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DEA and the doc

isiscleoiisiscleo Posts: 8
edited 06/11/2012 - 8:48 AM in Chronic Pain
My doc was recently contacted by the DEA as the doc prescribed me more than 1000 (one thousand) pills at once. He did this AT MY REQUEST because 90-day Rx's are cheaper for me now! Since the DEA call, the doc got scared and began reducing the pain med by a total of 16mg a day without warning!! I am scared, in pain, and feel I am victim to the systema and the doc's fear. What can I do??? What should I say to the doc at the next follow-up appt? The med is Dilaudid and I was taking 12mg every 4-6 hours. Now I am on 8mg every 4-6 hours. No weening!

All comments and help is so appreciated!



  • I would call the doctor right now. Maybe it is a mistake. If not you need to speak to him about how you effect that kind of change, both in terms of withdrawal and in terms of pain management.
  • Thanks Kris. It is NOT a mistake, I went back to the doc's office the next day after the last appt and verified. The DEA is telling him what to do or putting pressure on him. The doc is usually an awesome pain mgmt doc but this issue he wont budge on, no matter how much I reiterate my fear of withdrawls. I am now withdrawing, feeling like %^&$( and wanted to write here for support, help, and direction.
  • 90 day prescriptions of schedule II medications are not legal. Maybe you should find a doctor who is aware of the law rather than breaking it and then making medical decisions as a result of the consequences?

  • Hi. I have been getting ALL of my Schedule 2's as 90 days for a while. The doc writes them AND the mail order pharmacy fills them. That wasn't event the concern of the DEA.
  • isiscleo said:
    Hi. I have been getting ALL of my Schedule 2's as 90 days for a while. The doc writes them AND the mail order pharmacy fills them. That wasn't event the concern of the DEA.
    happyHBmom is correct in that it is illegal to prescribe for more than 30 days. My doctor requires an in office visit to refill said schedule II scripts.

    It could be the DEA just caught on to how your medications were being prescribed. Having retired from a federal agency that enforced drug laws, I'm sure there are issues brought to the doctors attention that wasn't revealed to you. I know, it stinks, but your doctor has to protect him/herself and you.

    Now as to the reduction. That you will have to work out with your doctor unfortunately.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I think it was a concern with the DEA, because as was mentioned, it is illegal.

    I'm sorry that you are suffering for your Drs mistakes, but perhaps finding a new Dr would be a good idea.
  • Sorry, I got that wrong- it's a state requirement, not a federal requirement (although most states do have that limit). It's possible you live in one of the states that don't.

    What doesn't make any sense is that you would need 1000 pills for 90 days when dilaudid comes in 8 mg capsules. Since each dilaudid capsule is equivalent to 40-60 mg of morphine, that's equivalent to 400-600 mg of morphine a day.

    Yes, I'd think the DEA would question that, it's over what they consider their "high dose" threshold, which is I think 200 mg morphine equivalent.

    Good luck finding a doctor who will keep you on that level. You can ask whether it would be useful to go off of meds entirely for a while (a med vacation) and reduce your tolerance so you can achieve pain relief at a lower dose?
  • There is no federal limit as to the amount of controlled substances a practitioner can legitimately prescribe. However, if a registered practitioner issues multiple schedule II prescriptions, he /she is limited to the combined effect of allowing a patient to receive,
      over time,
    up to a 90-day supply of a particular schedule II controlled substance.

    The rule does not stipulate how many separate prescriptions per schedule II controlled substance may be issued for the 90-day supply. It is up to the practitioner to determine how many separate prescriptions to be filled sequentially are needed to provide adequate medical care. For example, a practitioner may issue three 30-day schedule II prescriptions to cover a 90-day supply or he/she may issue nine prescriptions for the same schedule II controlled substance, each for a ten-day supply, having the combined effect of a 90-day supply.
    This rule became effective on December 19, 2007.


  • happyHBmom said:
    Since each dilaudid capsule is equivalent to 40-60 mg of morphine, that's equivalent to 400-600 mg of morphine a day.

    Yes, I'd think the DEA would question that, it's over what they consider their "high dose" threshold, which is I think 200 mg morphine equivalent.
    I did some research this evening and found that 8mg of oral dilaudid is equivalent to 32mg of oral morphine. Let's say worst case scenario and IsisCleo is taking a max dose every 4 hours (6 doses in a day), that's 72mg in a day or 288mg of oral morphine. His downgraded dosage is now at 48mg per day or 192mg of oral morphine.

    HB, where did you find the magic number of what the DEA considers to be their "high dose" threshold?

  • I got the 40-60 number from published prescription information. I am not sure where the other information comes from.

