Wednesday, April 24, 2013

Tennessee's pain medication laws are insane!

Following a recurrence of problems with the disabling injury I suffered some years ago, I've been in and out of doctor's offices and hospital facilities over the past few days.  In the process, I've run headlong into what are undoubtedly the most iniquitous pain medication laws and regulations I've ever encountered.  It seems that in the state of Tennessee, if you ask for medication to control serious pain, you're immediately regarded as a potential drug abuser.  It's the most heavy-handed, distrustful, in-your-face 'Big Brother' approach I've ever seen, and it's infuriating!

The first sign of trouble came when my physician flatly refused to even consider prescribing any painkiller stronger than 'Ranger candy'.  He wouldn't go into detail, just said that if I wanted the good stuff, I'd have to see a pain management specialist.  This annoyed me, because back in Louisiana (where I suffered my injury) pain medication was a matter of a quick prescription from any doctor for whatever they considered appropriate.  In fact, I'd once had to ask for a reduction in the strength of my pain medication, as it was so potent it was making me come over all Biblical!  At one point I had a monthly prescription for Ultracet, plus a bottle of 100 Percocet prescribed on an annual basis "for when the Ultracet isn't strong enough".  I never abused the latter - in fact, I usually ended the year with 50 or 60 tablets remaining!  That didn't faze the doctor concerned, who would happily write out another prescription for the coming year.  He knew me, after all, and knew I wasn't abusing them or letting others have them.  There was a relationship of trust between us.

I had another inkling that things were different in Tennessee when I received a fat packet of documentation in the mail, all of which I had to fill in and sign ad nauseam.  Turns out that the physician's office, under Tennessee law, can (and must) call me at irregular intervals and require me to show up at their office (or the nearest pharmacy) within 24 hours, complete with my pill bottle, so that the remaining pills can be counted.  It's apparently an offense to hold back some of the pills if you haven't used them all.  I can be summoned for a urine test at random, and may have to provide one during my 'pill count' too - in fact, I had to provide a urine sample before they'd even see me today!  Furthermore, there were all sorts of dire warnings that my personal information would be shared with the authorities for investigative purposes, and I had to sign a waiver permitting my prescription and other information to be released to them.  Finally, they wouldn't give me a prescription for a few months' supply at a time, or a renewable prescription.  No, I got only 30 days worth, plus two more appointments at 30-day intervals (for which I have to come up with a co-payment every time, thank you very much!).  "After that, we'll see."  The fact that my injury has been well-documented since 2004, with abundant prescriptions for pain medication from pain management specialists in another state, apparently counted for nothing at all.

I was so angry at this invasive, overly officious, bureaucratic intrusion into my privacy that I protested vigorously to the nurses at the office.  They apologized, but said that the abuse of prescription drugs was a big problem in Tennessee.  This is how the legislature had chosen to address the issue.  The state was deliberately trying to make it as difficult as possible to get pain medication in order to combat the abuse.  The fact that this means treating legitimate patients as criminals-in-waiting clearly doesn't bother the authorities at all.  They've done the same for anti-allergy medications containing pseudoephedrine, which can be abused as a precursor chemical for the manufacture of methamphetamines.  One has to jump through hoops to get those as well.  (They're still available without a prescription, but some politicians are making noises about changing that, too!)

What happened to the presumption of innocence until guilt is proven?  It looks like Tennessee's controlled substances laws and regulations assume you're intending to abuse prescription drugs unless and until you can prove you're not - and even then, the powers that be will look upon you with dire suspicion!  It's no wonder my physician didn't want anything to do with prescribing pain medication.  If I found the process burdensome and irritating as a patient, what must it be like for medical practitioners to deal with all the administrative overhead and bureaucratic obfuscation involved?  It must be mind-bogglingly frustrating!

What about your states, readers?  How many of you have to put up with this sort of 'Big Brother' intrusiveness when you need pain or allergy medication?  I'd be interested to see how widespread this is.  Certainly, Louisiana was a libertarian nirvana by comparison!  Furthermore, are there any groups fighting this sort of nonsense?  I'm more than willing to contribute to their cause now!  Meanwhile, I'm going to look into ways and means to obtain the medication I need without jumping through all these hoops.  I'm no criminal:  but if Tennessee wants to pass stupid laws, the state needn't be surprised if people decide that obeying them is equally stupid!



The Great and Powerful Oz said...

I think I saw an article a while back on how to convert readily available methamphetamine into pseudoephedrin for allergy sufferers in states that ban the sale.

Carteach said...

Not having to deal with such stupidity in PA just yet, but it would not surprise me to see it coming.

