2014 New Pain Medication Laws Dictating To Doctors That They Cannot Prescribe Anything Equivalent 120 Mg Of Morphine Or Higher A Day Per Patient (Page 35)

I was told Friday by my Pain Management Doctor at my monthly appointment that the DEA was implementing a new law dictating to doctors on how much pain medication they could prescribe per patient per day. It could be equal to no more than 120 mg of Morphine per day per patient and they had to comply within 3 months for all of their patients. I am trying to find out as much information on this as possible. I don't know if my Pain Management Doctor is stating fact or if he is just running scared and if he is stating fact, I don't know if this is federal or state (Alabama) mandated. I spoke directly with the Southeastern division of the DEA in Atlanta this morning and they are not aware of any law of this nature coming into effect and I also contacted another pain clinic locally that has never heard of it either. So I have been trying to reach my Pain Management Clinic and get a copy of the law itself so I will know if it's federal or state and if it is an actual law or just a state regulation and if it's even true but so far no one has called me back so I thought I'd try my luck here and see if anyone has heard of this. This really has me bothered. It looks like either way, true or not, to get adequate pain care I am at least going to have to move out of state if not the entire country. I will ask my questions about that in a different post. But if this is in any way true, and it seems my pain doctor is going to be going by these guidelines whether it is or is not true, it is going to cut my pain meds by almost half. I am on 120 mg of Oxycodone and 8 mg of Dilaudid per day which I was told equals 212 mg of Morphine per day. And before someone decides to tell me that I don't need that much pain medication, I will go ahead and say to you, you don't know me, you don't know what conditions I have that cause me Daily Severe Chronic Pain and other Daily Severe Pain to warrant that much medication, you don't know my tolerance for pain meds, I do NOT take any pain medication to feel high, I ONLY take pain medication to relieve some of the pain as what I am on doesn't even relieve all of my pain, I do NOT drink, I do NOT do street drugs, I see my doctor every 28 days just as I am supposed to, I take my medication as prescribed and the way I am supposed to take it except when I had extreme oral surgery a month ago and I did have to break up my tablets for about a week but they were put on my tongue and NOT up my nose and they were IR tablets so I was fine doing that as I had checked with my pharmacist prior, and you don't feel what I feel or see me lying in bed 24/7 crying from the pain because it is so excruciating and unrelenting so please before anyone starts telling me that I don't need that much pain medicine just stop now before you even start. Those of you that have to live with daily pain will surely understand where I am coming from being this defensive as I'm sure you know you are treated as a drug addict by most doctors even. Thanks in advance for any help with my question.

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Re: Anne (# 18)

Hi, I'm in the same boat with the 120mg "law". My Dr. has cut me from 100mcg of fentanyl to 25mcg in 2 months. Also I was taking 15mg of oxy for breakthrough pain. The withdrawals are unbearable, I had 3 back operations & a spinal fusion. Also after all that I still need an operation on another disc (L5-S1) which I begged my surgeon to do at the same time to include it in the fusion. But we patients don't know anything about our bodies or our pain. Due to a very low hemoglobin problem (for which I've received 7 blood transfusions in less than a year) I can't even consider surgery. I've been seeing my pain Dr for over 10 yrs & it took years to get the right combination of medicine to be able to have some quality of life. Now it's all been taken away by some jacka**'s that don't know what chronic, long-term pain is. My basic civil rights to lead a somewhat normal life are being trampled on. And I'm sick about it. Whoever is in charge or formed this group to resist and call this so-called mandate, but not a real law out as the b.s. it is please contact me.

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Re: Eileen (# 9)

I? have been told the same information from my pain management doctor but even more recently told been told that that no more than 90mg total per person per day may be prescribed recently had a medicene pump put in so medicene needed should be less and side effects also will be less this was not a easy decision but with the government sticking their nose in where it doesn’t belong they will continue to force doctors hands to be tied and frankly do not feel would want to continue to live in constant pain with no relief in site this is not a easy road we travel for good headlines for the government. this is going to be my answer praying one bad apple has made it tuff for all of us good luck God Bless

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Re: GimpyD (# 680)

