Find someone else to bend the rules

[Buzzard]

Nanny state, greedy docs, needless regulations, don't care about the patients...

Yeah. About that. It's not the pill junkie who has to pick up the debris when they come crashing down (in various levels of 'literally'). The addict isn't going to reassemble any lives, not even their own.
Having a doc around who actually gives a shit about the lives under his/her care: Effing PRICELESS.
Keep it up, skeptic.

[earl colby pottinger]

Also

Some of those people want you to allow them to get extra pills so they can sell them for money to people who would have a hard time getting them legally.

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What I find funny is I have not pain killers in my personal drugs, just blood pressure, heart rate, kidney, etc. And since I go on cruises and long trips to the USA I find I often have to ask for extra pills, but I can not get them without doctor's permission and that often takes a week or more to go thru. So to get the extra pills I call the pharmacy early and make my request weeks before I need them.

[Rosco the Iroc]

In addition:-

I know it's popular to rail about the "nanny state" and complain about the government interfering in our lives BUT.

I believe where people cannot help themselves, where addiction is involved, where scum profit from that addiction, there needs to be rules and regulations that mitigates these problems.

You keep your job by not giving in to these addicts and sleep well at night knowing you are doing the right thing. They may suffer some amount of pain in the short term, but that pain is nothing compared to the danger they face from large doses of these drugs.

P.S. This is not Fratching material - everyone is agreeing. :-)

Oh I have to admit I get on the nanny thing early and loudly, however This does not fall in that realm. It's not like we are stopping them from having a larger soda. Prescription abuse has been a issue and for a while got out really out of hand till docs got tools like this database to see that someone is farming every doc in town and out. Like OP said, pain will not kill you the drugs might.

[gerund]

In addition:-

I know it's popular to rail about the "nanny state" and complain about the government interfering in our lives BUT.

I believe where people cannot help themselves, where addiction is involved, where scum profit from that addiction, there needs to be rules and regulations that mitigates these problems.

You keep your job by not giving in to these addicts and sleep well at night knowing you are doing the right thing. They may suffer some amount of pain in the short term, but that pain is nothing compared to the danger they face from large doses of these drugs.

P.S. This is not Fratching material - everyone is agreeing. :-)

[MoonCat]

These people ARE addicts. Thank you for not giving in to them! You are living up to the oath that says, "Do no harm."

[RealUnimportant]

"You don't care about patients, you just want money!"

I love when they yell shit like this when you won't do what they want; it shows how little attention they're paying. If it was just a case of wanting to part them from their money then you'd be filling the scrips, because there's sure as hell no other way to get them to pay for anything!

[gerund]

our state and my employer have strict rules about prescribing controlled substances. They also apply to non-opioid stuff like benzodiazepines (Valium, Xanax etc) and ADD meds (Adderall, Ritalin etc).

Legal drugs are sometimes more dangerous than the illegal ones. Often the street drugs are diluted and sometimes they are talc power packaged like drugs. The legal drugs are always full strength (what it says on the packet) and ignoring the warnings (also on and in the packet) is easy. The warnings are in fine print, and it's easy to forget them.

I had cluster headaches at one stage of my life and became used to Panadol Forte and Mersyndol in large doses. 5 years after stopping them because the cluster headaches were gone, my doctor suggested I take some Panadol Forte for a sore throat.

Without thought or reading the packet I took them on an empty stomach, then passed out from the pain about 20 minutes later. That lead to head trauma from the fall and 5 days in hospital.

Now, those painkillers are not available without a prescription. At the time I nearly died I could buy them over the counter, and if I had wanted more it would have been easy to shop hop to get large amounts.

You are doing the right thing, not just because there is a law that says you must, but because those drugs (even though they are legal) are dangerous. The law simply gives you an excuse for not dispensing large quantities. Do not lose heart when you are abused. Addiction is a powerful force and addicts will say anything to get their fix.

[skeptic53]

I will try to stay out of fratching territory. Due to the quite-real, not-fake-news opioid crisis, our state and my employer have strict rules about prescribing controlled substances. They also apply to non-opioid stuff like benzodiazepines (Valium, Xanax etc) and ADD meds (Adderall, Ritalin etc). Patients have to sign an agreement, they are supposed to get 3 printed and signed refill prescriptions that have directions to the pharmacist about when they are to be filled. The Rx's are supposed to be for 28 days each, so the refills always come due during the week. They have to have an appointment to get refills. We don't refill controlled substances on weekends, even though our urgent-care clinic is open. Another rule, set by my employer, is that patients are not supposed to be on both opioids and benzodiazepines. We are supposed to be tapering people off one or the other, not continuing both, due to the risk of accidental death. Another big change is we are only supposed to give 3 day's worth of pills for minor injuries like sprains, a flare of chronic back pain, etc.

Well. You can imagine how this plays out with patients who want what they want, when they want it, in the quantities they have been used to getting. There are plenty of docs out there (some in my clinic) that are fine with early refills, higher quantities, and dangerous combinations continually refilled. I'm not. I freely admit my bias, I was married for 21 years to an alcoholic/addict. She has a master's degree, was working, dressed well, spoke well, and binged on alcohol and drugs. She would get a few here and a few there and have herself a party. Nearly died several times. It's harder to pull this off now, the state has an online database of all controlled substance prescriptions filled anywhere in the state. But many docs don't take the time to consult the database. Due to HIPPA it's pretty time-consuming to log on. My other bias is that no one ever died of back pain but they sure as hell die of combining sedating drugs, especially if they mix them with alcohol. Families of addicts go through a ton of psychological pain dealing with their loved one. If I don't know a patient well, I'm not going to bend the rules for them. Heck, I don't bend the rules for patients I DO know well! There are several safe regimens that can control pain well enough, just not as well as opiates do. I've successfully gotten quite a few people off or substantially reduced their opiates if they were willing to try. Opiates are the best at relieving pain BUT they increase the sensitivity of pain receptors and pain nerves, when the drug wears off, the pain is frequently much worse. Taper off opiates and the pain that needs to be treated is less intense, and frequently treatable without opiates. It's also amazing how people can quickly adapt to not having opiates that they "couldn't live without", when their employer suddenly starts drug testing everyone.

Anyway, this past week I had a lot of patients irate at me for not bending the rules. Nearly all of these folk are not drug-seeking addicts like my ex, but they have become dependent and are using too many pills, they are flirting hard with trouble. For some reason over half were people who had seen me once or twice before, I had told them how I do things, and they were back asking me to risk my job all over again. I'm polite and professional and express sympathy, but no. I find the arguments very stressful, I hate conflict. One guy was reaming me out for consulting the database and telling him I wouldn't prescribe because he was getting multiple prescriptions from multiple doctors, and he was asking for an early refill without telling me that. He was yelling "This is bullshit!" and trying to guilt-trip me, saying "You don't care about patients, you just want money!" and crap like that. What I want to do is shake them and say "Have you not heard of Dr. Feelgood down the street???! Go see him!! He'll give you what you want! Stop bothering me and stressing me out! READ MY LIPS, I LIKE KEEPING MY JOB! I DON"T BEND THE RULES!!" But I can't do that. I have to stay polite. I'm not allowed to dismiss patients from seeing me without a lengthy due-process involving multiple warnings. On the other hand, I'm monitored and part of my pay depends on following the prescribing rules. It's so similar to the clerks who must ID people for cigarettes and booze and get yelled at all the time. Fortunately for me it comes up much less often than for them.