I would like to know if the FDA has recently passed a new law stating if you are on opiates for pain, that you can no longer take benzodiazipines? I have been on both for 23 years (alprazolam) due to MS, defective sleep structures in my brain, etc… I do not sleep without alprazolam. My pain doctor told me in April he would not write my script for oxycodone if I took alprazolam. I slept a total of 9 1/2 hours the whole month of April. My visit with the pain doc on May 3rd, I was told this was a new FDA ruling that just went into effect. I had to make a choice of taking alprazolam or oxycodone. I choose the alprazolam because it also helps tamper the pain I have from 2 failed back surgeries in the 70’s, severe osteoporosis & osteoarthritis with many breaks, spinal hemangiomas,, several surgeries to correct some of these problems to no avail just more pain problems. I will now be weaned off of the oxycodone by the pain management doctor. I took my alprazalom last night, got 8 1/2 hours hour of restful restorative sleep, & did not have to take a oxycodone this morning. Lack of sleep & increase of pain go hand in hand. I don’t believe the alprazalom will relieve all the pain so wonder if this law is true or not, or if this pain doc just wants me to get off of everything that lets me function as a normal human being. I have much to do as my husband is totally bedridden, plus life in general! Am I to just sign up for a nursing home myself? If this is a new rule, we must fight it!
There is something called BEERS CRITERIA
http://chpw.org/resources/Providers/Beers_Criteria.pdf
INTENDED USE
The goal of this clinical tool is to improve care of older adults by reducing their exposure to Potentially Inappropriate Medications (PIMs).
This should be viewed as a guide for identifying medications for which the risks of use in older adults outweigh the benefits.
These criteria are not meant to be applied in a punitive manner.
This list is not meant to supersede clinical judgment or an individual patient’s values and needs. Prescribing and managing disease conditions should be individualized and involve shared decision-making.
These criteria also underscore the importance of using a team approach to prescribing and the use of non-pharmacological approaches and of having economic and organizational incentives for this type of model.
Implicit criteria such as the STOPP/START criteria and Medication Appropriateness Index should be used in a complementary manner with the 2012 AGS
Beers Criteria
to guide clinicians in making decisions about safe medication use in older adults.
The criteria are not applicable in all circumstances (eg, patient’s receiving palliative and hospice care). If a clinician is not able to find an alternative and chooses to continue to use a drug on this list in an individual patient, designation of the medication as potentially inappropriate can serve as a reminder for close monitoring so that the potential for an adverse drug effect can be incorporated into the medical record and prevented or detect early
This is just CRITERIA… doesn’t get up to the level of GUIDELINES… first question is what is an OLDER ADULT ? Some of us believe that Beers is a bunch of academic BS. They made recommendations and then they put statements such as these in the guideline:
This list is not meant to supersede clinical judgment or an individual patient’s values and needs.
What this pt is running into is that the DEA claims that they don’t tell prescribers what medication to give which pts.. then because some people take excessive doses of opiates, benzos, and muscle relaxants like Soma… maybe mix with alcohol and end up DEAD… the DEA comes out and said that there is no valid medical use of those three medications being used in the same pt. Doesn’t make any difference that millions of people have taken those medications together and in appropriate doses and get improved quality of life… and NONE HAVE OD’d…
Jeff Walsh, DEA Asst. Special Agent, sits down with WESH 2’s Matt Grant to discuss issues patients are having getting legitimate prescriptions filled.
JEFF WALSH is one of those DEA agents that spends the majority of his time – sitting behind a desk… I have spoke with Pharmacists who relay what they are being told by DEA agents in the field… and what Agent Walsh states in this video interview does not match up with what community pharmacists and prescribers are being told.
Report Matt Grant at www.wesh.com in Orlando did a couple of dozen of pieces – including two-30 minute specials – on the denial of care in FL… you can find most of them on www.youtube.com
My suggestion to pts when they are told by a prescriber that “it is the law”.. simply as for a copy of the law and or the state statue number… so you can look it up on the web… if they can’t/won’t provide the information… most likely it is because there is no such LAW … so they can’t enforce a LAW that doesn’t exist.
When the prescriber states that “THEY” are putting pressure on the prescriber… politely ask who in the hell “THEY” are ?
Healthcare professionals are suppose to function on FACTS… they don’t start you on hypertension, diabetes, cholesterol or other chronic disease medications without some sort of labs/testing to document that they have FACTS that you do in fact need medication to treat a verified disease.