Before you start pointing fingers at anyone you need to stop and think before you open your mouth. There is no law about how much pain medication your doctor can prescribe. Instead of listening to doctors who are lying to you, go to the AMA website. All that has been written are suggestions. PERIOD. Your doctor can write you anything he/she thinks you need. If your doctor is telling you anything different then he/she is just scared, who knows maybe your doctor has a reason to be scared. Don’t you dare blame this on people who are addicted to the meds that our Doctors wrote us. I was given opiates, barbiturates and even quaaludes at a very young age. I was an addict before I knew what the word even meant. You are no better or worse than me. I’m sorry for whatever you were born with that is so painful but don’t you blame people for what the Pharmaceutical Companies started with their OxyContin. BTW. I’ve never even taken the drugs you are talking about. If you need to blame someone then ask your doctor why he/she is lying to you. That’s no one's fault.

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Re: Grace C. (# 6)

Just now read your message I go to pain consultants of east Tennessee. Been going for 25 years. Doctor Joe browder. They are in weisgarber road.

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Re: Patrice (# 683)

Wow, attack much? The truth is a scam WAS done to make a lot of $$$ for the drug company and Dr’s were given a cut or incentive. The drug was called “SubSys” and was/is a fentanyl sublingual spray that is immediate release. Fentanyl patches have helped many people continue to work and function. It’s available in generic form, so to keep the highest profit they did as they often do...change the delivery method. Dr’s were told it was good for all pain types and “not addictive”. I’m not a Dr. but I knew what fentanyl was, and didn’t want to take it yet, saving the strongest meds for when I HAD to have them. I went to my pain management Dr. one day and was told I was going to be put on this new drug “SubSys” 600mcg. It was sent UPS right to my house. Each dose was in its own applicator. It resembled an asthma inhaler, but each one had only one dose. The one month supply took up a box a little bigger than a box of reams of copy paper. Very inconvenient, no more putting it in my purse or hidden easily. My son was in high school and I was very careful so he couldn’t just help himself. Sadly, teens do experiment with things. The starting dose for opioid tolerant patients was 100mcg (according to the drug info in the box. I told my Dr. (a Yale Grad) I didn’t want this drug, but he said it was that or nothing. My co-pay was $3,000 a month, but was paid by a charity foundation. I got alarmed when I saw a car following the UPS truck that I saw pull over and write something before driving away to follow the truck. I knew what the box looked like, so anyone could see too. You may be in denial about people who get affected to powerful opiates, though they don’t have pain, they use it to feel good and keep withdrawal at bay. I quickly packed a bag and left. If addicts (yes, addicts) will rob drug stores, breaking and entering is a walk in the park compared to robbing a drug store. After I moved and had my Dr. refer me to a pain specialist in the area I moved to. I got the referral, but my records and imaging were not sent.

Looking back, that was red flag #1. I would run out before the first available appt. but my old Dr. refused to order another months worth. Told me to call the new Dr. as I was no longer his patient. The new pain specialist couldn’t prescribe me anything without seeing me first. My appt. was 3 weeks later, and I was out in a couple of days. I went into full withdrawal. Though I’d never abused my meds it was horrible. My mom called to chat and I told her what happened. Her husband drove her to my house, and took me to my new PCP. They couldn’t get a blood pressure with the normal machine, but my pulse was 40, and my blood pressure taken by the (Dr. or nurse-it’s so fuzzy) was very low. I’d been fighting to just get to the bathroom, a trip to the Dr. and waiting in the office was torture. Mom brought out a wheelchair and got me, wrapped in the warmest blanket I had (in July in AR) my body was struggling just to remain alive. Horrible is way too nice in describing what I was feeling) my PCP prescribed me just enough (opiate pills) to get me through to my appt with the new pain Dr. after I was able to walk and eat, sleep and think...I wanted to donate to the charity for their help in paying my co-pay. I was told it was a charity that helped cancer patients pay for their meds. I gave them my ID# on the card, and was told my Dr. had told them I was a cancer patient! I was shocked. I actually thought I must have cancer, but my (old) Dr. knew I was alone, my kids grown and no caregiver. That’s a strange feeling. I decided I’d rather not know. Just as long as my pain was managed, I’m not afraid of death. In fact, that’s the only thing that will stop my pain completely.