    The high dose threshold is published in research. If you read pain management research, they mention it now and then. It will probably take me a bit to dig back through the research I was doing and find the reference, but if you do a google search you can find similar information as the "high dose threshold" or "watchful dose" or "red flag dose" in morphine equivalent.

    And there is nothing to say a doctor can't prescribe that amount, that's just an amount over which people take more notice- so a doctor would want to be secure in his ability to justify it. I certainly wouldn't want to receive a dose of medication that my doctor didn't feel comfortable justifying!

    But if Cleo was taking only 6 pills a day, she would have needed 540 to last 90 days. She said she got over 1,000 pills for 90 days, which is where I took my numbers. Something doesn't add up.
  • There was an article in a newspaper yesterday that was talking about a big DEA bust in NY State recently. Not sure isiscleo if you're in this state or not? They caught a bunch of patients, who were getting large amounts of oxycontin, then turning around and selling them to drug dealers. Many of the people apparently were on Medicaid as well, and in or around their 60s! The dealers would tell them what to say to their doctors to get more or higher doses of it. If you're in this state, could be the reason why your doctor was contacted.
    APROUD CANADIANveteranButNOTa doctor, my thoughts are my own
  • That happens all the time here. Every so often you hear on the news about a big bust. There was one a year or so ago where the doctor ran a "clinic" in Brooklyn. It was literally a walk in where he did no exam, just wrote scripts. The patients had medicaid/medicare so he was billing for office visits...hundreds a day which I think is what got him caught. Then the patients filled the scripts using their medicaid/medicare and then sold them to a dealer.

    Doctor got paid
    Patient got paid
    Dealer made money

    Government paid for office visit and meds!!

    This happens to the tune of millions before it is caught. We had a similar operation on a smaller scale here in my nice suburban neighborhood.
  • That's exactly what the article said! I'd post the link, but not sure if it would get past the link police, LOL. (j/k mods, you know I think you guys do a terrific job!!) It also said that there is now a "restricted" list of patients, they are only allowed a certain amount of meds now because of dr/pharm hopping. The list in NY has over 10,000 people on it.But I guess that's actually not that much considering the population. This particular bust happened in Buffalo.
    APROUD CANADIANveteranButNOTa doctor, my thoughts are my own
  • Every war has some collateral damage. In the "war on drugs" some chronic pain patients will be the losers.
  • While the others here debate the issue of what is being prescribed, I would like to address the issue with possible withdrawal.

    If you are concerned and are possibly beginning to feel the effects of the lowered dose, contact your doc to request assistance with that (other than an increase back to your previous dose). Let your doc know that you are willing to work with him to not only keep him comfortable with regard to the DEA, but with regards to your own comfort and health. There are other ways your doc can help you to stave off withdrawal symptoms and keep you comfortable. Some of these methods are also good in helping with the battle against chronic pain. You can also help yourself out by making certain the foods you eat are ones that help reduce inflammation, battle pain and not those that contribute to it.

    Best wishes,

  • i have on my own volition reduced my dose of fentanyl lollipops from 7oo micrograms to 500. I did this to reduce costs. i have not experienced any withdrawl symptoms. in fact i believe as long as there are some narcotics in your system, withdrawl is minimal. the only time i experienced it was when i went off cold turkey. it was my decision, not the drs and this was about 15 years ago. withdrawl is not great, but i did not experience horrendous symptoms at all, just a mild case of the runs, sleep disorders, and some pain in the legs. it was no big deal for me. i would not like to do it again but it was not that bad. my dr gives me 2 scripts of 30 days each. i have to see him every other month for refulls. i never miss an appointment. i have also had my oxy reduced and no problems either. going on line to get scripts is not a good idea in my opinion either. make sure you have repitable drs and pharmacies for your meds.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • This is why pain doctors manage tolerance rather than just throwing more and more meds at people. I talked to someone on another board once who was on 800 mcg/hour of fentanyl (he put 8 100 mcg/hour patches on) and his doctor lost her license and he couldn't find anyone willing to give him that level of meds, and was forced to rapidly withdraw.

    It also shows how important it is for us to understand the "complications" surrounding our treatments and be our own advocates.

    I have read that a 25% reduction is an acceptable taper, so 33% isn't that much greater. Hopefully any symptoms will be mild. As C said, if you start having symptoms you can ask for other help if symptoms are severe.
  • I totally understand the doctors fears as he has a license to protect, and i totally understand the DEA's concern. 1000 Pills in a patients hands is a lot. I have never really heard of a doctor in regards to pain meds, especially diludud make it easier for the patient and give them a 90 day supply. Perhaps you are also not the only patient the doctor is doing this for,hence the red flag by the DEA.That really is so many pills in a patients hands.Regardless the DEA is looking at him , i am sure his fear is great.