I still have the same bottle of pain killers the doc prescribed for me years ago when I took a shot at cutting off my finger tip. I asked him a while back if it was okay to keep on keeping them... as it were... as just-in-case meds. I still have almost all. He pointed out they were worth $20 a pill on the street, and told me to keep them in a safe place.

Anonymous said...

I live in Michigan. I'm a 64-year-old Navy retiree with pancreatic cancer, and my primary care doc is a (shirttail) relative.
I can't get a renewable prescription for hydrocodone, which I've been taking since December to manage my pain. I have to get a renewal every month, and I must hie me to the office to pick up the paper in person - no phone-ins for narcotics!
I wish it were that difficult for abusers to score prescription meds, but unfortunately, it ain't!

Erik said...

I'm in Sweden, not the US, but I've never heard of it being a problem here. If the doctor prescribes it, you get it. The only problem could be getting the doctor to prescribe it in the first place.

No checks on whether you use it or not, just stern remarks that "when you dont need it anymore, turn in the rest. Don't just flush it, turn it in so we can dispose it safely".

Same with allergy medication, if you need it. I once asked a doctor if it was possible to get stronger stuff if it would turn out to be a bad year, and he said something like "the prescription stuff isn't stronger, just different. Try the off the counter stuff first, and if it doesn't help come back and we'll get you something else"

Dad29 said...

Yes, indeed, it's going national.

ObozoCare is the vehicle. When the political winds shift one way or the other, various medications/treatment regimes will be pushed, or pulled.

Forcing Catholics to pony up for abortions is only the first paragraph of the first chapter.

Erik said...

Thinking about it, it's possible they seem so relaxed about it here because of the healthcare system. They have my complete medical history on file, and they would know in an instant if I had any kind of history with drug use.

They might also have a few notes there that I've been known to deny painkillers if I felt I could handle the pain without it.

Someone that has a different medical history might be treated different, but I've never heard of anyone in pain being denied painkillers. And I'm pretty sure it would make the papers if it happened.

In any case, it would still be the doctors decision, the government doesn't get involved.

dave said...

Welcome to the War On Drugs.

Go look up the case of Richard Paey.

Also, this isn't just at the state level;, in the form of the DEA, is pushing it as well.

This is why the War On Drugs is such an important issue. Expect it to get worse.

Titan Mk6B said...

I live in Oklahoma and we don't have that kind of crap to weed through. Our GP can and will prescribe pain meds but my wife was referred to a pain specialist because of the complexity of her problems. They require (not the state) a urine test but only to verify that she is indeed taking the drugs.

The more I hear about the rest of the nation the happier I am that I live in OK. Very minimal state government interferance. Hell, I have more problems with my neighborhood association.

Pat St. Jean said...

I'm in Texas. I make my own beer and mead, and usually make a yeast starter in an Erlenmeyer flask, on a stir plate. In order to buy one, you need a certificate from the state police, otherwise it's a felony. They actually do a home inspection, making sure they'll be locked up when not in use. Something about meth production.

It was pretty funny seeing the look on the DPS officer's face when he saw the gun safe.

perlhaqr said...

Richard Paey, Siobhan Reynolds, Stephen Schneider. Worth googling for more background on the "War on Pain Relief".

It's good that I'm not a Christian, so I don't have to worry about being unchristian when I say things like: "I hope the assholes who passed laws like these all get stomach cancer, and then can't get any damn pain medication to help deal with it."

firedigger said...

Meds, guns, no difference. Because some people don't use them properly, we'll screw over all the good, law-abiding folks.

Anonymous said...

Will your Louisiana doc write you a scrip? It may be a pain in the ass to get it, but it might be a bigger pain not to.


Anonymous said...

Jeez, whataloadacrap.

You, a law-abiding citizen, have to jump through 48 hoops while, just down the street, the pill mill doctors sell as many as they want because... all together now...

Criminals don't care about the law !

Anonymous said...

My wife and I use to live in Ohio but moved to Texas in 2007. At that time my wife was on some major pain meds and when I tried to find a doc to get new prescriptions I found out that Texas isn't an easy place to get legal pain meds. All of the Drs, (pain specialists) wanted to do surgery. Finally found one that would perscribe but my wife had to make a trip every month to get new prescriptions, fill out a bunch of forms, etc. All scripts were three part and one copy went to the DEA I think.

Anonymous said...

AL here - not as bad as TN. Family member with chronic pain uses a pain management clinic. Still is drug tested, to make sure there are drugs in the system but no pill counting nonsense. FWIW, this individual has about 2 lbs of TI in the back, so the pain issue will never get better or go away. No pain meds = no quality of life at all. I guess we've been lucky so far. When I say I feel your pain, there is NO pun involved.

Take care & keep writing.

Mike_C said...