I expressed my desire to take the smallest effective doses of the meds I needed to be able to live alone. Live with dignity. Years later I found out the whole story. That drug, “SubSys” was only approved for cancer patients. The Drugs manufacturers had set up a whole system allowing non cancer patients to get this name brand only drug that in reality was $30,000 a MONTH. The first month put me into catastrophic coverage, my part was only 1%. ($3000). Another greedy grab by big pharma. Yes, Dr’s had to be part of it and willing to say the patient had cancer while knowing they didn’t. Maybe some didn’t know, but couldn’t resist the reward or incentive offered by the reps. OxyContin was also falsely claiming to be safe and abuse-proof. (When it first came out). The truth comes out in the end, and patients bear the repercussions. In the case of SubSys, I think some Dr’s were reprimanded if they knowingly broke the law. Some were arrested for writing “too many” prescriptions to patients. Pain specialists...well, that’s what they do! Of course they write more pain RX’s than other Dr’s. Greed was behind this whole “opioid epidemic”. Not greed by pain patients, but we get the end result. Pain that’s not treated effectively. Suffering, and the lost ability to care for themselves. The addicts I was talking about that you got so upset that I “dare” to blame are junkies. Apparently illicit drugs are now much stronger, and there have been more overdosing. Those deaths are listed as “opioid deaths” along with pain patients. The numbers aren’t being separated. It makes it look like we (pain patients) are dropping like flies from overdoses.

After decades of pain management I never overdosed, never abused my meds. (I never got OxyContin either) The problem is pain patients are being thrown under the bus from greed by drug companies, some Dr’s, and junkies. If you want to stand up for junkies, that’s your business, but if someone can go through rehab and get off narcotics and have a good life, free from pain, but don’t...yes, I hold them responsible. Anyone who doesn’t have pain but abuses opiates is the enemy in my book, along with greedy drug companies and Dr’s who don’t take their patients best interest into account are the enemy in my book. How Dare I? I dare use common sense. I dare to research and find the truth. I’m trying so hard to live with more pain than I can handle after asking for my meds be lowered to the minimum effective dose so I don’t get such a tolerance that my pain can’t be controlled. Now my minimum is too much. I’d cut my dose (before SubSys) in half, and it’s been hard, but it’s been hard my whole life, but now, that half dose is now 1/4 what I was taking before SubSys. I was able to be active, and was going to get another BS in something I can do from a wheelchair. Now I’m barely able to take care of myself, but I’m afraid to tell them because I’m afraid I’ll end up in a nursing home. I dare speak the TRUTH. Sorry you were offended.

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Re: GimpyD (# 676)

I’m in the same boat. A young Dr. afraid of losing her license. Refuses to write over the guidelines. I’m looking for an older Dr. who knows what’s what. I wish you the best of luck. I’m so sorry so many innocent patients are being made to suffer in ways that housepets allowed to be in pain like this would be considered abuse.

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Oh, my first hip was built with bone from my rt. Hip, they cut it from the upper round part, not from the joint. I was 8. They’d tried traction, body casts and braces from 17 months when I was diagnosed. It didn’t work. The hip Dr. Steele made me at AR Children’s Hospital was really incredible. I was told to wait as long as possible before having a total hip replacement. I made it to 35. Most surgeons wouldn’t touch me. I finally found a surgeon who not only agreed I needed a THR, but had a pioneering new method. He got my legs the same length, ordered PT from the beginning, in my own home. No riding in a car or leaving my house for 6 weeks. I recovered with stronger muscles than before the surgery and no limp! I loved that hip! I had 3 kids and got my degree despite my disability. It was getting overwhelming to try to teach and just keep house, shop, and cook. Unfortunately the plastic cup was sterilized with gamma rays with oxygen exposure. They found out that weakened the cellular structure of the special plastic that was strong enough to ice skate on before the gamma/oxygen. They’d learned to use gamma rays in a vacuum to sterilize the cups, but old ones weren’t pulled from the shelf, and I got one. The surgeon brought the ball from my old hip to show me. It was worn flat. I’d been bone on bone he said. I knew that. Dr’s just didn’t believe me when I told them how bad it hurt. That THR was a miracle to me. I had no pain for the first time in my life! I took the kids camping, took my class on nature walks, I was like a normal person! It lasted 12 years.

