Opioids - Are we throwing baby out, etc.?

[Koolau]

Went to doc because of a recurring low-back pain issue. He believes it's important for me to "keep moving" even though there is some pain. Using low-dose opiates allows me to get though an "episode" (yes, I'm going to be going for PT as well, and NO, it's not "just" arthritis nor is it sciatica or other obvious "nerve" issue.) SO, I get to the pharmacy and the Part D insurance will only cover 7 days of treatment (not the 10 days written by the doc.) I called the Rx mgr and they said it's Medicare's fault - even though the pharmacy itself said they COULD fill for the 10 days, BUT the Part D insurer wouldn't cover it.

The benefit manager had the nerve to suggest "all you have to do is go back to the doc and he will then write you a script for a month and WE WILL FILL that because you have had the 7 day script already." I understand none of this - not even the intent, but I pointed out to the nice lady that I would THEN have to pay for another visit to the doc (which MC picks up quite a bit.)

Anyone know what's actually going on here?

My best guess is enough people have screamed the "THE GUMMINT HAS DO DO SOMETHING" about the opioid crisis - and this is their first shot at DOING something. By the way, my script is the very low dose variety. I'm sure you COULD get addicted to it, but it's not oxycontin or Fentanyl. My last batch of 20 was over 6 months ago.

 

[GrayHare]

I've seen similar elsewhere, a short rx, followed by longer if the MD says so. Whether that's due to new government regs I'm not sure.

 

[MRG]

We've gone through the same garbage. I think it's everybody's doing something, none of it coordinated or thought out.

DW had an opioid script that insurance wouldn't cover, Walmart no longer accepts Goodrx for opioids. Out $240 for a med DW couldn't tolerate. Then we were offered narcan for 20 tylenol 3. Next the ER isn't going to use opioids because they worked; instead DW gets ketamine. You know "Special K"? It's a party drug, a dis-associative. Can only be administered by a doctor because some folks freak out. Great until it wore off 30 minutes later. Oh yeah, then there's the jerk that told DW "opioids are evil and nobody's ever died from pain"!

Yes indeed the pendulum has swung way too far. I'm sorry taking a tool away without a replacement is not an answer. People don't die from pain, they die attempting to stop pain.

I hope the PT is an answer for you. Back pain stinks.

 

[Koolau]

We've gone through the same garbage. I think it's everybody's doing something, none of it coordinated or thought out.

DW had an opioid script that insurance wouldn't cover, Walmart no longer accepts Goodrx for opioids. Out $240 for a med DW couldn't tolerate. Then we were offered narcan for 20 tylenol 3. Next the ER isn't going to use opioids because they worked; instead DW gets ketamine. You know "Special K"? It's a party drug, a dis-associative. Can only be administered by a doctor because some folks freak out. Great until it wore off 30 minutes later. Oh yeah, then there's the jerk that told DW "opioids are evil and nobody's ever died from pain"!

Yes indeed the pendulum has swung way too far. I'm sorry taking a tool away without a replacement is not an answer. People don't die from pain, they die attempting to stop pain.

I hope the PT is an answer for you. Back pain stinks.

Thanks for the kind thoughts. I have high hopes for the PT.

This whole thing of having the gummint deciding whats "good" for us is a bit frightening - though, full disclosure, I'm still not certain WHO is putting the brakes on here. Could just be the ins. company trying to save a couple of bucks. Heh, heh, don't get me started on them!

 

[MissMolly]

Yes, it's being driven by state laws now. Here is a state-by-state breakdown,

https://ballotpedia.org/Opioid_prescription_limits_and_policies_by_state

 

[Walt34]

Yes indeed the pendulum has swung way too far. I'm sorry taking a tool away without a replacement is not an answer. People don't die from pain, they die attempting to stop pain.

I've seen that happen several times at work, and once with a back yard neighbor who after years of suffering from TMJ pain was told there was nothing more that could be done. He then shot himself. That's better than opioids and possible (not certain) addiction? Evidently some people think so.

And it just frosts me no end that a bunch of lawyers in a state capitol will have the audacity to think they know better than someone's doctor what pain relief is best for a given patient.

 

[Scrapr]

I think the Oregon legislature is talking about this right now. Mrs Scpr has cancer. When she got a biopsy the Dr wrote a script for Oxy. She got like 7 pills. She was in severe pain. 7 pills would have lasted less than 2 days. We called over to oncology dept and got 100 no prob. It's hard to figure

 

[SnowBound]

My story starting 3 weeks ago: Broke fibula and dislocated ankle. Told the ER doctor nope on the Oxy, will be just fine ibuprofen. He said no on ibuprofen, yes it works well for reducing pain and swelling; BUT could slow down healing and thins the blood, not good for surgery that will likely be having in five days. So it was Oxy for me, did need it to sleep.

