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pill counts

dmoonchildddmoonchild Posts: 383
edited 06/11/2012 - 8:21 AM in Pain Management
My new PM dr says they do pill counts randomly. How does this work? Do they call you at home and say to come in to the office? The reason I ask is that my husband travels with work. He will be taking my car to the airport. I cant drive his car because it's a stick shift. He is only going away fo 2 days. What if they call for me to come in? Will they give a few days to get in? I know I am required to bring my unused pills to every monthly appointment.


  • of that one. I would assume that they will randomly count on your reg appt time. I do not think that they will have you come in at different times than appt. For one thing that would be very time consuming for them. Maybe someone that knows for sure will come along and answer this for you.
  • If you signed a pain contract when your pain doctor gave you your meds,then they can do a pill count at anytime....
  • dmoon- I never have been called in for a pill count so I do not know how that works. I have had urine tests done randomly though at my pain drs office during routine appointments. jade
  • On my second visit to my pain doctor, his office gal came in before he and told me to sign it(pain contract)and said everyone who is treated at their facility must sign one. I didn't even have a chance to read it, I was in excruciating pain, crying etc., so I signed the darn thing just to get on with the appoitment...should I have signed it? My GP gave me an anti-anxiety scrip and my pain doc was livid! What is protocol here and can I get pain help without the signed pain contract? Thanks y'all for your experienced and knowlegable answers/comments.
  • Random pill counts are just that. They call you and give you a time frame to come into the office and bring your pills with you. If you don't show up, then it counts as a failed test and they can terminate you.
    I would suggest that if you don't have a copy of your contract, that you call and ask them to mail you one if it is a long time before you see the PM doctor again.
    If you have transportation issues, you need to let them know right away, and depending on the practice rules, so that they can tell you what will happen if you can't make the time frame.
    The reason that your PM doctor threw a hissy fit about the anti anxiety drugs is that you are supposed to either get any schedule II drugs from your PM or notify them first before you fill the script. You might want to clarify that with your PM so that you don't get in trouble again for it.
    Like Paul said, PM is hugely regulated and strict these days, so it is best to ask questions and make sure that you are sticking to your contract, otherwise, you can find yourself blacklisted or flagged for something that you didn't know was a problem.
  • I can toatally understand why they do it and I cant blame them. I was a little concerned if I dont have a car and if I would have a few days to get in if they called. I could always ask someone to drive me if they wanted me in ASAP.
  • I have been going to my PM for 3 1/2 years now and have never been asked to sign a pain contract. This site is the first place that I have ever even heard of them.