When x-rays showed the cup wearing badly I was set up for surgery. I thought I was just having the cup replaced, and I’d be back in the classroom after Christmas break. My immune system attacked the plastic particles from the cup that drifted down. When the surgeon got in he found a large abscess behind the hip, and a lot of bone and tissue damage. He had to do a revision. After removing the damaged bone and tissue there wasn’t enough bone left for a new hip, but he used donor bone and bone cement, and lots of long screws that go through the bone into (?) I see on x-rays. When I came out of anesthesia I was in so much pain I was literally freaking out, shaking uncontrollably, and in panic. I was still in the OR on a gurney and the surgeon and his team were at the operating table. I guess the next patient was on there. I don’t know. I remember a nurse trying to calm me down and saying the Dr. thought I was “faking” but blood pressure doesn’t lie and she was giving me 12 grains of morphine. I have no idea what that means, but whatever it was it worked. I stopped panicking, and with a nice warm blanket, I went off to sleepy town. Woke up in my room, in a ridiculous amount of pain. It felt like a semi had driven over my left hip. But I was the new owner of a great big DePuy metal on metal hip. No plastic cup to wear out! Yay! (I thought) I just couldn’t walk. The pain was insane. I looked at the surgical site and saw it was so swollen the staples were dimpled into the swollen hip area. No drain. I’d had a drain the last surgery, and had donated 4 units of blood that were all used. This time I got blood, but not mine. It was awful. It’s still awful. I was sent to pain management for my DDD, but the pain meds also help my hip and I’ve been able to keep it 9 years. When it’s removed I don’t have enough bone for another. I’ll have a plastic spacer, like they use in case of an infection. Only I’ll have it for good and never walk again.

If I could I’d have had another hip put in, but I worked so hard to be able to walk. It’s really hard for me to imagine trying to keep house and do laundry in a wheelchair. I know it’s coming though, and was planning to move to a wheelchair accessible apt. after selling my house. Now with my meds cut, I can’t pack to move. Standing in the shower I’ve got to be fast before the pain takes over. I wanted to take my grandson shopping today, but if a shower hurts, I’ll never make it walking in a big store. It’s so frustrating. I’m stuck in rural NW AR. My PCP moved and no Dr’s are taking new patients. I need to do laundry. I gave up trying to cook. I live on nuts and cheese, crackers, soup...anything fast. I used to cook for 5 every day after teaching all day. Now I’m living in my bed. Wow. Sorry. I didn’t mean to have a pity party. Not looking for sympathy, just saying I know what you mean about those DePuy hips. I wish you much luck. My recommendation is to have a CT scan so the surgeon can see any abscess or tissue damage before going in. I’d asked my surgeon to do that, but he assured me he knew what he was doing, he’d done so many hips. But, I sure wish he had. It wouldn’t have changed the outcome, but I could have been prepared for what I was getting into. I wasn’t told that revisions aren’t as good as the first total hip replacement. I needed to know. To plan on being out of my class longer. Maybe I just have rotten luck. I truly pray yours goes off without a hitch! Hang in there! My hip was deformed from day one, so that may be the thing that made everything go badly. Yours should be much better!

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Re: Jace (# 667)

Yup. It’s not a LAW, but pain Dr’s are scared. Mine refuses to even write me 3 30’s of oxycodone. I found if I took half every 3 hours it worked for me. I practiced with my last RX of 4 a day. Took half every 4 hours. It worked better than the 4 20’s I’m getting. I take the whole pill, and it stops working after 2 hours. Well, not stopped...no withdrawals, but not enough pain relief. I managed to get a shower after my noon dose, but I was hurting even after a short shower. Back in bed until 6:00 when I hope to do a load or two of laundry. I’m determined to get my grandson some pants tomorrow. I’d hoped to today, but no dice. He’s in HS and he’s growing SO tall. His pants are too short. I want to get him some Levi’s and get them a couple of inches too long. He can roll them up a little, I see guys doing it, so it must be in fashion. At least they won’t be too short in two months. I’m fighting self loathing. I feel awful I’m not able to do such a simple thing...ugh. So sad.

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With the new laws can you explain how 120 hydrocodone 10/325 and 60 oxycodone is equivalent to 200mg of morphine? Why does everything have to be equivalent to morphine? I don't even take morphine? Why does the CDC do this?

