my posting this discussion (and you and others replying to it) is helping to bring a little awareness to all of us in the Opiate Therapy group.

Take care. Johanna

Stef said:

Johanna,

I did some of my own digging last night. I found some literature on the subject, but not these specific links. Thank you for posting. I could open all but one, which is not system compatible.

This is an emotionally charged subject for me. My primary goal in life, right now, is to be a good mother. Pain relief is key, for me, in achieving this goal. So, when things like this come into question, it evokes the "Mama Bear" in me, not to mention the scores of friends I have who are chronic pain patients and my concern for their wellbeing, as well as the doctors who ARE interested in treating real pain with opiates, if they are required.

If I am reading these correctly, physicians with the authority to do so, are not limited in their ability to prescribe.

The article regarding CVS is alarming! I think there is a growing problem throughout the pharmaceutical industry. They want to pick and choose what drugs they dispense. I call ahead to make sure that the pharmacies I use keep the medicines I am prescribed stocked. Some must order them.

But, needless to say, although I am looking to change pharmacies this month, this article alone assures me of one pharmacy which will NOT be getting my business. This is very important information, which I would like to share with the group. I feel I should warn the other members of this group that CVS has made the decision to discriminate against those who are prescribed a certain medication. It is like the one doctor said, it is a business decision. However, they are a large chain who can afford to lose business, I suppose.

CVS is the only store which stocks the shampoo I use at a reasonable price, but speaking strictly for myself, even if it is in Florida, I have no patience with any entity which chooses to make life more complicated for chronic pain patients.

Best wishes, and thank you for providing these links. I hope you do not mind that I copy one to the main message board of this group.

Your friend,

Stef


Johanna Smith said:

Here are the links I mentioned:

WA State Law (link is to the WA State legal code). Upon reading more this law addresses the difference between dependency and abuse. The law also addresses the lack of treatment of chronic pain due to the fear of disciplinary action by physicians. The law is designed to give physicians guidelines for treating chronic pain; attaining proper education to manage chronic pain, pain mgmt. contracts, patient monitoring through appts., assessments (including UA's) and then a new Commission which will evaulate physicians if they are deemed to not be following the guidelines of the new law.


http://apps.leg.wa.gov/wac/default.aspx?cite=246-919

http://www.medscape.com/resource/opioid/opioid-washington

Morphine Equiavalent Chart WA State: (I was mistaken on the suggested limit for non-cancer patients. It is 120 mg.)


http://www.agencymeddirectors.wa.gov/Files/DosingCalc.xls

News Story; Florida CVS Pharmacies & pain medications:

http://www.tampabay.com/news/health/cvs-tells-some-florida-doctors-...

Stef said:

Hello, Johanna.

I have signed similar contracts with both of the Pain Management Clinics where I've been a patient.

However, I do not at all recall the mention of doctors having limits, or reducing the amount of what they can prescribe to non-cancer patients. This, indeed, would be a step back for those with chronic intractable pain at the levels that many ATN and TN patients experience.

There are already so many hoops to jump through just to be treated fairly, and without prejudice when dealing with doctors and pharmacies who we rely on for the medications which some of us have no choice to rely upon for any kind of quality of life whatsoever.

It seems that anyone who requires opiate medication to control their pain is treated as a potential "drug seeker". In the United States, even criminals are innocent until proven guilty! In my experience, too many of us are treated as "drug seekers" (well, of course we are seeking pain relief, so I find that phrase inappropriate at any rate), although there is no indication of illegal activity regarding our usage of medications which are meant to treat pain! I would go as far as far as to say, and I think we all know that, these drugs SAVE LIVES, if you catch my drift, without me becoming too melodramatic here.

It is encouraging that you've found nothing of the like on Google.

My children and husband have seen me, personally, suffer so badly when unable to obtain the medications which keep my pain at levels where I can maintain any quality of life that, even though I try to shield them from knowledge of how precarious my position is, that they are on pins and needles every time I have a Pain Management Appointment, even though I have someone who seems to be a knowledgeable and compassionate specialist who goes the extra mile to help me manage my pain effectively. Right now, it's working! I have my life back to a large degree! When I think of the anxiety that such a bill would cause my family, I get a bit emotional. Every evening before my youngest goes to bed, she prays that Mom will have the medicine that she needs to not hurt so bad! She has seen the change in me since I've received the correct medications to control my pain. I tried to be the mother, and wife that was needed before, but my pain made me withdrawn and unable to get out of bed or off the couch some days. Now, it's as if my family have been given their mother/wife back! It's been miraculous! The house stays nice. I volunteer to do things at their schools. I am able to cook more and to shop with them whenever they need something without constantly grabbing my face, and being almost at the point of tears from the pain, and unable to converse with them about what they are buying (I am recalling a school shopping trip that went very badly one time, because I was in severe Type II, TN pain).