  • I asked my doctor for a contract to show him how serious pain relief is to me and that I understand the potential pitfalls of narcotic pain meds.Plus the quantity required it due to possible diversion (120 x 10/325 Norco).I am open to random testings and pill counts, so far none, but I have no issues following the rules.My doctor is a GP, so it protects him too.
  • That's incredible. I have never heard of this one. Bringing in your unused portion to the Dr. to count the pills? That is totally outrageous unless of course you signed some ridiculous contract that states you do this absurd thing. Wow, I can't believe that. I am required to give urine 3 times a year that would be every second visit as I go to the Dr. every other month. That is all I am required to do, and I am not sure why I am required to do that. I have no problem with it, so I do it, but bringing in unused meds to count, you gotta draw the line somewhere!
  • I too have never heard of this before reading it here. although I have been going to a PM for a year now I get my meds from my GP. He has never questioned pill counts . when I am getting low I just go back and ask. when I was first having problems I saw him and told him the meds wernt working and he gave me stonger ones.The last time he just asked me which ones I wanted.I dont see how they can do a pill count . I take mine as needed which is every so ofton so how can they determine in a case like that if you were off on the count. If you were coming back every week or so for more if say the gave you 40 or so then I could see they would question it.
  • The thing is this:
    If the Dr. writes a script for 30 days and it's for 180 pills, you take one every 4 hours as needed. That's 180 max for 30 days. If you get called into the office for a pill count at 15 days, you should have somewhere between 88-92 pills. I'm guessing that if you only have 15 of them, the Dr. isn't going to be very happy. Just a guess, but I would imagine that's how it happens.
  • I just saw my PM dr. The nurse comes in and asks for my bottles of meds. What.?? I never heard of this or have never done it before. I freaked out as I did not have them with me. Do I need to go back home?? :/ :/
    Then she brings in a new form to sign saying to bring unused meds to appt. The dr says it's OK as I was not told. #:S
    I never got a chance to read it as my mother read it out loud the same time my dr was talking to me. @)
    They keep changing stuff and I sure wish I did not need the meds. I don't know what they are looking for?? jade
  • This all goes towards the Dr. Patient relationship. I am 54 years old and I have been with my PM Doc for 6 years or so. I had a small problem at first when I was prescribed 40 mg OC to take 2 of them BID. I developed a wicked addiction to these things and before I knew it, I was taking 10-12 of them a day and running out 2 weeks early. I had to see a psychiatrist and tell my PM Doc that I was addicted to the OC. He told me that the first thing we need to do is put some space between me and the OC. Anyway, to make a long story short, 2 years later I went back to him on a referral from my Neurosurgeon and we struck up an interesting conversation. To shorten it up more, he trusted me and I like him and I don't try to take advantage of his compassion. I could very easily walk into his office and tell him that the meds I am on now just aren't cutting it and that I need something stronger. He would gladly oblige. That's how cool he is. On the other hand, why would I want to do that? Everything is going good now. So you see, it's all a matter of trust. Maybe I should tell you that you don't see my PM Doc without a referral from another Dr. This way, right off the bat, he knows that there is a real problem that most GPs don't want to mess with. The fact that you're not just coming in off of the street helps too. I sure would hate to see the day that my PM Doc starts asking for unused portions of medicine to be brought in to the office for some nurse to count. Sorry about the length of this and by the way, Paulgla, I do understand the whole urine thing. In my office, I guess if you do it for one you have to do it for all. I am going to ask him next visit, why do I have to give him urine 3 times a year. It's all a matter of TRUST!!!
  • It just seems weird to me that I would have to have the pills counted as yet one more rule. I have never had any problems with the PM but she did say it was a rule by the nurses. I did not know nurses had to do this. So I'll have to count before I go so I get back exactly what I brought in. I have had several urine tests and pass them. I do take my meds as written and don't know why now after several years. I was once warned that people have been robbed of their pain meds at this office. :O :O

    They keep changing rules and forms. I asked for a copy of a medical record and now it costs $1 a page and it was free. sigh.. jade
  • X( I have never been given the option of a urine test! My doctor knows that I have problems with geeting blood draws because my veins have so much scar tissue from the many tests that I have had over the years and the many hospital stays and ER visits that I have had. I also happen to have tiny lttile veins that blow the second that the needle goes in and they have to restick me over and over again. Yet, he sticks with the blood test instead. I had never known that they could do this with a simple urine test. I am dumbfouned! X(
  • Hey Jade,
    If I were you I would begin a search for a new PM Dr. I seriously have never heard of this "rule" and I have been troubled by a bad back for over 30 years. Of course the PM Dr. didn't come into the picture until about 15 years back but anywhere I have been and that's plenty of Dr. offices, I have never been confronted with this type of thing. I have a Neurosurgeon that isn't too fond of me because I strongly believe in pain meds. He thinks that pain meds were made for post surgical pain and after 10 days, you're finished with that. Luckily he referred me to a PM Dr. I don't know where I would be today if I hadn't been referred to this guy. I guess I would have eventually found him by myself. The point is this, there is no reason for any Dr. office to have you come in on a random call to count your pills. If you don't take the meds the way you're supposed to, you're gonna pay for it one way or another. Why call you in and count them. Just another slap in the face for the CP sufferer.
  • herrball- I guess I am a little frustrated being a chronic pain patient. The rules change alot and I follow all the rules but it just is one more thing to deal with. Well so far, it is at my next appt. But I guess it will be at every appt from now on. I have not yet been called in and I am unsure if I have to do that yet. I'll find out later... :| jade
  • Hiya Jade~*

