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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.”

WHAT?! 

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Lynnae Clark
    4 years ago

    thank you lisa leena.. i agree with you 100% I have been on pain meds for about 24 years.. started out with 3 gone bad back surgeries.. not healing right due to my diabetes an ect. I am in level 4 now with my RA. i wouldnt be able to move with out my pain meds. Not everyone gets addicted to there pain meds. I do agree some foods may help out.. but then others may be alergic to seveal foods too. For others who suffer wtih RA an other conditions an you dont get pain relief from your dr. then find a new dr.!! No one should ever have to suffer from so much pain..

  • Lynnae Clark
    4 years ago

    I wil agree its a pain in the buns to get your meds refilled on time.. I am lucky to have a dr. who is willing to mail my script to my pharmacy for me.. to save me a trip to the dr. office each month.. I wish we could do three months at a time.. that would save so much time.. but if there is a fear of people not taking there meds like there prescribed then they should call the patients in an bring there meds with.. so you can prove you dont take them more than prescribed.. its kinda sad that we have to prove we are ok with our meds. but atleast it would weed out from those who are abusing them too…

  • Nancy McHugh
    4 years ago

    Sorry, I can’t agree with the poster or the comments to the post. 80% of persons addicted to pain meds started out with a dr prescribed medication. Drs created the epidemic of opiate addicts and now the government has instructed them to cut back. My rheumatologist always wants to give hydrocodone (an opiate) for my pain. I politely decline – nutrition is key as well as vitamins. I have discovered Niacin (non flush) 1000 mg a day. Found super interesting info on a website doctoryourself.com. I have stopped taking Humira 6 weeks ago because I feel so good. My rheumatologist is going to be mad when I tell her-I am sitting in her office right now waiting for my appt. But drs are not taught anything in medical school about vitamin therapy or nutrition – Big Pharma has a say in that I believe. As for the commenter who posted that she went into withdrawal because she couldn’t get a refill on her pain meds,sorry to say you are now addicted to opiates. Opiates change the brain’s chemistry and when you didn’t get your meds, your neurotransmitters – for dopamine – went nuts.

  • Lisaleena1
    4 years ago

    That’s great that you think vitamins work for you!
    I find it interesting that you don’t trust big phrama, but you trust their statistics?
    Even if that were true to fact(which I don’t think 80%) is accurate, there are plenty of people that need these drugs to function.
    I will agree to one of your points(however the snotty way you said it I didn’t care for) yes she is addicted.
    Here’s the problem with that and your attitude about it.
    Addiction to these drugs are physiological and psychological and yes there can be one without the other.
    Example being if you are on these drugs for long periods of time there is no doubt your body becomes addicted to it and if you stop you will go through withdrawals. There are also issue with drawling from non opiate drugs.
    The problem is when you are pyscholigically addicted, and start taking it for the wrong reasons or take more than is prescribed and it becomes a problem in your life affecting work, relationships ect..
    And while yes there are people who form unhealthy addictions from taking it for legit reasons, it does not mean everyone will.
    And also does not mean we should make it hard for the large population of chronic pain sufferers.
    Maybe you should try looking into understanding of the whole situation instead of comment on the parts you feel superior about!

  • Anita
    4 years ago

    Ouch. I totally understand. It’s so dumb to make people who are in so much pain have to physically go to get a prescription. If the pain is making your mobility an even bigger problem, how are you supposed to manage? I regularly curse all the “recreational” drug users who have ruined things for the rest of us with legitimate needs. Those people should spend a day in our pain-filled bodies to make them realize the negative impact their actions have on others.

  • Cfitzy2012
    4 years ago

    I was diagnosed with RA a few months ago. Despite repeatedly asking for pain meds for the few days a week I need it, my doctors REFUSE. To give me anything for pain. This causes me to have to go to the emergency department whenever I can’t bear the pain.

  • Lynnae Clark
    4 years ago

    look for a new dr. that is willing to listen to you an the pain your in… please keep looking… you should not have to deal with so much pain that you cant even do your normal life activities. im lucky to have a dr. who does understand… i have needed level 2 an 3 drugs for my pain..

  • mamarama
    4 years ago

    Can you see a pain specialist? My RA doc and GP prefer me to see a pain specialist because they believe that doctor will be better educated about what is right for ME as an individual. My older sister has RA and we have only one drug in common – everyone is different.

  • RA SISTER
    4 years ago

    Been there! It is such a struggle to get meds sometimes. My brother passed away last month and I had to rush out of town. Well, my meds ran out while I was gone… Nothing I could do, so I had to go through withdrawal while attending his funeral. Really bad experience. 🙁 Something has to change.

  • janlorraine
    4 years ago

    My understanding is that the new law allows physicians to write a 90 supply, but it seems that many doctors are confused about this aspect of the law and think that they are restricted to 30 days. I have also read that recently a new ruling allowing electronic prescribing of controlled substances has gone into effect: http://www.medscape.com/viewarticle/850268
    Our physicians just need to learn the rules so that our lives can be made easier. Correct me if I am wrong.
    Jan

  • mamarama
    4 years ago

    Or were you referring to this: “Issuance of Multiple Prescriptions for Schedule II Substances

    DEA has revised its regulations regarding the issuance of multiple prescriptions for schedule II controlled substances. Under the new regulation, which became effective December 19, 2007, an individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a schedule II controlled substance provided the following conditions are met:

    Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice.
    The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription.
    The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse.
    The issuance of multiple prescriptions is permissible under applicable state laws.
    The individual practitioner complies fully with all other applicable requirements under the Controlled Substances Act and Code of Federal Regulations, as well as any additional requirements under state law.
    It should be noted that the implementation of this change in the regulation should not be construed as encouraging individual practitioners to issue multiple prescriptions or to see their patients only once every 90 days when prescribing schedule II controlled substances. Rather, individual practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so.”

    I’ll ask my pain doc about this when I see him next month but I do know that for now, we are still experimenting with dosages. The rules are long, wordy and not always clear but I suspect my doc has a clear understanding of them as well as what his group recommends their doctors do. I do not know what rules my state or insurer have regarding Schedule II drugs but I suspect if they have any, they are tight.

  • mamarama
    4 years ago

    Just looked it up: Schedule II Substances

    Schedule II controlled substances require a written prescription which must be signed by the practitioner. There is no federal time limit within which a Schedule II prescription must be filled after being signed by the practitioner.

    While some states and many insurance carriers limit the quantity of controlled substance dispensed to a 30-day supply, there are no specific federal limits to quantities of drugs dispensed via a prescription.

    So, a doctor could write a scrip stating that the patient needs 3 pills a day (when in fact only one per day is actually prescribed) so the patient can go 3 months. But I suspect a doctor could get into trouble for doing this. Also, scrips for Sched II drugs cannot have refills on them.

  • mamarama
    4 years ago

    I see a pain doctor as my RA doc and my GP both agree a pain specialist is best. I believe him when he says he cannot prescribe more than a 30 Rx of the Fentanyl patches I am on. I drug test at each 30 day visit and pick up a hard copy scrip. I CAN get a 90 day supply of Mobic (I can no longer take OTC NSAIDs) but they are limited to 30 days for Schedule II meds. I used to take Hydrocodone and the rule was the same. 30 days and a hard copy scrip necessary.

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