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New Federal law about pain and other medications.

paul1598419

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I just got back from my doctor's appointment today and found out that last year's congress and this president passed some new laws on how much pain medications one can have and what other drugs they can no longer take if they are taking opioids for chronic pain. Now you can only get the equivalent on 90 mg per day of oral morphine. If you are not aware of this fact, morphine is 6 times less effective orally than parenterally. Also, you can no longer have a prescription for an opioid and any benzodiazepine or muscle relaxer, so I lost all my sleep meds, anxiety meds and a third of my pain meds just today.
I can't express the amount of anger it gives me to know that politicians are telling my physician what I can and can't have now. This is all in response to some people who have died from over dosages of these medications, though I believe that number is small when compared to the number of people who are getting relief from chronic pain and sleepless nights from these medications. There is nothing I can do about it unless and until there are people in power here who care about people who have to deal with chronic pain on a daily basis. I guess I'll just have to learn to live with more pain and less sleep.
 

WizardG

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Well Paul, at least you're i a state with legal weed. That should help quite a bit with sleep, and a little with your pain too. But if anxiety is an issue stick to sativas. :cool:
 

Encap

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You are in the State of Washington, right? May not be as bad as you have been lead to believe --who knows.
Just had a look at the rules effective 1 Jan 2019 see: https://wmc.wa.gov/sites/default/fi...stoopioidperscribingandmonitoringonesheet.pdf

They say:
"Rumor Busting
Rumor: You will no longer be able to prescribe opioids for chronic pain patients.
Fact: These rules do not change your ability to prescribe opioids to chronic pain patients. These rules do
not impose a prescribing limit.
In fact, you can prescribe up to 120 MED without the need to consult a pain
management specialist. As in the 2012 Pain Management Rules, when prescribing in excess of 120 MED first consult with a pain management specialist and document such in the patient record"

See also: https://wmc.wa.gov/sites/default/files/public/Newsletter/3.faq.pdf
It says: "
As far as the chronic pain patient is concerned, nothing has changed for them. You can still prescribe over 120 MED if you document
the reason in the patient record"

Seems all that needs be done is to have a Pain Management Specialist document the need.
 
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RedCowboy

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I just got back from my doctor's appointment today and found out that last year's congress and this president passed some new laws on how much pain medications one can have and what other drugs they can no longer take if they are taking opioids for chronic pain. Now you can only get the equivalent on 90 mg per day of oral morphine. If you are not aware of this fact, morphine is 6 times less effective orally than parenterally. Also, you can no longer have a prescription for an opioid and any benzodiazepine or muscle relaxer, so I lost all my sleep meds, anxiety meds and a third of my pain meds just today.
I can't express the amount of anger it gives me to know that politicians are telling my physician what I can and can't have now. This is all in response to some people who have died from over dosages of these medications, though I believe that number is small when compared to the number of people who are getting relief from chronic pain and sleepless nights from these medications. There is nothing I can do about it unless and until there are people in power here who care about people who have to deal with chronic pain on a daily basis. I guess I'll just have to learn to live with more pain and less sleep.


You must be wrong about that amount, that's practically a starting dose.......is that for new patients ? How can that be for chronic patients, it's insane as there are already people committing suicide for lack of pain management and this will cause a tremendous hardship for many patients including veterans and wounded soldiers, how can we fight for our country knowing when wounded that out home life will be living in agony ?

Is this actually a law or a guideline ?

---edit---

Yes 120 doses per month is a guideline now but total of 90 morph equiv I have not heard about.
The reason they care about the number of doses/pills is they want to deter diversion.
 