    I've been around SH for awhile, but not since they revamped the place and I had to get a new identity :B (I used to be known as TBoo1974). The reason I'm telling you this is because I've read many times on the boards that people have had to honor pain contracts in a variety of ways, from pill counts to UA's to serum (blood) tox screens. I've been in pain management for over 3 years-I take MS Contin, Lyrica, Flexeril and Oxycodone for BT-(first PM was a complete jackhole; current PM I've been with since 10/06 and I love him dearly!) and in that time I've only been "checked up on" twice...first time was with PM doc #1 (well, his nurse actually) who called me and -get this-asked ME to count my pills right then and TELL HER how many I had left! :jawdrop: (as if a person couldn't just shoot off some random number if they really WERE short :S ). The 2nd time was a UA with my current PM doc and this was about 6 months or so ago and kind of a shock to me as they'd never tested anyone that I knew about (I know a lot of people in the area due to when I was a Paramedic with the County EMS) so I was freaked that he thought I was abusing! I knew I wasn't, and in fact I almost always have extra Oxy's left over that I keep in a seperate bottle (long story short I have Medicaid ins. and they often times abruptly stop covering meds I'm on so I'm always afraid they will do the same with my pain meds, and having been out of meds for most of a weekend once-another long story-I don't EVER wanna go thru withdrawals again!!! :& :S ). Anyway, the nurse told me that they were having problems with a lot of patients so they were going to start doing the UA's randomly "frequently" because of that. I'm fine with them checking up on me, and actually I welcome it, because that way I KNOW the doc has no reason not to trust me. In fact, I went in on Monday for my refills, which was early but the only appt they could get me in, and I asked them to write "do not fill before 8/16" on the scrips and to note in my file that I asked, just so they wouldn't have any worry at all that I might try to fill early as I wasn't due to run out till the 17th. They had also inadvertently given me a script for Flexeril but I still had 2 refills left on that (not that it works that well anyway but that's another story in itself /:) ), so I handed it back to the doc, who immediately gave me a "holy shit" look, and said "wow, thank you for your honesty-I really appreciate that! It's not something that, unfortunately, most of my patients would do anymore."

    The mere moments I might "enjoy" due to abusing pain meds simply aren't worth what I would have to endure for the rest of my life....I'm sure you're the same way, but unfortunately for those of us with chronic pain, there are many people out there that would rather have those few moments of euphoria...no matter the cost...

    I wouldn't worry about the pill count thing. Sure they can do it at any time, and they very well might, but I'm sure if you were at home w/o a vehicle for a day or two that they would allow you to come in as soon as your hubby got home or you could get a ride from a friend, as long as you didn't have the same "excuse" every time they might want to check your supply. I don't think the pill count is the preferred method by most PM docs anyway...UA and serum tox screen would tell them if you're taking the meds-whether the right dosage, or too much. Don't fret...as the others have expressed...just keep the trust between you and your doc and all will be well! :)

    Have a great day!
  • tanya- I have seen this dr for about 7 years and some of the nurse practs. My 1st urine test was a surprise as I had no contract at that point. :O

    I got called back by nurse who said to me that your dr ordered a test on you. I figured it was a drug test when she asked me what pills I took, the dosage and what time it was. I had no problem but wondered what happened ?? as after the test I saw a sign stating effective as of this date that they will do random drug testing. :?

    I have had a test every several months so I know to expect it anytime. The pill count is just one more thing to add to keeping a PM dr. They added forms that must be completed to document the pain levels, where, when, treatments. They added a pain contract and now an additional requirement.

    I have so many medical problems and pain. I feel like I have to justify seeing a PM dr. I suppose it stems from being treated a long time ago as if I did not have any medical problems. And that I saw drs just for attention. Wrong! I was and am sick. I wonder if they treated when I 1st saw drs that I would not be in the condition that I am in. :< jade
  • Aww sweetie~I understand how you feel, I really do. It simply makes my blood boil that WE have to be treated with such distrust and all this red tape because of those people who think taking these meds is "cool"! X( I remember several years ago when I was having some pretty rough "female" issues and I would get a HUGE bottle of Vicodin HP, with 4 refills each time and nobody ever batted an eyelash-especially not the pharmacist (hometown pharmacy, not the chains that most of us HAVE to use now a days because they ran all the smaller guys out of business)! It's just maddening.....

