Pain Meds and the DEA guidelines

Mzmerz

Does anyone have a link to the DEA guidelines discussing that cancer patients are an exception to the rules of prescribing opioid medications? I was just told by a pharmacist that cancer patients are not exempt from these guidelines, but I'm fairly sure she is wrong.

Or am I wrong?

thanks

glennie19

What specific rule? Could you provide a little more detail?

Edit: oops,,, didn't realize this was the Stage IV when I answered. I'm a pharmacist, so if you don't mind me posting here, and if you can provide some more detail, I'll try to answer.

Mzmerz

Hi Glennie

I am referring to the rules/guidelines as outlined in here, the CDC guidelines. http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.

This is my problem. My doctor had prescribed me Tylenol 3, 1 every 6 hours for pain = 120 pills but limited the prescription to 60 pills and must last 30 days. I have new mets, and she was out on maternity leave. None of the other doctors in her practice were willing to do anything with my pain meds, all stating the DEA/CDC guidelines. I ran out of meds after a trip to another state. When I returned home, I tried to get more - there is 7 days left in the "30 days" but she was reluctant to give me more until I could see her. I had no problem with that except she had no openings until next week, which left me with no pain meds for the weekend. I am being evaluated for brain mets, scanned yesterday, because of headaches that are not ending. After several phone calls and me actually going to my onc office for help - Onc won't give pain meds, refers to pain clinic, 1st avail appointment is February - I finally got a script for more T3, 120 pills this time, but pharmacy wouldn't fill it because it was early and the DEA guidelines will not allow for early refill. I explained cancer patients should be exempt, and I was told that was not true. Hence my reason for asking. The guidelines state "This guideline provides recommendations for the prescribing of opioid pain medication by primary care clinicians for chronic pain (i.e., pain conditions that typically last >3 months or past the time of normal tissue healing) in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care."

Someone tell me what I am not understanding? Or I could just be stupid.

glennie19

Mzmerz: These guidelines that you linked are meant for non-cancer chronic pain. The first line says it all:

Summary

This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

Chronic pain OUTSIDE of active cancer treatment,, which I believe you fall under. I am sad that your doctors are treating you this way. They should be more proactive in helping you obtain your meds. And they should be prescribing you better drugs too. #60 Tylenol 3 to last 30 days. That is nuts. That is only 2 tabs a day for a med that only lasts 4-6 hours in duration,,, obviously not enough to get you thru the whole day. And Tylenol 3 is a crap pain med. (If it works for you, forgive me for saying that! But it is not the best choice)

As for the pharmacy: I would print that guideline and highlight that line that says OUTSIDE of active cancer treatment and let them know you are in treatment and you need your meds.

Many medical professionals are so afraid of the DEA that they allow their patients to suffer for fear of what might happen to their license. With proper documentation in your records explaining why you need the pain meds, it would not be an issue in case of an audit.

I hope you can find the relief that you need.

glennie

Mzmerz

Thank you Glennie! I will take the guidelines to the pharmacy and show the pharmacist.

I am allergic to Hydrocodone and oxycodone, so that's why the Tylenol 3. I'm going to meet with my PCP to talk about other pain options.

Thank you again for taking the time to answer my question!

Amy

glennie19

Nothing against Tylenol 3,, if it works for you! It is just not usually first option. And definitely you need more than 2 a day. Minimum you should be "allowed" is 4 to 6 a day. Best of luck with the doctor.

april485

First sorry I am posting in the Stage IV but this came up in active threads and I read the title and knew I should respond.

Mzmerz, bone mets are painful and as such, you deserve to have your pain controlled. If I were you, I would call the Pain Management clinic you were referred to and explain your situation and that you cannot wait until Feb. as your pain is not being managed by your MO and you NEED help! I see a PM for another condition that I have and I am prescribed far more and stronger meds than you and your condition falls under the highest need for pain meds. Hugs and hope you get relief!

Bestbird

In response to the increasing hesitancy to adequately medicate cancer patients for pain, the American Society of Clinical Oncology (ASCO) issued the "ASCO Policy Statement on Opioid Therapy: Protecting Access to Treatment for Cancer-Related Pain," in May 2016.The statement provides principles to balance public health concerns regarding the abuse and misuse of prescription opioids with the need to ensure access to appropriate pain management for cancer patients and survivors: The policy states, "Cancer Patients Are a Special Population - ASCO believes that cancer patients should be largely exempt from regulations restricting access to or limiting doses of prescription opioids in recognition of the unique nature of their disease, its treatment, and potentially life-long adverse health effects from having had cancer." From:http://www.asco.org/advocacy-policy/asco-in-action/asco-releases-principles-balancing-appropriate-patient-access?et_cid=37861275&et_rid=1396253832&linkid=ASCO+Releases+Policy+Statement+on+Opioid+Therapy:+Protecting+Access+to+Treatment+for+Cancer-Related+Pain_btn

Fitztwins

UGH, total crap. I understand about the opioid addiction they are trying to crack down on, but we need our meds!

I am going to ask my oncologist next time I see him. I might start hoarding meds!

PattyPeppermint

wow. I agree giving Tylenol 3 twice a day is crazy. Cancer pain is totally not on the same guidelines. Shame on to your dr for making you wait.

My Mo is very generous with pain meds we have tried many many different meds and strengths. Refills for him is never a problem and hospital stays he always gives me a demerol pain pump to control my own pain. His nurse says he is like this with all patients. Just doesn't seem right to have cancer patients living in constant pain. My problem is the insurance. Not the pharmacist fault. Insurance is extremely strict about refills. They only allow a refill 1 day before prescription ends. One pain med is for 30 days and 1 is for 27 ( the insurance allows a max qty written at one time ) so I have to go pharmacy twice in one week. Grr. Once a year they allow an early refill of 3 days for vacation. There is also 1 hospitalists who always tries to limit my pain meds at hospital but thankfully my Mo over rides his order.

Longtermsurvivor

This is a huge problem from the patients' perspective, but it's also about the US policy on the War on Drugs circa 1985; global access to pain control; legislative attempts to curb abuse and corporate/pharma greed in pushing opioids too very far.

In the USA and the rest of the world...too much availability and use here and too little elsewhere. N. America and Europe consume most of the world's opiates, while drug policies have limited availability of opioids in the rest of the world.

Drug maker thwarted plan to limit OxyContin prescriptions at dawn of opioid epidemic

https://www.statnews.com/2016/10/26/oxycontin-maker-thwarted-limits/

How do you treat pain when most of the world can't get opioids?

http://www.latimes.com/opinion/op-ed/la-oe-rajagopal-pain-opioids-20150304-story.html

I get so frustrated that cancer patients are pawns foot soldiers in a global war. What's a little personal loss and suffering when there's a global war on drugs to be waged?

Here's a good blog on the issue:

PAIN POLICY: IMPROVING GLOBAL PAIN RELIEF BY ACHIEVING BALANCED ACCESS TO OPIOIDS WORLDWIDE

https://painpolicy.wordpress.com

Best healing regards for all, Stephanie