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In TN, yes they started this craziness spring 2017, after mind you, after most everyone had been dosed way down. How were benzos not dangerous when we got much stronger pain med? I was told if a psych said I needed the benzo I could stay on, otherwise pick one or the other. Word got out pretty quickly that no psychs were approving it with pain meds & a lot were trying to say the pt was addicted… So why even go? It was a fast track way to get you to a psych who would do anything to send you to an addiction center. Did you all catch the “me too” campaign on FB? Women were using it to say yeah someone looked at me funny. Better watch it bc if you were abused they can deny your pain meds bc well you know – high risk to off ourselves regardless of never taking too much etc. Here’s where I am at – I no longer trust any of my drs! Why should I? Lies, lies, and more lies. It’s simply not true that saying lies over and over makes them true!
So how many of us can no longer sleep! Lots! Getting rid of us every wY they can!
Steve I appreciate your site, Andrew kolodny says these guidelines are not law yet pain specialists are saying they can’t prescribe narcotics for fear of DEA. It’s alot of doublespeak. My husband on same pain meds same dose, clean urine 12 years is all of a sudden being cut off. So, not only does he have pain but is withdrawing. That it’s happening at the same time our,streets are flooded with fake pain pills made of fentanyl or carfentenil is very suspicious to me. Are they hoping pain patients will try a fake pain pill and die?
Thank you!!
In TN they are sending patients taking benzos and opiates to a shrink b4 continuing or starting care. I was told this by three PM, 2/I have seen, I asked. I have myositis and having taken a whopping dose of 4mg per day diazepam I am probably at risk for OD or suicide who knows . who the hell ever gave bureaucrats, unelected paper pushers control over our lives? The DEA is what is what is illegal no unelected bureaucrats are to make or enforce law per Constitution!
I live on the TN /GA line, so I drive to ga for my care. When we first moved back to this area after my husband’s deployment, I drove 243 miles one way, back to my old pain management doctor for about a year, until I found a suitable replacement. If I hadn’t ran into problems getting my scripts filled (because his office was over 50 miles away from the pharmacy here where I live now, or at least that’s the excuse pharmacies gave as to why they’d fill it this time, but I needed to find care closer to my new home because they wouldn’t fill it for long), I would probably still be seeing my old doctor. I had established a good relationship with him over the past 5 years, and I actually saw him when something was really wrong instead of the NP. The only time I see my new doctor is on procedure days. I have no problem with the nurse practitioner, but I’d like to see the doctor without being rushed.
Come to think of it, I rarely ever felt rushed at the previous doctor office.
Oh my old doctor was located in TN, and I had so much trouble getting my script filled, even though the pharmacy could look on the drug database to see that I had been a long time patient! I knew after several attempts and several consultations with pain management doctors in the area, the pharmacies looked at me like I had 3 heads, that the current climate on my life saving medications was getting ready to just get worse. And here we are, the government is making a bad situation worse.
My PM said the same thing. Went off it, during a very stressful month. Now taking carafate and protonix… instead of clonazepam, which gave me a good nights sleep. I don’t sleep well now, and yes my doctor had a good reason to prescribe; PM does their little quizzes (with all negative – points to problem multiple choice answers), and diagnose me with depression and anxiety. Yes it’s depressing to be in pain and since they rewrite the law, I’m in panic mode when I get there. But, I’m off that terrible medicine. And waiting to see if I have an ulcer or this nearly month long bout of gastritis will go away. I know it might not be because of quitting, but I also know it well may be. They didn’t mention age. I did feel like they are taking away another chunk of what’s left of “quality” of life. What did we do to deserve this?
Has anyone seen the latest? Request to remove pain meds from market? This PROP is the same group that has forced us in to the position we are in re pain management
https://www.regulations.gov/docketBrowser?rpp=25&so=DESC&sb=commentDueDate&po=0&D=FDA-2017-P-5396
I hope KARMA gets members of PROP, and in my lifetime, so I can watch their downfall.
Good grief! I guess that sounds ugly of me. It is what it is at this point.
God help us all.
I understand!
Thank you Steve! I figured it wasn’t a law. This pain doc just wants to get rid of me to protect his practice from the Dea raiding him. I will be following your suggestion to the letter. I had to agree to one or the other, so the oxycodone is on a reduction schedule.already.I tried showing them all my medical papers stating my conditions, to no avail. Said there are many patients in the same boat. Of course they say I am an addict! Lol My own PCP was quite upset this happened, & said if nothing had happened in 23 years it wasn’t going to! I am a very careful patient, do my research on all conditions etc… They don’t give me credit for anything. Just looking out for themselves. I will be asking for the copy of their so called law.
Wanted to also mention that I only take these two medications, & not any others like it or similar to them. I will be having to drop 1 oxycodone pill a month to wean from it. I will be showing them the Beeres criteria for sure, but doubt that it will affect my outcome. If they continue with the regime they are doing, I will be bed bound along with my husband. Not a good outcome at all. I need to be functional!.