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There are new guidelines for prescribing beginning last year that do not support doses over 100mg morphine equivalent. These guidelines have become a relatively firm maximum. It is not against the law to prescribe higher doses. but there is a huge risk to the doctor if he is not following standard of care; the DEA is likely to visit him and if a pt overdoses he will virtually be presumed at fault for not following standard of care. Pharmacies are increasingly taking these guidelines as absolute and some are not providing doses in amounts higher that that. This is a terrible witch hunt that is grossly unfair to pts, but it is not the pain docs fault. He is responding to a profoundly changed TX landscape. this will only get worse over time.

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Re: GimpyD (# 688)

You need to ask your grandson to help with the laundry and other things around the house.

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A lot of medicare prescription plans have put on these regulations. Only 90 mg of oxycodone a day, 120 mg of morphine, and so on, unless you can get your doctor to get a change thru the drug plan. It is hard to believe senior citizens are made to suffer so much. And all cheap generics too, I hope that my doctor can get an override on mine.

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Re: Sam (# 692)

Medicare has been monitoring Medicare Part D beneficiaries for overuse of opiates and certain other drugs the past several years. Recently, CMS has proposed tighter restrictions. See the link below:

Medicare Drug plan coverage rules-
medicare.gov/part-d/coverage/rules/drug-plan-coverage-rules.html

2019 Medicare Advantage and Part D Advance Notice Part II and Draft Call Letter-(Scroll to 2018 Draft Call Letter)
cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-02-01.html

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Re: Anne (# 18)

This country is one by one denying our rights protected... Now they want to take all guns... It's not enough that greed & power outweigh quality of life... Drug abusers will get what they want no matter what. These decisions are totally irresponsible, violation of my right to live without inhumane suffering...Many productive, responsible members of each society are being targeted for a system that started this mess in the 70s...Put everyone in jail that has a disease... Now the others who suffer with excruciating pain...Which takes ur hope, will, and quality of life away... What's next...No anesthesia for surgery... These ppl that chose to make severe decisions are grasping at the wrong straws...My god, how is it even possible to be denied quality of life in the usa...But the usa will allow people that chose to be american citizens, damn us, command us to change all we fought for...Brings us peace...Stands for everything that brought so many immigrants here for refuge... Now each group demands we submit to everyone's beliefs...Never take a chance to offer our hand in god's name... Peace is being replaced with angered hateful ppl whom ran for comfort of our strength... What strength? Every right is being taken or changed.

All that made our country great, is being traded for lies, greed, power, no more love, compassion for ppl truly suffering every minute... Then allowed our borders to flood with the real poison...American people....The foundations this country supposedly is built on has no rights... The ppl that hate us have everything they need...Openingly damn us while on our soil, while money flows from our borders back to strengthen the horrible place they needed to leave... I am not against immigration. I am against humiliation, disrespect, weakness and being a joke among so many nations... We look weak...We allow our elderly to starve, suffer, live in fear...Horrible pain is being banned ...Wtf??? What is wrong with this picture? Who is defending americans rights as 1st priority and keeping us united to stand by each other to show our hearts ...Our strength...Family values, loyalty to preserve one nation under god...Why do we keep bowing to orders to weaken us....As a nation...So all our haters strengthen as our enemy while comfortable on our soil...

I feel like this is the twilight zone & the muppets r running our country...We look like *****s... Gutless, heartless selfish ppl living in fear and they don't even care why...Find the truth ppl... Just bc it's on tv doesn't make it true... Dig for info... My grandchildren do not deserve to be made fun of then left to take blame for corrupt greedy liars, posing to be doing what will save our pathetic country... Open ur eyes...Make ur own decisions on what is right & wrong...Who should suffer & die...Who lives and thrives...All this in our country and u really believe opiates r the problem to focus on and punish more bc they have pain...Not of their choosing. Omg, addicts will always get what they want. Innocent people are the only people suffering...Bc of many bad choices...Definitely not bc of pain relief which should be given to those that have strong evidence of horrible pain and now punished for becoming ill....This country needs to wake the hell up and get priorities in order...Educate urself...Stop just ignoring the most horrible pain of all...Stripping the usa of everything we stand for and died for....Wow!!!! Wake up!!!

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Re: Pam (# 689)

When you change medications in the same class, we need to know what dose of new medicine to prescribe, so equivalent doses are used to minimize risk of withdrawal or overdose. All benzo's are compared to Valium (the oldest benzo); all opioids are compared to Morphine. You can go online and type in "morphine equivalent," and you will get numerous versions of the equivalency chart with all opioids compared to morphine.