> what must it be like for medical practitioners

A gigantic (figurative) pain. Apart from the paperwork and general hassle, there's a background worry that someone is going to decide that you prescribe too many pain medications and therefore you're up to no good. This along with the annoyance of trying to identify narcotic abusers, as opposed to people actually with pain, makes many of us not want to deal with pain issues at all. Which is horribly unfair to patients. Compounding this there are also idiot physicians who have whacko (in my not so humble opinion) ideas about pain control, such as: "I don't want him to get addicted" as a reason to hold back adequate narcotics in a terminal, as in less than 2 months expected to live, cancer patient. Yeah, sounds like a good idea, that way little Billy's last memory of grandfather can be that of a wretched old man in agony rather than someone with a modicum of comfort who can conclude his earthly business and say goodbye to family and friends with some dignity. I don't know if it's incredibly rigid thinking, moral cowardice or plain assholishness with such MDs. Sorry, one of my pet peeves.

Dealing with the narcotic abusers can and does breed cynicism however. Walking into an ER room where the patient (who you've never seen before) is sleeping peacefully, you wake him to ask questions and get permission to examine him. "Can't talk doc, I'm in 10/10 pain and need demerol." "Okay, where is this pain? Is it new? If so, what happened to you?" "Look, I told you I'm in pain. Now couldja move, yer between me and the TV." But we're not supposed to confront such folks due to institutional fear of lawsuits, or god knows what. We'll come up with a bureaucratic "solution" instead: we'll impose onerous burdens on everyone so as to not have to deal with the actual problem makers, both on the seeker side and the MD side. Peter, very sorry you and other sufferers of chronic pain are being punished for the bad actions of a minority. It's no fun on the physician side either, but at least our pain is figurative and not literal.

Still, as with everything else, funny stuff happens. (I am stealing a colleague's story here, mea culpa.) About a decade ago (I have no idea how it works now) the VA required narcotics prescriptions to be written on special green prescription pads. Each sheet had its own serial number and the VA kept track of which pad (and thus sequence of numbers) went to which physician. One day someone walked into the physicians' break room and stole a bunch of backpacks and purses, including my colleague's bag with her magic green pad in it. So my friend gets a call a few nights later. The voice on the other end says "Doctor X? I'm pretty sure I know the answer, but you didn't happen to prescribe "A pound of mofeen" to anyone did you?

Shell said...

My sympathies, Peter. My mother-in-law is a tough old bird who's beat cancer twice. Due to ongoing health problems and scarring from radiation she sometimes *must have* the good stuff to ease - note: not take away, but just ease - her pain. Her former PCP was shit-scared to prescribe what was required. Thankfully, her new one, being an old hand who has been there and done that in a forty-plus year career, isn't. His attitude is, "Fuck 'em, my patient has to have it. *I'm* the doctor, not some bureaucrat asshole." Thankfully, here in Florida the bureaucracy isn't as draconian as in Tennessee. Yet.

On the doctor end, though, Gwad Fuhbid! (as it's said on Long Island) you should make a simple error in record-keeping. The Feds will come down on you like a hard rain. No, "Is this an error? Please correct it.", hell no. The immediate assumption is that you're running a pill mill and it's up to you to prove you're not.

BobF said...

Back after a few days out and just saw this post. My oxycodone is through the VA (service connected). I have to go in every 30 days to renew and on at least 1 of those visits (doc every 3 months and nurse in between) I do an "unannounced" urinanalysis. Doc and I thankfully have a mutual trust, but he still has to go by VA rules, which so far seem to be more interested in my medical issues than in treating me like a prospective criminal. Lucky for me my monthly drive is only 30 minutes one-way; I'm sure there are others for who it is a lot more of an issue.

But if you think about it, criminal-in-the-making identity is exactly what the gun control movement is all about, too.

Mark/GreyLocke said...

I"m in Texas as well, and I see the Doc once a month for my scrip and get a UA done a couple of times a year. Up until recently my eldest daughter could pick up my scrips at the pharmacy. Not anymore unless she has my ID. So in the morning I get to haul my sore butt to the pharmacy to get my scrip as I just took my last pill and I'm still sore from my drive to St. Louis and back.

I remember when my mom was undergoing cancer treatment, they looked at her med list and tried to accuse her of being an addict. Seriously? a 68 year old woman with ovarian cancer taking maybe 20 mg of lortab a day is an addict?

Some people need to get a life.

gary oakes said...

I would like an update on your efforts, sir. I have chronic pain due to stenonis in my back, resulting from a motorcyle accident that resulted in being hit by a car that turned in front of me and landed me in the other lane of traffic after flying over the car that hit me. Also, I fell off my roof a couple of years ago on my back. After numerous MRIs, I was told that I would never improve unless I had back surgery, which may or may not help. With no health insurance, that was not an option. In addition, I need a total knee replacement. Now, I have been told that I have to go to a pain management clinic, but no one will agree to see me as I have no heatlh insurance which is so expensive that I cannot afford it.

