Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
So, in my state at least, some insurance pharmacies and pharmacies now have new policies restricting the amount of certain painkillers - specifically, opiods - that you can get at one time.
Do some math with me here. I got a scrip on March 30 for Tramadol for pain (some of which is not actually related to RA). I had some reservations about it, but my rheumatologist said she felt it was warranted. The scrip was for 30 tablets. The instructions were to take 1-2 tablets up to three times a day, as needed. I had one refill. That first prescription was filled without any problem.
Now: that's a maximum of six pills a day. Thirty tablets in the bottle. Which means, in a truly intense situation, a person following their doctor's orders could take that many pills in five days.
I found it helpful in extreme situations: when the non-RA hip problem, an RA flare, and intesne physical work on the farm happened to line up. But I didn't need it very often.
I did not go for a refill until September 30. That is six months. That is a few more than 180 days. If it HAD been 180 days, that means it took me 36 times longer to use those thirty tablets than it could have - according to my doctor's instructions. It means I averaged one pill every six days before I went for the refill.
So I get to the pharmacy, and I am told - LOUDLY - that if I 'want' to get that drug, I have to have a counseling session with the pharmacist. And the most they will give me at one time is seven tablets. If I were to go back for the rest of the prescription, I would need another counselling session. It is now on my record at the pharmacy that I've been flagged for requesting opioids, as if I just wandered in off the street demanding them.
Now, please understand me: I understand the severity of the opioid epidemic. It has touched my extended family, my former students, and my friends. I understand that addicts can look like me, an overweight graying grandmother. I get it. I understand that there are doctors who will overprescribe, and that there are patients who game the system and visit multiple doctors hoping to get larger amounts of a drug.
But you know what the 'counselling' session was? A bored intern, twenty years old (I asked) reading a three page script off a clipboard. He did not pronounce all the big words correctly. He did not ask me a single question to see if I understood. He did not know if I was asleep or playing games on my phone or raptly listening as he spoke. When he finished, he walked out of the room. Period. No eye contact.
Part of the 'helpful advice' in the 'counselling' session was "Try distracting yourself with a favorite TV show! You might not need those pills after all!" I suppose there were exclamation points in the written script, because something that inane, I've found, is inevitably overly cheerful. The kid read it in a monotone, without punctuation of any kind, so I can't be sure.
It frosts my cookies on two levels here: one, the assumption that I was simply interested in getting high and I was unaware of the risks of opioids. (And I do understand that my indignation is a sign of white middle class privilege, but, indignant nonetheless.)
Two, if there's an issue here, shouldn't my doctor be the one getting the feedback? I'm trying to follow instructions. I'm trying to manage my disease. I have a doctor I respect and trust. I asked her for her medical advice, and I tried to folllow it. If thre's really a problem here, is it my judgment that ought to be questioned?
Three, if I was someone who really did have a problem, that silly little charade wouldn't have done a damn bit of good.
So, I left with seven pills. I may not even take them. I thought about just saying the hell with it and walking out, but I was genuinely curious about what this 'counselling' session was going to be like. I'm pissed on my behalf, on behalf of my POC friends who probably have worse assumptions made about them regularly. I'm pissed on behalf of my doctor, whose years of medical training have been disrespected by insurance agents. I'm pissed on behalf of people who may truly be on the brink of a dangerous addition and need help, because that approach sure as hell won't do any good.
Rant over. You may resume normal programming.
I had to go to a pain management doctor for a pain script for 'emergency' type situations per my out of state Rheumy. I was treated like an addict and this pain management doctor declared that I had been misdiagnosed by published Rheumatologists and it was all in my head. I walked out. It was a hospital owned practice, so now I am banned for life from pain meds, most likely.
I guess we are all just going to end up on Pot. Is that their plan? Seriously? I never even though that was a consideration, but as the disease progresses, is that my future? I hope not.
Nothing ticks me off more than some insurance idiot or pharmacy tech pretending to know more about the medicines I take than I do.
The research on it actually looks very promising. As a farmer, I've been interested in the production aspects of it too, but it's not something I'd do here, because I don't want the security risk.
I never thought of myself as a Libertarian and in fact disagree with them on several key points, but I do think the government and big business (insurance) ought to get out of medicine, specifically, in the sense that they're dictating treatment. I can accept government testing of new meds (remember thalidomide?). And I can understand that some doctors prescribe unnecessary tests because they have a financial interest in the testing companies. But good grief. Our system is so, so broken.
I take Nycunta, a sustained release tramadol. It is a synthetic opioid, not sure if you can even get high on it. I also take morphine, prn. Which is not much, lately!
My doctor is willing to give me scripts for both. But insurance demands that I cannot refill until the DAY the other prescription runs out. This is quite a hassle. That means, I need to go in, the day it can be filled. So, big trouble if I go out of town on that day or a few days before.
I also did the same thing with not using the morphine prescription. My doctor somehow gave me a prescription for 3 a day for 30 days. They gave me 100! It took me 7 months, during a med failure to use them up. But, next prescription, there I was, not getting them for 30 days, and only on the day after the last one expired. So, now I hoard. But, Nucynta is SR, and you need to take it twice daily for it to work. So, no hoarding possible.
If I was in a huge amount of pain, I don't know what I would do. It was different when my RA meds worked. Plus, now I have terrible damage from tendon flares. Some days, I need that morphine, just to get through the day. And then, a trip to the chiropractor or physiotherapist, and I don't take it for weeks. Or sometimes not, they make things worse!
I can't believe that a pain management doc would say you and your rheumatologist, are making up your RA! Seriously? That guy needs to lose his license! Because us gray haired, overweight grandma's are all drug seekers! That boils my blood.
My advice to everybody is that when you find a place in your treatment where you might want to slack a little, put something in a bottle for times down the road. Understand what I'm saying?
I've read a lot of articles about the "true" expiration of drugs, vs. the expiration date. I've been lucky and not needed some prescribed meds. I have to add that I have not tried to renew those prescriptions. However, don't throw away anything that may happen to accumuate, that might have helped you in the past. You know what I mean? Of course you do.
Things have become much stranger since was a needer, but have a surgery. They'll fix you up good! JK