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No not just Alabama. We're having the same problem here in Michigan. Thank the jacka** in the White House, he & his cronies don't care about us (people that go to pain clinics & take our meds correctly). Why don't you stop the flow of heroin, cocaine & illegal benzos coming in the country? 120 mg equal of morphine is the amount the "professionals" say is sufficient to control chronic pain. Politicians don't know anything about the little people's problems, they can afford any drug they want. I've ranted, raved and cried but the doctor just tells me if I don't like to find a new one. Sucks and there's no help in sight.

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I haven’t heard anything about the DEA regulations. I’ll have to check that out. My pain specialist talks about the restrictions put on doctors by the CDC, and I’ve researched that. According to the CDC, their recommendations are for a daily maximum of 90 mg MME’s (Morphine Measurement Equivalents is what I believe it stands for). When my Primary Care Physician was no longer allowed to treat chronic pain patients, I had to change to a pain clinic. They immediately cut my daily dose of 180 mg MME to 115. I have neuropathic pain which has remained with me since a fall on the ice in 2012 and spinal surgery later that year. My research on that recently indicates that it takes a larger dose of opioids to control such pain, that dose tolerance is rarely achieved, and that the patients don’t become addicted to the medications.

I was functional in the world under the care of my PCP, but, since changing to a pain specialist a year ago this month, I’ve become homebound. My pain specialist says his hands are tied, and that he already has me slightly above what the CDC wants, although he’d really love to help me. I was suspicious, too, about whether or not he was telling me the truth, so I checked out the CDC regulations myself and found him correct in what he was telling me.

I’ve been in isolation from the world since losing the amount of medication, last year, that I need to take the edge off my pain. This isolation has left me increasingly desperate, so I’ve recently had a new MRI and will be seeing a new spinal surgeon soon to see if there’s anything that can be done for me surgically now. My seven years of Friday-night-dinners-out with my husband’s and my best friends ended in March 2017, as did my Sunday School and church attendance, parties at friends’ homes, shopping trips with my husband, etc. Even though my husband is awaiting double-hip replacement surgeries, he’s still the one who has to do all grocery shopping and cooking. Worse, he misses me terribly. But clothes hurt me so badly that I only wear street clothes now to go doctors’ appointments. I could return to work next fall on the same faculty my husband still is part of, but it takes me a full day just to recover from two hours’ out to see a doctor. How can I work?

I know well the fix you’re in. I’m living it already. What angers me so is how we chronic pain patients have been lumped in with a fake “Opioid Epidemic.” That’s what’s hurt us so badly, I think. This epidemic is grossly misnamed, and I think we all should be fighting against it. What this country has is a “Heroin Epidemic!” Statistics show there’s been a 65% increase in deaths by heroin, yet a 10% increase in deaths for chronic pain patients being treated by prescription opioid medications. We’re being hurt by a misrepresentation of what’s really going on in this country, and I get so angry when I hear that term “Opioid Epidemic” (or Crisis). It’s chronic pain patients who are in crisis by being thrown, without reason, into what illegal drug users are doing.

I’m very sorry for your pain and wish you a better ending than what my life appears to be taking. I could be a productive member of society again, but young people looking for a high aren’t the people the government can save so they’ve picked us as people they can regulate to try to make themselves look like they’re controlling a problem they can’t control — people on street drugs.

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Re: GimpyD (# 679)

Older doctors are not necessarily more likely to write high dose opioid scripts. They have less time to retirement and are trying to get their nest egg at the end. They are also probably wanting to sell their practices and don't want any legal entanglements prior to that.

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Re: Comments (# 697)

The CDC made Recommendations. Recommendations are not the same as Laws.. But, most doctors are using these Recommendations as if they were Laws.

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Re: Anne (# 20)

I go to an internist in the Phila area. My pharmacist would not fill my oxycodone because it had the wrong diagnoses on it. Fortunately I had an appointment with him today. He told me my rite aid had talked to him yesterday. They were concerned that I was taking klonopin and oxycodone together and that they think I should be seeing a pain management doctor. He told them that I had been taking he same dose for over ten years with no increase and he said he was good with that, he said if I needed more, he would agree with them. Just a little info from a doc.
Sam

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