The Pain of Pain Medication
This October will mark a year of Vicodin and other hydrocodone combination products (HCPs) being reclassified by the DEA into a stricter category of controlled substances--from a Schedule III drug to the much more restrictive Schedule II. It will also mark a year of extra frustration and pain for me regarding getting these prescriptions filled.
An example of some of the main changes regarding this reclassification include:
- Prescribers are no longer be able to authorize refills for these medications and are limited to prescribing a 30-day supply. Before the change, patients could receive refills and up to an 180-day supply of the medications.
- Patients now have to be seen by a doctor for a new prescription, or at least they have to physically travel to their clinic to pick up the paper prescription in person (depending on what their doctor is willing to do). Before this change, refills for these drugs could be called in to a pharmacy.
The FDA and the DEA argue that the reclassification is necessary to curb the abuse and over-prescribing of these opioid drugs. Statistics showing opioid-related overdoses and deaths increasing over the last several years isn't good, obviously. And there are a lot of people who do end up abusing these drugs. But what about the people who legitimately need them and use them correctly?
I have been one of those legitimate, responsible patients for the last couple of years, even though I wish I weren't. I would much prefer to not have to take HCP painkillers, but right now I need them to help with my pain. And they do help, thankfully. What doesn't help is that it's now a huge inconvenience to get access to them, even when your doctor is on your side and willing to prescribe them. The amount of red tape I've had to cut through since October 2014 is ridiculous.
There was some major red tape strangling me during my recent attempt to get a Vicodin refill. Or a new 30-day Vicodin prescription, I should say. It was nearing the end of July when it came time that my health insurance company and pharmacy would allow me to get another month's supply of hydrocodone/acetominophen filled. Great! I really needed it after doing way too much walking when my sister was visiting me in NYC for a week. By the end of her visit I had trouble walking normally (well, my "normal") and I feared that my poor feet and other joints were about to erupt into a full-blown flare-up. My fears were correct, sadly. I was in a lot of pain--and out of pain medication.
It was near the end of the week that my sister was visiting that I realized I was going to run out and that I needed a new prescription ASAP. My feet were growing steadily more inflamed and painful and I didn't know how I was going to survive the final weekend of sight-seeing and walking miles in Manhattan without adequate pain relief.
I contacted my doctor and her assistant that Thursday afternoon, I think, but I was soon anxious to learn that my doctor was out of the office that Friday. I couldn't get a refill until Monday at the earliest--if she approved it. Oh no! I was stuck over the weekend unless I wanted pay a lot of money to go to urgent care or the E.R. But getting Vicodin at either urgent care or in the E.R. would then mess up me getting my next 30-day refill because of the strict regulations. So I pushed through without it, stopping frequently to take breaks, holding back the tears forming in my eyes from the pain and exhaustion.
Finally it was Monday and I got an e-mail from my doctor's assistant confirming that I could come in and pick up the prescription at the clinic. Yes! However, my celebrating was cut short when I realized that I would have to travel at least an hour from Brooklyn to the Upper East Side of Manhattan to get there--taking two trains, plus a lot of walking, all on one of the most oppressively hot and humid days I've ever experienced. I was angry and stressed-out already, remembering how much easier it used to be to get a refill. And now I had to cause myself extra stress and discomfort just to pick up the prescription in person. Sure, I could have the prescription mailed to my apartment, but I needed it right away. I didn't have time to wait for it to arrive three days later with the chance of something going wrong with the mail and not receiving it at all. What a PAIN!
So I left my apartment and limped down into the sauna-like subway that instantly made my shirt and hair wet with sweat and my lungs feel like I was submerged under water. I felt sick and dizzy and my ankles were throbbing uncontrollably from stabbing pain. I had only been waiting on the subway platform for about five minutes; this was going to be a long, miserable trip.
Luckily I was able to sit down for the entire ride from Brooklyn to Manhattan on the F train, but then I had to transfer to a busier, packed express train to get to the clinic. Please let there be a free seat, I silently prayed as I stepped onto the next train. Nope, nothing. Something was also wrong with the AC on this particular train. Sweat was literally dripping off people as they stood smashed together, clinging to poles and handles. Even though my right ankle was tightly wrapped in a conspicuously light-colored Ace bandage, nobody noticed my "disability" or offered me a seat. I wasn't surprised by this so I just tried to suffer through the ride as best as possible. I need my pain medication!
After that journey from hell was finished and I hobbled into the main entrance of the Hospital for Special Surgery where my doctor is located, I felt a rush of delicious cool air hit me and much relief. I was so sweaty and exhausted by this point, before I even took the elevators up to the clinic to get that treasured piece of paper. Please let it be there, please let it be there...I chanted in my head.
It was there. Whew. I thanked my doctor's assistant and my doctor herself, who I happened to run into. I then grabbed the script and tucked it safely into my purse before trudging back into the sickening heat and sweat of a NYC day in July. Now I had to find the closest pharmacy to get this thing filled before making the arduous trip back to Brooklyn. Luckily there was a pharmacy only a couple blocks from the hospital, so I slowly made my way there--still sweating, still in pain. You can do it, I kept telling myself. This is almost over. Well, until next month.
I walked through the door of Duane Reade (Walgreen's affiliated) and limped back to the pharmacy department, where of course there was a long line of people waiting to get their prescriptions filled. I was so close, yet so faraway! Finally it was my turn, after I spent what felt like an eternity of shifting my weight from one bad foot to the other. As I handed over the prescription and my I.D. I was met with some very bad news.
"Your insurance isn't going to cover this," explained the pharmacist. "It's not written for the generic form of the drug."
My stomach instantly churned. What was she talking about? I was sure that my rheumatologist had written it just as she had last time. And, I found out later, that she had written the prescription exactly as she had the previous month, so I wasn't sure what the problem was now. Was it the pharmacy being difficult? Or my insurance? Whatever the case, the pharmacist firmly told me to go back to my doctor to get a new prescription. I left livid and on the verge of tears.
I folded the piece of paper and stuffed it back into my purse and headed back the way I had come, because there was nothing else I could do. The pharmacist couldn't even speak with my doctor over the phone to get a new verbal prescription. I had to go in person, despite the fact that by this time I felt like collapsing.
After more painful, unnecessary steps walking back to the hospital, and more agonizing waiting, then more walking back to the pharmacy--I finally got my Vicodin. Then I dramatically swallowed the whole bottle. No, just kidding. But I did do something else that I'm not proud of while I was waiting for that one little prescription to get filled. I sat there and cried. I couldn't help it.
Tears rolled down my face as I thought about how unfair all of this was. As a chronic pain sufferer and patient of 18 years, I shouldn't have to go through this ordeal just to get pain relief. Nobody should. I really wish the bureaucrats and lawmakers and those who vote for these types of health regulations could spend one day in my shoes. No, in my feet, and feel that the pain is real and that the need for good access to pain medication is real, too.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?