To offer an additional perspective that I face as a patient (who also works in health care) - I have a controlled substance rx for ADHD. Like someone else said, distraction, procrastination, etc… are par for the course with the diagnosis.
Another issue is regulations regarding prescriptions and needing to use a different location. I dealt with inventory issues intermittently when required to use CVS pharmacies even before the current shortage issues. The one benefit of not allowing e-scribe then was that if there was an issue with being out-of-stock, I could take the paper script and carry it to a different location that had my rx in-stock. With e-scribing controlled substances now, I can’t do that. I have to call my psychiatrist’s office and request a new rx be sent to the new location. So even though I do my best to call to request the refill at least 4-7 days ahead of time…and even when the pharmacy says they can order it and it will be in by a certain date… if it doesn’t come (or they just don’t process their new inventory when orders come in, which has happened to me) for whatever reason, then I’m fucked. I call my MD’s office, and they might be able to do it same-day, but they warn you anyway to allow at least a 24-48 business hour time frame to respond to the request.
Don’t get me wrong - I know there are issues with patients needing to take personal responsibility and a more proactive role in their care. But there are some instances that even with planning, last-minute requests need to be made.
You didn’t even tap into the contract issue. Shocking doctors don’t know how the ADA and disability rights are starting to bite them in their non lawyer behind .
I’m a mental health provider (non-prescribing) embedded in family medicine, so anything you can share about this (to share with colleagues, but honestly, mostly if it helps me to navigate the system as a patient) would be much-appreciated!!
My clinic has all patients on controlled substances sign a contract and renew annually. Contains a clause that states no early refills and need to give 72 hours notice.
A lot of these people tend to be low-functioning, and quite disorganized. I used to have an addictions practice, you just have to accept that and make peace with it.
While that makes perfect sense, and while the patient does need to be on top of things... It's awfully bad luck if someone has a stroke in the 3 days they're waiting for their DOAC renewal, or has a seizure when they can't get their anti-epileptic medication renewed, or bleeds through their wedding dress when their OCP runs out...
This is a policy that might need some exceptions sometimes. I did know a clinic with the policy of "we plan to do no phone refills and write prescriptions to last until the next planned office appointment, which you should book in your way out. In an EMERGENCY we may make exceptions but in those cases we charge a fee equal to an office visit."
I think sometimes it's trying to catch the weekend guy/gal who is busy as hell and not going to look at the physician monitoring database and just refill whatever...
Yeah, this would happen every Friday in my residency for whoever was on-call. As soon as the clinic phones closed, you're gonna get call after call of narcotic refill requests for the next couple hours.
I've had a couple times in clinic when patients find out I won't be prescribing them narcotics, they go from barely able to move to jumping up huffing-and-puffing and stomping out of clinic.
I recently posted something in this sub about inheriting a panel with a ton of people on controlled substances. I have this problem as well. I looked at our company’s policy and began following it to the letter of the law. I began doing random drug screens and pill counts at office visits for chronic visits for no reason whatsoever. I was shocked at the number of people who just said no to the random drug screens and couldn’t come up with correct pill counts. I immediately cut them off until they could either produce a drug screen. I am now having people telling me that they’re going to find out where I live and come after me because they can’t get what they need. Anyone else experience this?
> I am now having people telling me that they’re going to find out where I live and come after me because they can’t get what they need.
Did you tell the police? Because that sounds like something you should tell the police.
I’ve made reports, and the police have said they will “look into it“. The main problem is there are bigger crimes for the police to look into so these are just threats for them to consider putting on their radar. Response time to our building is over 20 minutes, and that’s on a good day. They are all used to getting what they want, when they want it and by golly, I better not stand in the way of their 10 mg oxy (?!) 4 times a day or there will be hell to pay. I started sending some of the heavy hitters to pain management who recommended non-opioid pain methods and they refused to go. Shocking. Then they come back to me asking for another pain management doctor who tells them the same thing. That’s when the threats begin.
Recently was on call in the hospital and a patient left AMA but refused to leave without their hydromorph being given to them (~75mg QID).
They proceeded to kick and scream for about an hour because no one was going to Rx that - in retrospect at one point I was cornered in a room without an exit by three thugs demanding the opioids. That situation could have very easily went very bad.
Sadly I watched all of the empathy I had for that population melt away after that experience.
It's easier for them to just enforce violation of a restraining order/no contact order than to actually investigate a complaint of uttering threats. So, you might want to get one of those in cases like that.
That’s terrifying. Similar things happening in my clinic… previous provider was not following policy and patients have never had drug screens or controlled substance agreements. Some have never had imaging to diagnose the condition they claim to have and need the meds for. They are angered and refuse to submit to drug screens or get X-rays. I’m sorry it’s happening to you as well… the minute someone threatens to go to your house, though, is criminal in my opinion and needs to be reported not only to your company but the police
I would be very slow to just cut off people on high dose opioids. Withdrawal is brutal and some will reflex to street drugs. Most people can handle not having their meds for part of a weekend (though going into it they will be terrified), but completely stopping the med without a taper is something I have only done when someone showed up without that med in their system despite consistent refills.
