Prescription question

[newbie but goodie]

Hi all. I have a sort of complicated (to me) question and I thought maybe someone here could help me work through it.

I have been having recurrent UTIs that my PCP and neuro both feel were caused by bladder spasms and low WBC from Gilenya. I do not currently have an infection but do experience constant bladder discomfort and pain. My PCP has been prescribing me 5 mg of diazepam and it has been working wonders and without and weird side effects or drowsiness.

HOWEVER.... he makes me come to his office for an appointment every month to get a paper prescription. Said the board that certifies him does not allow it. But my sister, the pharmacy technician, said she sees scripts for Schedule 4 drugs with up to 5 refills all the time. CVS even said he could fax it in with up to 5 refills.

I feel like I am being punished for a chronic condition. Now he wants to switch me to Elavil (off label) and will give me 3 refills. I hate to think this but I almost feel like he is taking advantage of my insurance payments! Also- I am not enthused at the thought of adding an antidepressant to my regimen. They are rough sometimes.

Can anyone shed some light on the differences between what he says he is required to do and what the law and pharmacies require? Am I literally stuck with monthly appts forever if I want to remain symptom-free? I am really struggling with this one.

[Marco]

I am sorry this is causing you needless stress. I would talk to your pharmacist and ask them if refills are possible for diazepam. If so, ask the pharmacist to to call the doctor's office and discuss it with them. The doctor may have another valid reason for seeing you monthly. If your doctor is just being a pain you could visit a pain management doctor for the prescription. I have to go monthly to pain management and it's a chore, but still better than dealing with chronic pain.

[KatieAgain]

I have been on Valium since I was diagnosed for CNS dizziness. It is considered a "controlled substance". My understanding is the prescription is void after 6 months and it can it must not be refilled more than once every 30 days. Therefore, you should indeed be able to get a script for initial plus five refills.

My script is written that way.

[SNOOPY]

I have been using a Benzodiazepine for 14 years. My reason for using a Benzodiazepine is different than yours.

Most common in my case were prescriptions that had anywhere from 4 to 6 refills.

Although I had refills I still had follow up appointments approximately every 4 to 6 weeks and the last 2 or 3 years appointments were stretched out to every 3 months.

he makes me come to his office for an appointment every month to get a paper prescription. Said the board that certifies him does not allow it.

Benzodiazepines can be addictive and may be the reason your Dr. will not do refills without seeing you. Or, maybe he is telling you the truth, I don't know.

[newbie but goodie]

Thanks everyone.

Marco- I don't think the Dr has much reason to see me that frequently. He never does any test or monitoring of my condition when I'm there, just writes the script.

Katie Again- that is my understanding of the law too. Glad I am not just losing my mind here. I know that everyone in the country on schedule 4s don't have to go in each month- the insurance companies would be squawking!

Snoopy- I do know they can be addictive, that is a valid concern. But they do work so well... maybe I will find something else that is effective also that does not require all this leg work.

Fingers crossed!

[Marco]

Marco- I don't think the Dr has much reason to see me that frequently. He never does any test or monitoring of my condition when I'm there, just writes the script.

Yes, I understand. I would LOVE to find something with less stringent requirements. Refills are not permitted for my pain medication. My brief appointments are 28 days apart for the explicit reason of getting a handwritten original prescription. I am essentially trading a co-pay for the ability to take a drug on a special government list. I also have to submit to random urinalysis to ensure I am not abusing drugs.

This is just a situation where valid users jump through hurdles because of prior abuses and abusers.

[Kimba22]

Hi newbie but goodie,

Nice to see you again, but sorry to hear you've been having bladder discomfort and pain. And then when you find something that works to help control that, it turns into another pain ...

Can anyone shed some light on the differences between what he says he is required to do and what the law and pharmacies require? Am I literally stuck with monthly appts forever if I want to remain symptom-free? I am really struggling with this one.

Here is the federal law regarding refills on controlled substances. (States can impose stricter limits than this, but I 'm assuming your sister lives in the same state, so that wouldn't apply to your situation). From the U.S. Department of Justice, and DEA's Office of Diversion Control:

Question: Can controlled substance prescriptions be refilled?

Answer: Prescriptions for schedule II controlled substances cannot be refilled. A new prescription must be issued. Prescriptions for schedules III and IV controlled substances may be refilled up to five times in six months. Prescriptions for schedule V controlled substances may be refilled as authorized by the practitioner.

http://www.deadiversion.usdoj.gov/faq/prescriptions.htm

I have no idea what your doctor is talking about in regards to what board certifies him, but I'm not qualified to pass judgement on that. But, the DEA can put restrictictions on, suspend, or revoke a license. (If that's the case, then there's usually a good "reason." )

But, regardless, I think the key words here are may and up. Doctors who are registered with the DEA to prescribe controlled substances may authorize anywhere up to 5 refills on Schedule IV drugs. It's then up to each one to use their own professional judgement when they prescribe any medication (along with refills), not just controlled substances, to care for their patients. They are the ones who would most likely be held responsible if anything terrible happened to you because of something they prescribed.