Three days later at the Orthopedic Doctor: You are not having surgery for eight days because of swelling typical with this injury, you are okay to take ibuprofen for two days then need to stop because thins the blood, not good for surgery. So could of taken ibuprofen from the start. Stopped the Oxy, only one left out of 8 I started with.

Two days before surgery, called the Orthopedic and asked for eight more Oxy thinking this going to hurt a lot. Said no problem with a refill. Picked up a Rx, got twenty for $2.51, a bag of M&Ms costs more.

Pre-Op: Nurse says we need someone to go pick a Rx in the hospital pharmacy for your pain killers you are going to need post surgery. My response was I have 21 Oxy’s, don’t need the hospital Rx. Response was you need these great special pain killers. So I’m ready to crutch it out of there now, nurse finally relented. Some sort drug racket going on here (would like to more about this) not the best thing to think about being pushed into the operating room.

Post Surgery Nurse: Take one regular 81mg asprin once a day to prevent clots. Response: Isn’t one asprin like 300mg. Oops, well take half asprin twice a day. Response: Okay, then is it also to take ibuprofen? Yes, go for it. No response required but now thinking that there goes twenty Oxy’s into the toilet.

 

[Bamaman]

Laws are written by politicians. And they have no idea what the real world is like when someone's in serious pain. They're often giving lip service to the initial 7 day prescriptions of pain meds. It's just something the politicians think will help minimize taking of opoids--and they're not thinking about the serious long term people in this world that are really hurting.

When someone in serious pain takes strong pain meds, it relieves pain and they act normal. When someone is not in pain, they act goofy and do stupid things when they take strong pain meds.

When someone that's in serious pain can no longer get their meds, they go to the street sellers. And in many cases, they end up overdosing and dying. That's what's not been said.

My wife has terrible arthritis, and she goes to a fine pain management clinic. Without her meds, she'd be in a nursing home and/or in and out of hospitals. Her pain mgmt. doctor keeps her out enjoying life and living a normal life. She's one of the success stories.

 

[Koolau]

Laws are written by politicians. And they have no idea what the real world is like when someone's in serious pain. They're often giving lip service to the initial 7 day prescriptions of pain meds. It's just something the politicians think will help minimize taking of opoids--and they're not thinking about the serious long term people in this world that are really hurting.

When someone in serious pain takes strong pain meds, it relieves pain and they act normal. When someone is not in pain, they act goofy and do stupid things when they take strong pain meds.

When someone that's in serious pain can no longer get their meds, they go to the street sellers. And in many cases, they end up overdosing and dying. That's what's not been said.

My wife has terrible arthritis, and she goes to a fine pain management clinic. Without her meds, she'd be in a nursing home and/or in and out of hospitals. Her pain mgmt. doctor keeps her out enjoying life and living a normal life. She's one of the success stories.

My big fear is that we'll turn over all of our health care decisions to the gummint (it's bad enough when insurance companies do it - at least there are still a few of them and not just one.) One size fits all works well when you're voting on a bill but not so much when individuals are involved.

I do think it's important to investigate the opioid crisis. They are killing lots of folks. But if we forget the patient in all of this, we all lose. As always, YMMV.

 

[MBSC]

Anyone know what's actually going on here?

My last batch of 20 was over 6 months ago.

CMS implemented new Part D rules for opioids on January 1.

Specific to prescription opioids, beginning in January 2019, Medicare Part D plans will employ the following new safety alerts at the pharmacy:

* 7 day supply limit for opioid naïve patients: Part D plans are expected to implement a hard safety edit to limit initial dispensing to a supply of 7 days or less. A hard safety edit stops the pharmacy from processing a prescription until an override is entered or authorized by the plan. This policy will affect Medicare patients who have not filled an opioid prescription recently (for example, within the past 60 days) when they present a prescription at the pharmacy for an opioid pain medication for greater than a 7 day supply.

If a prescriber believes that an opioid naïve patient will need more than a 7 day supply initially, the provider can proactively request a coverage determination on behalf of the patient attesting to the medical need for a supply greater than 7 days.