    Even tho I have a great PM doc, I have to admit that because I've been on the MS Contin and Oxycodone for over a year now and I've built up a tolerance to it-I'm afraid to push the issue with him for fear he'll think I just want stronger pills for the "fun" of it. I've casually mentioned that they're not lasting as long as they used to but I just don't think he realizes my resistance to drugs (all of them, not just narc's). That's why I decided to make an appt with my primary doc to discuss this stuff. I'm hoping he'll talk to the PM doc and let him know my tolerance and reassure him that I'm not making things up. I don't really have any reason to think my PM doc doesn't trust me-in fact I've done all I can to prove otherwise, but in this day and age I can't blame any PM for wanting to be cautious. Course, I'm also hindered by Medicaid on what they'll cover so that doesn't help any. Ideally I'd like to get the Fentanyl patch with something for BT (maybe go back to the Vicodin HP for awhile and switch between that and the Oxy to help prevent the tolerance) but I'm afraid it would be an uphill battle fighting Medicaid for the patches. :S

    I wish you the very best...keep us posted, OK? Take care of you...
  • But therein lies the problem...

    It's not about trust and relationships anymore. The random counts, random urine tests, and medication reduction trials are all part of the documentation required since big brother started sticking his proverbial nose into our doctor-patient relationships and questioning our physicians' judgement. X(

    My doctor told me up front that he doesn't test my urine or count my pills because he doesn't trust me; he tests my urine and counts my pills because the DEA doesn't trust him. I'm just an innocent bystander that's required to produce pills and pee on command.
  • I've been reading with great interest all the comments about UA's and pill counts and trust between doctors and patients. I believe it is so unfortunate that this has become such an issue nationwide. My PM doc does random UA's and requires anyone who is having their medicationsa changed bring the unused portion into the office so it can be destroyed. Its all very understandable given the pressure physicians have come under from the DEA. Here in Georgia there have been dozens of pain management clinics closed and doctors arrested in the past 5 or so years, one right here in my tiny home town. It is a case of some bad apples ruining it for the majority who legitimately need powerful medications just to make it through the day. The thing that scares me the most about all of this is spector of "universal healthcare". Everyone of us knows that as soon as any government entity gets involved in anything, the costs go up and the quality of care goes down. We who deal with chronic pain face a frightening and unknown future when bureauacrats begin making the decisions concerning when and what kind of treatments we receive. For all it's faults and contradictions pain management has given me a life back. I don't want it to change.

    Chig in Georgia
  • tanya- thxs for the feedback. I have a PCP dr that tells me to get off all the pain meds as she worries that I will have a problem. I sure wish I could.

    chig- The rules at my PM drs offices are changing. For example, there was a rule to bring in unused meds to be diposed of properly; then it went to bring in a prior med when changing to a new med; to bring in all meds.
    I follow all the rules but when the drs nurse came in and asked me where my pill bottles were, my blood pressure shot up to 140/90 and it was usually low. I guess I'll keep checking my blood pressure as that is a new potential issue.. :S jade
  • think it sux. I understand that PM clinics won't treat you if you don't abide by their "rules". But where does it stop??? They are already taking a UA, which in my book is an invasion of privacy. What I do on my own time is my business. But I can understand them testing for the drugs they prescribe. (don't agree with it, but can understand it) But Pill Counts??? When they start paying for the dam things they ought to be able to count them! And UA don't even test for the most abused drug in North America? I guess because too many docs like to have a drink.

    This is not meant to shame or degrade anyone who has to do this to get treated. Seriously. But what other practice asks you to UA test for BP meds? or seizure meds? or anything else?

    I just think it sux that with everything else we go through as pain patients, they degrade us more by saying "we agree to treat you and take your money and expect you to trust us, but we don't trust you!"
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