If that means they want to see their patient more often, so be it. I don't think there's much the patient can do about that, except find another doctor. Back when I was first diagnosed, I did not question much of what my neuro prescribed. I was pretty loopey when I first started taking Valium (yes, there were refills ), and became a "functioning zombie" until I saw him again a few months later. Probably wasn't the best judgement at the time for him to put me on the dose of Valium he did back then.

Which brings me to your neuro. Will he/ she prescribe it with any refills? Mine will prescribe valium to me, but it's usually only with one or two refills. But, I think the most qualified to doctor to prescribe medications for your condition would be a urologist. (Just sayin' what you probably already know ... )

Not only can Valium become addictive, it also may not work as well over time, requiring different dosing. http://www.drugs.com/pro/valium.htm. Maybe give the Elavil a try and see how it goes? It does pop up when Googling as one of the treatments used for your condition.

On a side note, PCP's are prescribing Schedule 2 drugs less and less. They need to follow even more restrictive guidelines. Like Marco said, that's the result of abuse. http://www.msworld.org/forum/showthread.php?t=132856. Who knows, but maybe your doctor is concerned about prescribing any type of controlled substance?

Anyways, I really hope you find a better solution! Keep us updated and best of luck!

[J-Bo]

I have to say, people who abuse pain meds really make angry. They make millions of people like us suffer just because they want to get high. But then people who want to keep pot illegal honk me off too. I just want the pain to stop, and it isn't right that we should be treated like criminals for wanting that.

[TaoWarrior]

I used to be on Valium for muscle spasms in my leg and got 6 mo. at a time. Then neuro switched me to klonopin which he says is better (i haven't noticed a difference) also 6mo. at a time. 1+ 5 refill.

I am also on Vicodin which is schedule 3 and get that 1 + 5 also. I had one doctor who did the 1 month at a time of Vicodin and I got fed up and switched doctors. So if your sister is in the same state I would probably start looking for a new doctor who would do refills. Even if they are only willing to do 3 mo. at a time would be an improvement.

On that note I did just read that Vicodin may be moving to schedule 2 which means monthly visits. I can't afford that so will be talking with my doctor about another option.

[Kimba22]

Hi TaoWarrior,

On that note I did just read that Vicodin may be moving to schedule 2 which means monthly visits. I can't afford that so will be talking with my doctor about another option.

Here's some food for thought about the proposed change and the FDA approval of Zohydro ER (hydrocodone bitartrate):

"... within days before the approval of Zohydro ER©, the FDA also announced it would be recommending the DEA move all hydrocodone products – single-ingredient formulations as well as those containing acetaminophen, ibuprofen, etc. –from Schedule III to Schedule II.

Pharmacist representatives from several national organizations ... submitted a letter to the DEA, urging against rescheduling these C-III products ..."

You can read more here~
http://www.thepharmacyblog.com/the-n...or-zohydro-er/

Doesn't make much sense to me that a combination drug like Vicoden would fall into the same category as pure hydrocone ...

[TaoWarrior]

You can read more here~
http://www.thepharmacyblog.com/the-n...or-zohydro-er/

Doesn't make much sense to me that a combination drug like Vicoden would fall into the same category as pure hydrocone ...

No it doesn't make sense and I am on the 5/325 so it is not exactly like that is much of an abuse drug. Maybe the higher ones I could see but 50mg of hydrocodone vs. 5 is a pretty dramatic difference to be regulated at the same level. I know nursing homes, hospice and now pharmacists are all against the reschedule so there is hope. The AMA seems to support it though although they are divided and I couldn't find an official position.

Just have to see will be talking with my doc about alternatives just in case next appointment. Looks like codeine is about the strongest left on sched III if Vicodin goes away.

[newbie but goodie]

Sounds like both me and my doc have valid points of view here. Goan appointment with a urologist is something I'm working on. Having a heck of a time finding one around me to take my insurance. Will see my neuro on weds and see what he thinks. He is usually pretty helpful.

As for the schedule change of hydro condone... I think we try to fix problems with a sledgehammer sometimes. Other countries have more lax prescribing laws and don't have as much addiction problems. There has to be a better way, especially for those with chronic illness.

Good point about the diazepam losing effectiveness. Maybe I should consider a switch while it's still effective so I can keep it as an option when I have pain and spasms from a active infection.

Again, thanks everyone. So glad you are all here.

[SNOOPY]

Good point about the diazepam losing effectiveness. Maybe I should consider a switch while it's still effective so I can keep it as an option when I have pain and spasms from a active infection.

In the 14 years I used a Benzodiazepine (Klonopin) it never became "ineffective." If an increase to my prescription was made it was due to the need, medically, for a higher dose not because Klonopin was loosing it's effectiveness for me.

I used Klonopin on a regular basis for extended periods and when I could get by I used it as needed. It always worked in the way I needed even if I took a lower dose than prescribed.

Hope you find what works best for you