    I have to go like many on the forum and see the pm doc every month, also now because of the DEA everyone has to do a urine. I do not mind any of this as the DEA is all over the state of Florida. People actually drive down here just to go to some of the shady clinic. Every Sunday the paper runs front page stories of deaths of pill mills and the deaths. 7 people a day die from pills down here. I hate reading it, and so wish they would tell the other side but they don't.

    The decrease is not a major one, but as C said your doctor can help, you just need to reach out and ask. He is part of your team, and it there is nothing you can do about the DEA or the doctor.
    Be grateful they did not close him down. That has happened to others so there is something to be happy about. This is all part of what we have to go through .



    Robin: I will check out the link.

    C: Your really addressed my concerns and fears.

    J: I agree that 1000 pills is a lot at once. I recently switched to the 8mgs Dilaudid.

    My injury occured when I was assaulted at work in a psyc hospital when a patient was in crisis. C5-6 disc herniation, nerve impingement, right knee catilage loss.

    I am just in pain, had stabilized on the meds I was on, and have many concerns and feelings re: switiching the meds b/c the DEA calls. But, like J said, you can't control them.
  • Just to clarify with everyone, she was taking 4mgs Dilaudid, 3 pills, every 4 to 6 hours. So basically, she was getting 1080 pills every 3 months which equates to 48mg of dilaudid a day. Where it was thought she was taking almost 72mg was wrong and reality it was only 48mg. Funny how asking a simple question behind the scenes gets the desired information without calling into question the poster in public.

    Sometimes, when we post, what are brain thinks doesn't always come out the fingers yet in our minds it still makes sense even if we reread it a 1000 times.

    Welcome to the forum Steph. I hope the forum and the site will be able provide you some assistance. Out of curiosity, has it been proposed to repair or fuse the disc in your neck?

  • Well 4 mg makes a lot more sense in terms of the dose, but less sense in terms of how the doctor got into this mess.

    It is frustrating that it is so hard to change doctors. Why can't he give you 8mg and 4 mg tablets and/or 30 day prescriptions? That's not a suggestion, but it seems like there are 100 ways around this other than just telling you he has to reduce your dosage.

  • Welcome to the Spine Health and i hope that you find as i have all the support and friends from all over the place. When you feel up to it come and join us in chat sometime as well.

    I found SH the same way pain from a head on car collision. Your injury and your attack sounds horrid. The attack itself is something to deal with. I wish you well and hope to see you in chat sometime.

  • I also would like to welcome you to Spine-health. Sometimes we may get moody due to pain or other reasons, but that is no excuse if I offended you in any way as it was certainly not my intention. I don't always take the time that I should to post everything that I'm thinking or feeling at the time, and I'm not a fast typer.. so at times don't express myself as well as I could/should, but I'm working on that.. :)))
  • Well Steph welcome aboard!! :D I am so very sorry that you had to go through that attack and also the resulting injury...that must have been pretty scary!!!

    I am also sorry that this is happening with your Dr....In my opinion, and it is just my opinion, it is very sad when a caring, nice and compassionate Dr gets in trouble for trying to keep his patiant out of pain!! I really hope you dont feel any withdrawls and that your meds still keep your pain tolerable!!!

    If you ever need to rant/scream or just want to talk you can PM me anytime!!
  • I keep asking myself - who is anyone to question what someone is saying and why are they so determined to make a big spectacle out of how many pills someone else is or isn't taking rather they have the correct numbers or not?
    Why is it their business to begin with? Can't we just take people at face value and SUPPORT them fully? Show concern and compassion and be GOOD to one another? We are all in this pit, so why not make the best of it instead of picking every word apart like a bunch of gals that are employed at the government or something (LOL!) That was funny, I don't care who ya are - cuz you all know that's what these honeys do here! I hate it at work and I sure hate seeing that behavior on this awesome board. Be good to each other, and WELCOME STEPH!!!
  • Thank you for all of the commpassionate and welcoming words!! I am dealing with the attack in therapy, but have some serious PTSD. My neurosurgeon thought the injury required more than a fusion, and I had a disk replacement. Next I had an ulnar decompression surgery, to help decompress the nerve impingement, although the nerve root is damaged permanently.

    I really feel welcomed, and am happy I found the site!!
  • Keep us updated on how things are going! take care - Marion
  • Me too, glad you found us! We are an awesome bunch ;) Seriously, I think some of us find this place when we need it most. I hope your time here is helpful and even fun at times (we have to laugh) Welcome :)
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