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paul1598419

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Yes, it is limited to 90 mg of oral morphine in a day. I could only use marijuana if I got a doctor's prescription for medical marijuana because the DEA doesn't consider it a recreational drug and they control all the other drugs. I am not taking morphine for pain, but another opioid which went down from 80 mg/day to 50 mg/day today. All my BZDs are gone and there is no way to get them or even a muscle relaxer to substitute for it. You cannot get an opioid and any BZDs or any muscle relaxant, even flexeril, which s a really crappy muscle relaxant. My doctor is keeping me at 50 mg/day even though the chart they used to substitute for 90 mg of morphine says that is equal to 30 mg of what I am taking. He said the chart they are using is an extremely conservative one and he is using the chart for substitution for terminal cancer patients. So, I may end up losing 20 more mg per day if it doesn't stay where he has it now. I asked him if I could switch to morphine during our conversation and he said "sure, 3 30 mg MS Contins a day. That is not enough morphine to remove pain from an opioid naive patient in severe pain. I knew we were going to have some form of reduction because he told me my last two appointments that it would happen this year, but I had no idea it would be so sweeping.
 

RedCowboy

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Looks like Medicare is limiting to 90 starting 2019 but that's not a limit or law for private pay patients from what I have read.
 

paul1598419

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Well, I am on Medicare. I would just pay out of pocket for them, but it doesn't work that way, unfortunately. I am going by what my physician told me today and I've been seeing him for ten years. Maybe some people can get a higher dose than 90 mg, but you still can't get any muscle relaxants or BZDs at the same time. That killed two scripts I've been getting for over twenty years.
 

RedCowboy

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Yea I know. :(

You could take herbal supplements such as 5HTP and GABA for sleep/anxiety but read about it and be careful, also valerian root.
 
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Immo1282

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Sorry to hear that you're being stiffed by the system Paul. My thoughts are with you for finding a solution that works for you as soon as you can :)
 

GSS

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For real he shut you off from benzo's just like that? That's a seizure waiting to happen. At least tell us he's tapering you down slowly??
So people with real pain issue's have to suffer because addicts are abusing the system. Don't they see more patients with true pain issue's turning to the dark side and start to use fentanol laced heroin that's killing everyone.
They should ad stricter rules as far as Doctors having to do strict drug screening on their patient's. Yes iv'e heard it's expensive to screen but that's just company's charging crazy amounts because they can as drug screening these days is dirt cheap..
 

RedCowboy

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Hopefully patient rights groups will sue and get this lifted, I don't think the 90mg limit affects private pay at this time as my mother says she did not have any problem with that this month but she did have to meet the the 120 dose rule which meant changing pill size, half as many double size pills, but this 90mg MS equiv. is ignorant, there are 100mg single dose morphine ER tabs that a tolerant person would take twice or 3 times a day in addition to breakthrough control instant release doses, it's normal to develop a tolerance and this 90mg is not going to work for most chronic pain patients.

They pushed people off their instant release only regimen a couple years ago wanting everyone to take extended release with additional breakthrough and at a higher cost......bastards. I think Perdue made some campaign contributions for that, you know Perdue pharma, they don't even have stock holders and make billions of dollars.

How would you even have an extended release regimen ( which is what they wanted everyone to take saying it works better ) with only 90mg equiv. to work with ?

Most of the opiate based pain meds have single doses that exceed this ridiculous 90mg equiv daily limit because they are needed for chronic sufferers.

Oxycodone has a 2 to 3 hour half life so you really need a dose every 4 hours yet now they won't give out more than 4 pills a day and extended release is supposed to be good for 8 to 12 hours but it's not.......the concept of an extended release regimen with breakthrough doses when you only have 4 pills a day and 90mg morphine equiv. which is 60mg oxy and even less if others is just ignorant, these lawmakers as usual don't know anything about what they are doing, besides that it's illegal drugs that are killing people, this is disgusting, innocent people are made to suffer and for no good reason, it's disgusting and won't fix anything, it will only make things worse.

We are supposed to be a free people, our government has no business telling doctors and pharmacists that people can't have reasonable pain control, they are treating everyone like criminals and it's as if they want everyone who's on disability and/or pain management to drop dead, at a time when we are facing a swing towards socialism this will not help, not that people would be treated any better but many will grasp at any chance for a solution.