This seems to me to be a violation of the law and I would like to know if you have contacted your state representative or other official to address this.

Peter said...

@gary oakes: No change. I've had to go twice now, to get a month's prescription each time, and that's not likely to change. It's nothing more or less than a racket - but no-one seems willing to do anything about it.

Anton said...

I have been on a pain regiment for over 10 years now and I have seen the laws get tighter and tighter. I live the great state of Tennessee, my PCP retired in 2010 and I have been seeing my current DR. since. When I seen him in June he warned me about the new laws that will be taking effect July 1st and sure enough I went to see him on 7/24 like I have been for the last 3 years. Only this time I have to see him at a pain clinic which is now the new doctor, before I could see him I had to meet with a law enforcement official who finger printed me, took my picture, ran a background check on me, gave me a drug test and did a body scan for needle marks. Of course I had to pay for the background check and drug test, not to mention the extra 60 miles I had to drive to get to the pain clinic. I agree with you, they are treating patients like criminals, I am a combat veteran, I am the commander of my VFW and a rifleman in the Honor Guard for military services. To be in the Honor Guard we have to go through training and since we take our M-1 grand rifles home we all willingly take a psychiatric evaluation. Since I just went through all this red tape and BS I have contacted all my state representatives that like to come talk at my VFW post every election year and want all of us veterans to vote for them. I am one of many veterans that do not go to the VA since it is such a hassle and most of the time they make you go to Memphis or Nashville. If these legislators that want votes don't start changes I guess we will have to vote them out and vote in people who will help us. The only way to change this is through legislation, the same legislation that put these laws into effect can be repealed or changed. I can see if someone is on parole, probation or has been Dr. shopping or domestic violence, etc. but law abiding citizens who have never been in trouble before have to pay the price...

Mic said...

I recently moved to Tennessee. I have asthma, allergies, allergic fungal sinuous, high blood pressure, and two herniated disks which causes sciatic and back pain. I am losing the use/control of my foot, and am trying to avoid surgery. My PCP (Primary care provider) has been treating me with pain killers which does not get rid of all the pain but does keep me mobil. I am very happy with my progress and on the road to recovery. However, now that I have moved to Tennessee, I am shocked to find that NO doctor will take me on as a patient? I have been told "Because you have been prescribed pain medication you are disqualified as being a potential patient. The doctors here wont even consider it do to state registrations that came about do to the abuse increse here". I said well okay so your clinic wont can you recommend one that would take me on as a patient. Her response was "No". Then leveled with me saying it's ridiculous Hon, but the likelihood of you finding a doctor here in Tennessee that will take you on is low. You'll have to get a referral from your doctor to see a pain management clinic. Which are exploding with new business. I asked, Okay, I've seen them before but usually only for epidural like injections for long term pain relief, but they don't treat asthma, high blood pressure, or any of my other health issues. For which she said...Exactly, you will have to visit the ER to get any medical care like that. I've found it's not only people that are currently prescribed pain medication, it's for anyone who has ever been prescribed pain medication for any reason. So...I have to drive 7 hours away every other month to see my doctor in another state. The Irony in all this is that one of the reasons we moved her was for my wife's new job...She works for a pain clinic.

Anonymous said...

I moved to Tn in 2010 from Mi. I have had a lifelong battle with severe chronic migraines. Needless to say I have seen countless neurologists and many MMRIs brain scan and what not. All are normal. I was just born with the abililty to have migraines. Fortunately my Dr. in Michigan ( who had some common sense allowed me a great pain regimen, including codeine. and many many times I would see him or his nurse for a demerol shot, with great sensitivity to my plight. My last few months in Mi. I my Dr. was brave and kind enough to write a script for demerol injections for me to give myself at home. It was a LIFESAVER. to not have to sit and wait in an office, smell food that people would bring with them or find someone to drive me. So...when I moved to TN it was a rude awakening to discover how difficult it was to find a Dr. that would take a patient with chronic pain. I was stunned and it took a long time to find someone. Even at that, I felt as though I had to prove to them i was not an addict. so Demeaning. And my Dr. looked at me as if I had 3 heads when I asked if there was a possibility to take injections at home, they dont give any my her practice. Since I live 40 mins out in the country that options would be enormously helpful. What can those of us do to relieve some of the over the top regulations that bar good pain care for those of us who are in need. At my age I refuse to be a guinea pig for some pain management Drs. who have never experienced my pain. Thanks for listening.