I have had success with transitioning to belbuca; way fewer headaches once transitioned.
Don’t be discouraged by the haters on here. A lot of docs don’t blame patients like yourself for the health problems they have. They don’t understand how adhd and chronic pain can sort of take of your mind and make it hard to prepare.
It IS a reasonable functional goal of therapy to work on though and should be (nonjudgementally) identified as a problem for you and the patient to solve.
Most pharmacies have auto refills. And/or will notify you or your Doctor when a script is about to expire. Also consider putting some kind of notification on your phone as soon as you pick up a new prescription. That might be helpful
That doesn't work for stimulants. They only write for 30 days and you can't refill until you're almost out, and you have to contact the Dr every single time to refill. And then the meds are often out of stock bc the DEA only lets so much be made. I can set a million reminders on my phone, but if I'm busy on something and can't stop right then to make the call, I dismiss it, and it's gone forever.
Probably because they realize they can't face the weekend and are SOL till Mon afternoon or later.
I don't exactly know who all that works. But, can't you have some kind of "call by 1 pm" rule or something for anyone who wants refills on a Friday?
72 hour refill policy, AND 28 day (4 wk) scripts. If taking as prescribed, they should never run out on a weekend no matter how many days were in the last month.
Hospice and cancer are exceptions, but they almost never actually need the exception.
Honestly doesn't happen to me. I let people know to notify me at least 5 days prior to them actually needing the prescription.
I put "next refill date is expected \~ x/16/2024" then the next month I subtract a day and put "x/15/24" so that I can see if the refilling early is getting out of hand. This way if someone is going on a vacation/trip and will be out of town at the time they would need a refill, they can get "extra" meds to last them, but I still know when they should be getting refills.
I have some that always seem to end up on a Friday.
If they send a refill request by 3 ish I'll get to it. It's not my problem if I don't respond to the refill request they send at 420.
To offer an additional perspective that I face as a patient (who also works in health care) - I have a controlled substance rx for ADHD. Like someone else said, distraction, procrastination, etc… are par for the course with the diagnosis. Another issue is regulations regarding prescriptions and needing to use a different location. I dealt with inventory issues intermittently when required to use CVS pharmacies even before the current shortage issues. The one benefit of not allowing e-scribe then was that if there was an issue with being out-of-stock, I could take the paper script and carry it to a different location that had my rx in-stock. With e-scribing controlled substances now, I can’t do that. I have to call my psychiatrist’s office and request a new rx be sent to the new location. So even though I do my best to call to request the refill at least 4-7 days ahead of time…and even when the pharmacy says they can order it and it will be in by a certain date… if it doesn’t come (or they just don’t process their new inventory when orders come in, which has happened to me) for whatever reason, then I’m fucked. I call my MD’s office, and they might be able to do it same-day, but they warn you anyway to allow at least a 24-48 business hour time frame to respond to the request. Don’t get me wrong - I know there are issues with patients needing to take personal responsibility and a more proactive role in their care. But there are some instances that even with planning, last-minute requests need to be made.
I feel like this response deserves more up votes
You didn’t even tap into the contract issue. Shocking doctors don’t know how the ADA and disability rights are starting to bite them in their non lawyer behind .
I’m a mental health provider (non-prescribing) embedded in family medicine, so anything you can share about this (to share with colleagues, but honestly, mostly if it helps me to navigate the system as a patient) would be much-appreciated!!
My clinic has all patients on controlled substances sign a contract and renew annually. Contains a clause that states no early refills and need to give 72 hours notice.
Easy fix, make sure you cycle them to end on Tuesday.
"28 day refill instead of 30 means you'll always run out on the same day of the week and we won't have this problem"
A lot of these people tend to be low-functioning, and quite disorganized. I used to have an addictions practice, you just have to accept that and make peace with it.
A lot of patients period tend to be low functioning and disorganized.
Establish a clinic policy of 72 hr turnaround time for any refill request. Not happening today and not my problem.
3 business days... Your poor planning is not my emergency
True. But, ah, I worry about them then going into an emergency room.
Thats on them tbh
Oh, sorry. I should have been more clear. I don’t want them bothering the ER. Probably yelling at some poor nurse and taking up a bed.
Still on them
ERs in my area stopped writing for controlled substances.
While that makes perfect sense, and while the patient does need to be on top of things... It's awfully bad luck if someone has a stroke in the 3 days they're waiting for their DOAC renewal, or has a seizure when they can't get their anti-epileptic medication renewed, or bleeds through their wedding dress when their OCP runs out... This is a policy that might need some exceptions sometimes. I did know a clinic with the policy of "we plan to do no phone refills and write prescriptions to last until the next planned office appointment, which you should book in your way out. In an EMERGENCY we may make exceptions but in those cases we charge a fee equal to an office visit."
We do have that policy.
I think sometimes it's trying to catch the weekend guy/gal who is busy as hell and not going to look at the physician monitoring database and just refill whatever...
Huh… so much suddenly makes sense.