How can we ask citizens to fight in our armed forces if we won't even tend to their most basic needs when they come home crippled and in chronic pain ? This will have to change, it's cruel and disgusting to treat the most helpless people this way.

https://www.peoplespharmacy.com/2017/03/13/war-on-opioids-punishes-desperate-pain-patients/
 
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GSS

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These innocent people are going to be the first victim's of crime and what little pain meds they have left.
The first extended release meds were a joke as people quickly learned to just scratch of the "coating".
What are they doing or trying to do now as far as a good extended release med to work?
 

RedCowboy

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They made some changes a while back that made them more expensive, my mom was paying 700.00 a month for 90 pills that you could hold in your closed hand, they are more expensive than gold......that's what they were doing but Perdue has a long standing patent on ER oxy and only a small amount of generic is allowed to be made, and its also expensive.

IINM she's gone back to hydro buffered with Tylenol that costs less but it's not working as well, it's insane what's going on, there is no reason for this, let people buy what they need, take the profit out of illegal drugs and if people overdose, which they are doing anyway that is no reason to punish innocent chronic pain patients or help greedy drug makers to rob patients who are over a barrel and have little to no choice, this will further drive people towards socialism which is likely to be no better, it's just ignorant.
 

GSS

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Isn't the it also pretty much dirt cheap to manufacture pain meds in general as it's base is the cheap poppy plant?
The city i'm in now has a big drug issue, illegal and legal. To the point of the pharmacy's running out of meds and having to look for other vendors to fill the needs.
I'm on a benzo and "which 90% of the city seems to be" and quite frequently have to wait for CVS to restock.
When I moved here there was 3 well known Psychiatrist's known as feel good doctors and now it's down to 2, which one is in his 80's and the other is probably going to be shut down soon as he gives insane amounts.. It's come to the point that all the major brand pharmacy's aren't filling his scripts anymore because they are tired of people screaming for their refills early..
If or when these last 2 psychiatrists go, there will be riot's:whistle:
 

RedCowboy

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Maybe there needs to be riots ? That and lawsuits, call/write your congressman and representatives and let then know that patients are not criminals and medication is not dope. Tell them to stop attacking helpless patients simply because they can't solve the illegal drug problem.

It's pretty obvious that people are going to drink, smoke and use dope no matter what, making things hard on people with medical needs is not any kind of solution to an illegal drug problem that's been ongoing for decades, it's lazy and a transparent attempt to look like something is being done.

Maybe we need to make all drugs legal, let people have all they want and when those with no self control are all dead the rest can live without the hand of tyranny showing us how sick it is to push around people who are in chronic pain ? These coward politicians need to hear the voices of the voting pain patient not just the voice of the sad loved one who lost someone to drugs, it's all about the votes and the numbers of voices, everyone needs to speak up., in time I think they will.

Inadequate legitimate needs medication will expand the illegal drug problem, not reduce it, that's not hard to understand, I know where they got the 90mg number, one alphabet agency said 90mg and another said 200, so the went with 90, very soon they need to change that to the 200mg suggestion as 90 should be a new patient starting limit, not a limit for long term chronic patients.
 
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These drug laws are in fact a huge factor in causing the opioid epidemic. I have known many heroin addicts. No one wakes up in the morning and decides to be a junkie. If you ask 100 heroin addicts how they got started about 80 will have the same story: They start out with a legitimate need for doctor prescribed pain meds. Laws force the doctors to cut them off even when need persists. They turn to street purchase of their meds. It does not take long for them to figure out that heroin is much, much cheaper and far more effective.
I know one man who has 10 metal pins in has spine. He was arrested because his doctor prescribed pain pill was in his pocket instead of the labelled pill bottle. He did not want to carry the whole bottle around as this would make him a target for robbery. Now he is forbidden from taking any pain meds. Another woman needed surgery and was told by her probation officer that if she took her prescribed medicine that she would be in violation.
I do not have a good solution to offer, but the laws being passed are counter-productive.
 




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