Are there new limits on the amount of daily narcotics doses?

[Beartracks]

My spouse has been seeing the same pain management specialist for a few years. In addition to performing occasional radiofrequency ablations and/or epidural blocks, they prescribe a regimen of several medications for "long-term" pain management (taken daily) and "short-term" pain management (for acute "break-through" pain events). With a variety of physiological conditions (including fibromyalgia, compressed disks, and worn down cartilage), the overall treatment plan has been rather successful, and the docs always assured us that the doses of these meds, including the narcotics (like oxycontin and morphine) were nowhere NEAR what many of their patients take on a regular basis.

So it was quite a surprise when the doc said at last week's appointment that new drug regulations from the DEA were limiting patients to a total dosage of 120mg of narcotics a day. Total, cumulative among all prescriptions. Immediately.

Shit, the as-needed valium prescription alone was more than that.

So, he seemed to say, that's that, just take the short-acting stuff when you need it and quit the rest, see you next time -- as if my spouse was supposed to quit all this other stuff COLD TURKEY!! He acquiesced and suggested taking the remainder of the existing prescriptions at half doses daily until they were all gone, and that was it. Like benzo withdrawal is just a walk in the park.

He did at least write a scrip for Lyrica for the fibromyalgia. Like that's gonna help lift the load. I guess we'll see. I wonder what they're supposed to give the really heavy-hitting patients? Tylenol 3?

Anyhow, what I'm wondering is -- has anyone ever heard of such a "new regulation"? I mean, sure, over the last few years the narcotic drugs have been closely monitored and my spouse had to undergo periodic testing to make sure the blood levels were correct, and that seemed like sufficient regulation to ensure no one was abusing or selling. But to just cut narcotics willy-nilly to a total daily limit that is apparently way LOWER than ANY pain management patient ever takes?? That seems absurd.

Oh -- By the way, we know one other patient at this doctor and she had an appointment last week also, yet is still being allowed her narcotics prescriptions, which, to my understanding, exceed this supposed 120mg/day threshold. So we're upset AND confused.

[silverweb]

2. Haven't heard anything at all about it.

[font color="navy" face="Verdana"]As a medical transcriptionist, I do a fair number of pain clinic and palliative care reports, and this is the first I've heard about it. While new regulations aren't something a doctor would necessarily mention in a dictation, I also can't find anything in a computer search.

The closest thing I found was an article from 2009 limiting prescription dosages for "24 popular narcotics" in an effort to curtail accidental overdosing. Acetaminophen (Tylenol) limits were also changed in 2009 because of its potential for liver damage at higher doses and the fact that it's an ingredient in so many over-the-counter medications.

If you can get more specifics that would narrow a search, it might help. I'll keep looking in the meantime.

[silverweb]

3. Here's information from the FDA site.

[font color="navy" face="Verdana"]They're obviously encouraging special training and efforts to reduce narcotic over-use risks, but there's nothing about enforcement of daily limits in the articles here:

[face="Arial"]http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm330614.htm

[Warpy]

4. That's insane, but so are the DEA and the drug war it's fighting.

There is no upper limit known for human tolerance to morphine. Yes, people can overdose on it, but if the dosage is raised slowly, what would kill me and thee would barely touch a cancer patient's pain. Putting any sort of arbitrary limit on milligrams is both cruel and nuts.

Second, Valium is not a narcotic drug, it's in a separate classification.

Having the DEA lean on doctors who are treating pain is unconscionable. We need to limit their mission severely or, better yet, defund the agency and tell them to go get real jobs, preferably jobs where they never see other people.

ETA: it's for opiods only, the happy, peppy sunshiny publication is here: http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf

That idiotic guideline is soon reached by people on oral morphine since it's poorly absorbed by the gut. Strategies would be swapping drugs, swapping delivery systems of morphine, and using non opioids to potentiate the drug.

Somebody needs to sue those morons out of practicing medicine without a license.

[nenagh]

5. I can tell you from an Ontario perspective that there are new guidelines regarding narcotics

developed in part because it was determined that the number of fatalities due to narcotic ingestion (often combined with alcohol) had significantly increased in the province of Ontario to an unacceptable total loss of life.

Here in this small Ontario city, after new guidelines were in place...apparently many physicians suddenly severely cut back the amount of narcotics they were willing to prescribe on a daily basis.

Frankly, there was an inquest in this area due to the death of a teenager who had ingested narcotics which were legally prescribed to an older woman but she had given/sold? some of her meds to this young man.

I was not in Ontario when the new guidelines were finalized and implemented, but I have been told that as physicians altered their prescribing of narcotics to be in line with the new guidelines, that the dosages were greatly reduced or stopped.

I do not know about USA narcotic guidelines...

Hopefully your husband can taper off the meds...I would think it would be important for the sake of continuity to write down the times he takes each dose, so that you can remember these changes day to day and keep a record so that you have ready information for the physician and yourselves.

[cbayer]

6. This doesn't make sense.

Different narcotics have different strengths. A vicodin may have 500 my of the active ingredient while an oxycontin may have 10 mg. There is no way that narcotics could be regulated by mg's.

Also Valium is not a narcotic. Tylenol3 does contain a narcotic.

There are physicians that basically sell narcotic prescriptions for a living and I would love to see the hammer come down on them, but what you are describing here just makes no sense at all.

[Warpy]

7. I disagree about docs who sell prescriptions

I used to go to a GP in Boston who had a reputation as a Dr. Feelgood. If he knew an addict well, that addict could go to him if his connection had gotten busted or the town was dry for a few pills to tide him over. It was a very kind thing to do and I remember him as a very kind and caring doctor. I just went to him because I was sick and his was a drop in office.

Strangers couldn't get anything out of him, but he was extremely compassionate to his patients. He was elderly and probably out of practice before the DEA cowboys took over.

The bottom line is the drug war is a miserable failure. We're still awash in drugs, gangs are violent and prosperous, and the whole world has been poisoned by this "war." If some addicts are able to get pharmaceutical grade drugs, good for them, they'll live longer than people using street drugs. They'll certainly be healthier.

And that's really the point. Laws written by moralists always have unintended consequences that plunge a lot of people into hell instead of creating the sinless heaven the moralists intended.

[cbayer]

8. Well, you would be wrong, and I know this from the inside.

While I think the DEA sometimes goes after some good guys, there are some very bad guys out there.

This isn't about the drug war, this is about unscrupulous physicians. If you can get your hands on any state board of medical examiners regular publications, you can see it in black and white.

Detoxing patients who are getting Rx's for 180 Vicodin ES, 180 Soma and 180 Xanbars from multiple physicians is a nightmare. And they will tell you exactly who is doing what out there. To say nothing of the accidental overdoses.

I'm with you about the war on drugs having been a failure, but this is not about that at all.

[Warpy]

9. I personally know legit docs who have been leaned on heavily

and others who say there is a climate of fear among prescribers who never know when they've gone over some arbitrary and unpublished number of pain prescriptions the DEA doesn't find suspicious.

And I know all about detoxing patients. With no damned drug war, we could simply medicate them.

[cbayer]

10. I do too and I blame the physicians who are abusing their licenses for that.

What do you mean we could medicate them? These aren't pain patients, they are addicts.

[AC_Mem]

11. You hit the nail on the head

"Laws written by moralists always have unintended consequences that plunge a lot of people into hell instead of creating the sinless heaven the moralists intended."


Indeed.

Shine on,
Annette