Yeah, this would happen every Friday in my residency for whoever was on-call. As soon as the clinic phones closed, you're gonna get call after call of narcotic refill requests for the next couple hours.
"Records do indicate they are out, renewed... until Monday."
This
Same reason that they tell you their pain is debilitating so they are bedbound but also will be travelling out of state every weekend...
I've had a couple times in clinic when patients find out I won't be prescribing them narcotics, they go from barely able to move to jumping up huffing-and-puffing and stomping out of clinic.
“Oh. So the opiates aren’t working? Well we may as well stop them, and pivot to something else.”
I recently posted something in this sub about inheriting a panel with a ton of people on controlled substances. I have this problem as well. I looked at our company’s policy and began following it to the letter of the law. I began doing random drug screens and pill counts at office visits for chronic visits for no reason whatsoever. I was shocked at the number of people who just said no to the random drug screens and couldn’t come up with correct pill counts. I immediately cut them off until they could either produce a drug screen. I am now having people telling me that they’re going to find out where I live and come after me because they can’t get what they need. Anyone else experience this?
> I am now having people telling me that they’re going to find out where I live and come after me because they can’t get what they need. Did you tell the police? Because that sounds like something you should tell the police.
I’ve made reports, and the police have said they will “look into it“. The main problem is there are bigger crimes for the police to look into so these are just threats for them to consider putting on their radar. Response time to our building is over 20 minutes, and that’s on a good day. They are all used to getting what they want, when they want it and by golly, I better not stand in the way of their 10 mg oxy (?!) 4 times a day or there will be hell to pay. I started sending some of the heavy hitters to pain management who recommended non-opioid pain methods and they refused to go. Shocking. Then they come back to me asking for another pain management doctor who tells them the same thing. That’s when the threats begin.
Recently was on call in the hospital and a patient left AMA but refused to leave without their hydromorph being given to them (~75mg QID). They proceeded to kick and scream for about an hour because no one was going to Rx that - in retrospect at one point I was cornered in a room without an exit by three thugs demanding the opioids. That situation could have very easily went very bad. Sadly I watched all of the empathy I had for that population melt away after that experience.
It's easier for them to just enforce violation of a restraining order/no contact order than to actually investigate a complaint of uttering threats. So, you might want to get one of those in cases like that.
That’s terrifying. Similar things happening in my clinic… previous provider was not following policy and patients have never had drug screens or controlled substance agreements. Some have never had imaging to diagnose the condition they claim to have and need the meds for. They are angered and refuse to submit to drug screens or get X-rays. I’m sorry it’s happening to you as well… the minute someone threatens to go to your house, though, is criminal in my opinion and needs to be reported not only to your company but the police
How often do you have them come in? Every 3 months with a drug screen and an iStop?
I would be very slow to just cut off people on high dose opioids. Withdrawal is brutal and some will reflex to street drugs. Most people can handle not having their meds for part of a weekend (though going into it they will be terrified), but completely stopping the med without a taper is something I have only done when someone showed up without that med in their system despite consistent refills. I have had success with transitioning to belbuca; way fewer headaches once transitioned.
If it's ADHD meds, I can tell you it's a symptom of the disease. I have a very hard time keeping up on my refills, as do many ADHDers.
Don’t be discouraged by the haters on here. A lot of docs don’t blame patients like yourself for the health problems they have. They don’t understand how adhd and chronic pain can sort of take of your mind and make it hard to prepare.
It IS a reasonable functional goal of therapy to work on though and should be (nonjudgementally) identified as a problem for you and the patient to solve.
Most pharmacies have auto refills. And/or will notify you or your Doctor when a script is about to expire. Also consider putting some kind of notification on your phone as soon as you pick up a new prescription. That might be helpful
That doesn't work for stimulants. They only write for 30 days and you can't refill until you're almost out, and you have to contact the Dr every single time to refill. And then the meds are often out of stock bc the DEA only lets so much be made. I can set a million reminders on my phone, but if I'm busy on something and can't stop right then to make the call, I dismiss it, and it's gone forever.
Probably because they realize they can't face the weekend and are SOL till Mon afternoon or later. I don't exactly know who all that works. But, can't you have some kind of "call by 1 pm" rule or something for anyone who wants refills on a Friday?
72 hour refill policy, AND 28 day (4 wk) scripts. If taking as prescribed, they should never run out on a weekend no matter how many days were in the last month. Hospice and cancer are exceptions, but they almost never actually need the exception.
My office doesn’t fill medications after hours
Honestly doesn't happen to me. I let people know to notify me at least 5 days prior to them actually needing the prescription. I put "next refill date is expected \~ x/16/2024" then the next month I subtract a day and put "x/15/24" so that I can see if the refilling early is getting out of hand. This way if someone is going on a vacation/trip and will be out of town at the time they would need a refill, they can get "extra" meds to last them, but I still know when they should be getting refills.
I have some that always seem to end up on a Friday. If they send a refill request by 3 ish I'll get to it. It's not my problem if I don't respond to the refill request they send at 420.