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90 Days Of Narcotics: How To Best Use The New Drug Laws

March 19th, 2008 · 9 Comments

Last month, the DEA approved a change for prescribing what are called “schedule-II” medications.  These are “controlled substances,” which include narcotics as well as stimulants for ADD.  They’re labeled “controlled,” as they have the potential for addiction.

In the past, patients needed to go monthly to their doctor’s office for an appointment for these medications to be prescribed.  The new rules allow up to a 90 day supply given at a time.

How does this change things?

Benefits:
1.  For stable patients whose meds are not changing, this eliminates the need for extra office visits.  This can get rid of office visits:

  • which aren’t medically needed
  • which waste time for both patients and doctors
  • for which patients need to travek, which can increase pain for patients

2.  For physicians, this rule can:

  • eliminate visits which aren’t needed
  • make room for patients who really need to come in

Cautions:

1.  If your condition or medications are changing, be sure you’re scheduling visits as often as is medically needed.  The 90-day limit is an option, not a requirement.
2.  There are concerns regarding mis-use of medications, with a 90-day break between visits giving things a chance to get out of hand, such as:

  • not using medications appropriately
  • patients at risk of addiction not getting adequate supervision with medications
  • your condition changing and not getting adequate medication treatment

How to minimize the risks:

  • Both patients and doctors need to think carefully about who is seen less than monthly.
  • Patients need to report if they begin to use medications unwisely.
  • Doctors need to be sure regular monitoring for mis-use of medication is done.

So what do you think about the new guidelines?  Do they help you?  Any concerns?  Share your thoughts in the comments.

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9 responses so far ↓

  • Jeffrey // Mar 20, 2008 at 7:34 am

    I think the 90 day ruling is justified and will eliminate many unecessary costs in office visits for those who live in chronic pain if you can get the Dr’s to agree to do this as even though the DEA says it is OK it will be some time I’m afraid before the Dr’s are willing to give up the extra dollars for the unneeded office visits since it isn’t a requirement. I know of several who live in chronic pain who have had to go days without their meds due to the 30 day ruling and this is not only stressful and inhumaine in my opinion but also can be dangerouse with the withdrawl effects with some of these medications. It is about time someone looked at the consequences of those who live with chronic pain daily and actually see and understand their needs as far to many medical professionals just don’t get that the pain is real and that we aren’t seeking the medications for a high because personally I would prefer not to take any medications but have no choice other than living with the pain to the point of being bedridden all the time.

  • How to Cope with Pain // Mar 20, 2008 at 11:26 am

    Jeff, I’d be interested in knowing how a discussion with your doctor goes. What reservations does he/she have about giving more than 30 days? Do you really think it’s just money that your doctor keeps you coming in?

  • Debbie W // Mar 20, 2008 at 3:50 pm

    This is interesting, as I have to see my pain doctor monthly, in order to get my medications, some of which are narcotics. I have been seeing her for several years, and my dosages remain stable. I wonder if she would switch me to bi-monthly visits. Do you know how long this change has been in effect?

  • How to Cope with Pain // Mar 20, 2008 at 4:06 pm

    Debbie, just since December.

  • eJane // Mar 20, 2008 at 10:03 pm

    I hope doctors won’t refuse to use this new ruling because of loss of money from office visits! I think the ruling should be on a case-by-case basis for the reasons it was passed. If there is a possibility a patient would abuse this 90-day supply, the doc should make them come back every 30 days.

  • stacy // Apr 2, 2008 at 5:13 pm

    I think the key here isn’t necessarily if the doctor will allow it… what about *insurance*?! I am pretty sure that Medicare allows for a 90 day supply, but my insurance, Aetna, does not. Does anyone know if there is a deadline in which insurers must be compliant? Or do you know if they have to be at all? I know my doctors wouldn’t have an issue with prescribing every 2-3 months, but insurance would not cover the medications, and then by the time I was to fill the 2nd and 3rd prescriptions, they would be void (they *do* expire). I am really interested to know how this works as it would make my life so much easier.

  • How to Cope with Pain // Apr 3, 2008 at 5:31 am

    Stacy, for a 90-day supply, your doctor would give you 3 separate prescriptions, each with today’s date, but with a “Do Not Fill Before….” Then you would just take in 1 a month to fill. They cover 90 days, but you only get a 30-day supply at a time.

    So to your insurance, it looks no different as seeing your doctor once a month, as you just fill a 30-day supply at a time. (Insurance will be happy with this, as it can cut down MD visits by 2/3′s.)

    For example, if you saw your doctor today, you’d get:
    1) A 30-day prescription on 4/3/08
    2) A 30-day prescription, fillable only after 5/3/08
    3) A 30-day prescription, fillable only after 6/3/08.

  • Migraine Chick // Jun 12, 2008 at 7:40 am

    Thank you for the infomrmation. I wasn’t aware of this.

  • NJ // Jul 8, 2010 at 3:27 pm

    This looks good. The legislators do try to make efforts to control these substances but also create conditions where the chronically ill can get them.

    Unfortunately I have found that the written laws and the way pharmacists handle them can be two very different things. In many cases, eventually it becomes necessary to increase the amount of medication used, and over time this can create problems. One can be taking the same number of pills for two or three years, but eventually these doses will become less and less effective. When the doctor increases the dose, I have often run into problems with the pharmacies. Anything from them not having enough in stock, to just simply thinking that there is something inappropriate with the increase.

    In other cases, as the amount becomes less effective, a doctor might need to write an additional prescription for the same medication because they have told the patient “If you need to use a little more on a particularly bad day, do so, and I will write a second prescription next month so you will not run out” I have been through a lot of problems related to this sort of situation in the past.

    I have been seeing the same doctor for over five years. He is well aware of my conditions and the progression of my condition. I went for about 4 years on the same dosages, but in the last five months had to increase the dose of one medication and completely drop the one he had been prescribing for break through pain because of extremely bad side effects. So basically the increase of the one medication was not an increase in total pain medications, it was offsetting the amount that was being dropped in the other medication. The result at the pharmacy was mind boggling.

    But yes, if you establish a long term relationship with your doctor, they can and will simply allow you to call them, they will write a new prescription, for two, or even three months. My doctor started by allowing me to visit every two months, and after a year of that, every three months. If I have an emergency, such as needing trigger point injections of cortisone like medications, I can make emergency visits in between.

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