Dare I say it? Cancer patients may know that, by one means or another, an end to their pain is in sight. Procedures have not proven to be extremely effective for Type II patients, especially! There is no remedy for many Type I patients!

Many of us, as it seems to be with you, and I know it is with me, have exhausted almost every means necessary to prevent having to take medication which the body become dependent upon (not addicted, in the case of most pain patients - the only thing they are addicted to in most cases is a pain free life)!

I would like to run this information past Dr. Patty Verdugo, a lady who runs a support group, and is a patient and advocate of those who suffer from chronic intractable pain and are unable to obtain the medication they need. I wonder if she knows anything about this "new law" regulating limits of medication allowed to be prescribed to anyone aside from cancer patients.

Thank you for sharing this information with us, albeit it is cause for concern, it is good to know what may be coming around the pike. TN and ATN patients who have to take opiate medication never asked to be placed in the position in life to have to worry about things such as this, but if this is true, about the limits, it greatly concerns us all!

Best wishes to you, my friend!

Stef

11

This is an excellent topic. Fortunately for me I have all my Pain Management Meds delivered to me from a specialty pharmacy in Pittsburgh that deals specifically with end of life care, pain management, and nursing homes.

Currently Pennsylvania has no such laws but I will definately be researching this topic for sure. I would be pulling all my resources and protesting this if we did have such laws.

12

I live in Washington State...... just had to sign The Pain Contract... today.. I knew it was coming.. and I don't really mind signing it...

I only use my pain meds as directed... and only when needed...

I don't drink.... and I don't do drugs...

Or I mean I don't seek out ...

I am in Real Pain , as all of us are...

I don't think its fair that we should have to pay ... for what Junkies do...

and I"m tried of being treated like a nogoodnick ... if I just happen to have to go to the ER>>.

They treat ..... Chronic pain suffers... like we are scum beneath the earth... and that we don't deserve to be treated like human beings... just my bad experiences ..... too many to count ..

before I was dianosed with my TN...

I advoid that place like the plague.....

God Bless everyone and I hope for pain free days ... f or us all

13

I've had to sign docs at one of my drs. I don't mind doing anything to get my pain down but being hard to medicate I am still working fulltime by the hardest & they aren't sure how long that will be if it progresses. If they regulate the meds too much & I cannot be medicated property I will not be able to work. I miss alot of work now & have been grateful that my employer is working with me but you never know when they will get tired of it.

14

I am under the 'contract' with my doctor. He is cool about it. I have NO problem giving them a random urine test. It has been 3 years, and to date have had NO requests for a urine test. Getting the refill is a pain, having to call to request, wait a day or two, pick it up and drive to pharmacy, with my 2 kiddos. It could be worse, though. I feel uneasy waiting til the day I run out, or the day before, to get this done. I homeschool my 2 boys (I don't know how? The grace of God). But other than this, the opiate really helps the breakthru pain. The gabapentin is not enough. My first sign of 'oh geez, it is time!, is pin-prick needle pain in my tongue, then it spreads back to base of skull, etc. I am getting by, but have some days I am in severe pain where I have to try my best to remain calm. God Bless you all. You are not alone in this......................

15

Vicki-

Thanks for your reply. Wow, you sound like a superwoman! Homeschooling your kids! I don't have any children and I can't imagine what it would be like to be a parent and have TN. I am always amazed at how much energy and time it takes to raise children and mostly how much it takes to deal with pain on a daily basis.

You're lucky that you're able to fill your prescription on the early side. I requested from my doctors to have my prescription end on the day that I refill instead of the day before. So, I have two doses left on my refill date so I don't run out. I call my doctor on the day of my refill and they fax that day to my pharmacy (i live in a small town so this works well for them and we only have one pharmacy).

I, so far, haven't had any trouble with the contract. However, I have had some really severe breakthrough pain in the last few months and when I asked up my breakthrough dose for a week I was told I was in violation of my contract by asking this question. I need to clarify this with my doctor as this seems crazy to me that a person is locked into a dosage and can never increase even if needed. I don't have any problem with the drug tests and am not worried about them. Like you, I have never had one and it has also been 3 years.

I wish you the best!!!! Johanna

Vicki Anger said:

I am under the 'contract' with my doctor. He is cool about it. I have NO problem giving them a random urine test. It has been 3 years, and to date have had NO requests for a urine test. Getting the refill is a pain, having to call to request, wait a day or two, pick it up and drive to pharmacy, with my 2 kiddos. It could be worse, though. I feel uneasy waiting til the day I run out, or the day before, to get this done. I homeschool my 2 boys (I don't know how? The grace of God). But other than this, the opiate really helps the breakthru pain. The gabapentin is not enough. My first sign of 'oh geez, it is time!, is pin-prick needle pain in my tongue, then it spreads back to base of skull, etc. I am getting by, but have some days I am in severe pain where I have to try my best to remain calm. God Bless you all. You are not alone in this......................