* Opioid care coordination alert: This policy will affect Medicare patients when they present an opioid prescription at the pharmacy and their cumulative morphine milligram equivalent (MME) per day across all of their opioid prescription(s) reaches or exceeds 90 MME. Regardless of whether individual prescription(s) are written below the threshold, the alert will be triggered by the fill of the prescription that reaches the cumulative threshold of 90 MME or greater.

90 MME is cited in the CDC Guideline as the level above which prescribers should generally avoid. This is not a prescribing limit. In reviewing the alert, the pharmacist may need to consult with the prescriber to confirm medical need for the higher MME. The pharmacist can then indicate that the prescriber was consulted so the prescription claim can pay.

Are any patients exempt from the new opioid safety alert and drug management program policies?

CMS recognizes that a “one size fits all” approach does not take into account different circumstances related to opioid use. Residents of long-term care facilities, those in hospice care, patients receiving palliative or end-of-life care, and patients being treated for active cancer-related pain are exempt from these interventions.

Reference: https://www.cms.gov/Outreach-and-Ed...-MLN/MLNMattersArticles/downloads/SE18016.pdf

 

[Maenad]

Full disclosure: I used to work for a subsidiary of Endo Pharmaceuticals, which makes one of the big opioids (I've forgotten which). I've been working in Medical Devices for 15 years or so, often for companies getting a bad rap.

With that said...

We are throwing the baby out with the bathwater. The companies that make opioids didn't foresee how habit-forming they can be over medium- to long-term use. They didn't foresee the potential for recreational use on any significant scale. From my own experience in pharma and med device, it wasn't malevolence, just a blind spot.

Doctors saw these drugs as effective, and acted a little too credulously - they're human too, and want to help their patients, and had their own blind spots.

Most people didn't see the crisis approaching, just once it was too late to stop it. Most of us - patients, doctors, the FDA, legislators, we've all been taught that drug abuse is for the hard, illegal stuff. Prescriptions are under control, right?

And now we want someone to do something. Current pain control methods are... not good. And people are still people - we panic, we want something to be done NOW.

And most people, in general, aren't working with bad intentions. Yes, that includes the Evil Government (tm), and Evil Industry (tm). There are always some people valuing money or power over people's lives, and a few of them in certain positions can certainly wreak havoc, but most people are just flawed and... human.

OK, that got way more philosophical than maybe this thread calls for, but I know too many people in Evil Industries and Evil Government who genuinely want to help, and when I see the pitchforks being looked at, I feel the need to speak up.

And as to what we actually do? We need to start with a thorough study of what opioids are being used for, what conditions are present when use turns to abuse, effective treatments for addiction, etc. We need data, not emotion. Breaking down the stigma against drug addiction, so addicts aren't driven into secrecy, would assist a great deal.

But that starts getting into the causes of drug addiction in the first place, and we as a society don't want to face how we may be culpable in the cause. People don't become addicts because they're happy with their lives, and how much of that is because of societal forces, rather than personal moral failings? We really don't want to face that possibility.

 

[joeea]

This whole thing of having the gummint deciding whats "good" for us is a bit frightening

To be fair, you could pay for the extra 3 days out of pocket, so it's not really any gummint deciding what's "good", just what they are willing to pay for. You get to decide how important those 3 days worth of medication are to you.

I wish you well in your PT.

 

[Amethyst]

In 2017, I experienced back spasms so severe, I could not get off the floor. Husband panicked and called an ambulance. One of the EMTs insisted on giving me morphine, even though I said I'd rather not (I had never had it). I said I probably just had a bad sprain. But he said I would likely be in triage for hours, on a hard bed, and the M. would make me more comfortable.

He was right on both counts. But it certainly went against what we are seeing about "no opioids without a struggle." I even wondered about it at the time.

 

[Clone]

I had some surgery last fall, and struggled during recovery. I was refusing the Oxy, and was taking something else. It was not getting the job done and I was not sleeping and in a lot of pain. I asked the surgeon, and he straightened me out. Take the Oxy, get some rest, and recover. Within a day I was in much better shape. I did take the oxy for a few days following surgery, but then moved on to lesser meds.

I had a discussion with one of the nurses regarding the oxy- She blamed much of the problem on insurance companies. People have injuries that need to be fixed, but the insurance companies drag their feet to authorize surgery. So they keep them medicated, and it turns into an addiction. I suspect that there are many factors involved.
I think that what is important is for folks to recognize that there is a risk associated with the drugs, and to use them with caution.

 

[GrayHare]

To be fair, you could pay for the extra 3 days out of pocket, so it's not really any gummint deciding what's "good", just what they are willing to pay for. You get to decide how important those 3 days worth of medication are to you.

The problem is, as with so many things medical, the pricing of meds is distorted. I've seen out of pocket prices that are 100 times what insurance pays for the same item. If the prices were the same as, or close to the rate charged insurance, then I'd agree with your view.

 

[MRG]

I have degenerative disk disorder and when the pain comes it's unbearable. In 2000 my then PCP would only give me three days of oxy at a time and kept cutting down the dose. Of course nothing was done to help the pain. His office was 60 miles away, I dreaded the days DW would be gone for 2 1/2 hours. Days on end, I'd do nothing, but pray to God to not let me go for a walk with a 44 magnum. Try being honest about what you are thinking and get a big surprise.

I know everybody is different about addiction but after being on large doses of opioids for long periods over the years I think it's overrated. Quitting Skoal was more difficult than opioids, for me.

After watching the DW suffer with this headache I am going to sign up for biofeedback. I don't think the insurance will cover it. It's worth the money to do something that will help me tolerate the pain better.

 

[brewer12345]

Maybe I need to plant some poppies in a corner of the garden this year.

 

[Scrapr]

Maybe I need to plant some poppies in a corner of the garden this year.

can you get a Taliban connection for distribution?

*or hook a brother up?

 

[brewer12345]

can you get a Taliban connection for distribution?

*or hook a brother up?

It is more that if the gubmint wants to make something difficult to get, my natural reaction is to secure a supply.

Poppies aren't hard to grow and they are pretty. Plant some.

 

[aja8888]

Not related to pain meds per se...but

In September 2018, the Cardiologist I visited ordered a blood test when I was having SVT symptoms. Just 6 test items were specified. Once the SVT ablation was finished in late 12/18, the bills started flowing in. Medicare was billed $115,000 for the work (monitor wearing, stress tests, echocardiogram, ablation, etc) and rejected the very first test (blood test), saying three of the six analysis ordered were "not necessary".

Lets see....... Next time I need to see a doctor I guess I should call Medicare and ask them what tests and procedures they prescribe for my symptoms rather than go to a professional first?

 

[6miths]

Full disclosure: I
We are throwing the baby out with the bathwater. The companies that make opioids didn't foresee how habit-forming they can be over medium- to long-term use. They didn't foresee the potential for recreational use on any significant scale. From my own experience in pharma and med device, it wasn't malevolence, just a blind spot.

Not meaning to be argumentative but one of my favorite quotes is apropos:


“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

Upton Sinclair

Everyone (except perhaps those patients that didn't realize that these drugs were opoids) absolutely knew that there was a huge risk of addiction and abuse. European countries don't (yet) have a significant 'opoid crisis' because business does not rule there and marketing and prescribing is much better controlled. Studies suggest that two ibuprofen have just as much pain killing ability as two Tylenol 3 plus they work as an anti-inflammatory. There is a role for opoids in controlling pain but they clearly have huge downside risks and should be used with care.

 

[Koolau]

CMS implemented new Part D rules for opioids on January 1.

Thanks for the quote. I THINK this is what the nice lady on the phone was trying to convey to me, but (with respect to her) I don't believe English was her first language. The 60 days seems pretty arbitrary, but what would I expect. I keep coming back to "baby and bathwater" or perhaps no one wants to be the one sitting in front of Congress explaining why they didn't prevent someone from misusing opiates, etc. In any case, it doesn't sound too well thought out, since I have used one form or another of opiates for 60 years (admittedly, not on a routine basis - still I know better than to take more than stated doses - but not everyone does.)

I guess we're just going to have to work through this "brave new world" of opiate "enlightenment." Let's hope we come out on the other side with realistic "rules" but also a fair share of understanding that pain can be the loneliest experience of human kind. YMMV

 

[Koolau]

Oh, and thanks to all for participating in the discussion. Thanks for the understanding and direction. Others experience and wisdom make this forum a welcoming place to come.

 

[aaronc879]

When I had total hip replacement I got a 5 day prescription of Oxy which had to be picked up from a pharmacy not given out at the hospital. Then I had to get a refill 5 days later when there is no chance of being able to leave the house on my own. What do people who don't have anyone to help them do in that situation? I'm worried about later in life when I need a revison surgery and I don't have any family left to help me. If I didn't have any Oxy post-surgery I probably would have taken a bottle of Ibuprofen then used my walker to walk into traffic. Better than unneeded suffering from horrible pain.