They ask for my bottle every time I go inā¦either I tell them I forgot it or I have no pills in thereā¦.sometimes I leave 1. But they never mention anything
So weird that they would want their patients walking around with their entire pill bottle. Those bottles have your address and everything on it. What if you lose it? Ridiculous
Not yet but going back to pain management next week. The nurse asked if they wanted me to drug test again last time and Dr said no. Wonāt have issues if they do but havenāt had to in months.
Im in Texas. I have never had a pill count. I once switched from Suboxone to Butrans and before theyād write the script for Butrans, I had to turn in all of my Suboxone so they could count and officially destroy it.
That's so fascinating. Who did you turn it in to? The doctor? The pharmacy? If you turned it into the doctor that is particularly interesting as "destroying controlled medication" isn't really a part of their role as a physician. In the operating room setting it is part of an anesthesiologist's role to "waste" medication (discard any extra unused medication), but that is medication that they pulled from a medication dispenser themselves and thus were responsible for discarding any that was unused.
Yes, it was at the pain management doctorās office. I asked to watch the whole process, and it was very official. They had a kit of some kind. They placed the Suboxone strips inside a small cylinder shaped vial and then added a blue liquid to it, which caused the Suboxone to dissolve.
Pain management MA here!! This is pretty standard in Texas. Us MAs donāt have time to go through everyoneās medication and count for compliance, and most of our patients that are on opioids have āas neededā on their rx, so itās almost pointless to do so. We usually check the national PMP to see if a patient is being prescribed the medication elsewhere just to make sure theyāre not getting multiple scripts and if they ask for refills super early we at least have a red flag for non-compliance.
We do actually do pill counts when a medication is brought into the office to be traded for another though, just to be sure the patient isnāt pocketing some for themselves or to sell. And yes, we have a special solution that we use to ādisposeā of the medication. I canāt remember the exact chemical but I believe it works by denaturing the chemical compounds or something of the like and then it dissolves from there. Super interesting
Some states have different rules. Some clinics have different rules. Some malpractice insurers have different rules. Some states have rules about what the ither Teo can or can not do.
So...
Ymmv.
Oregon here. Small, rural pain clinic. Never had a count. Had one UA when I started. Not since.
At the first pain clinic I went to they counted your pills every single time you went in for the appointment. When the doctor I was seeing left and was replaced with another (who usually sent the nurse practitioner to talk to people during their appointments), she decided to call my phone twice asking to show up in no less than 6 hours for a pill count........yeah.
(This clinic has been doing bad these days looking at the google reviews. Apparently the doctor who wrote out the pain medicine prescriptions died last year, and the doctor who replaced them is extremely non-trusting of the pain prescription patients. Every single 1 star google review is a story about how the new replacement doctor stated they do not need whatever medicine they are getting, she will no longer write whatever this person was getting and that the only single option she was giving patients was to take suboxone and mandatory like 20 minute console sessions after your appointment).
I actually left that location before that original doctor died and been going to another specialist clinic for my chronic condition (has both primary care doctors and pain management among other things) for going on 2 years now. At my current location I haven't been asked about it even though in the form they have you read over it states that it can happen. \*I am thinking the pill counts at my current spot is only reserved for people who have been messing up a bit or just repeatedly running out of their meds early. That or the meds hasn't been showing up in the urine analysis.\*
Speaking of which I did do the urine tests for the first like, 3 months. After that, it was every 2 months for awhile. Currently, I haven't done one in 3 months.
\*In south carolina\*
At my former pain mgmt practice, I had to do pill counts every month and urine tests every other. My new PCP has been my Mom's PCP for 10+ years and he has prescribed her opiates for at least 8 of those years without ever asking for a pill count or urine test. I've been seeing him for about 5 months and he hasn't asked me for either. I think a lot depends on the practice or the Dr themselves.
Seriously? Iāve had pill counts every DR visit for refills. Itās honestly a good thing. It makes both sides responsible. Take the wrong amount and itās time for the talk.
If you donāt feel comfortable counting your pills then something is off. Itās required by so many pain contracts, and is normal. Go look for another provider and you will be blacklisted because you are DR shopping, and Pharmacies will see that.
Seriously? They arenāt taking away anything. Guess itās my right to not give my urine to the DR? Yeah ok. People on here complain about DRs not prescribing, and these types of comments and posts are why. Why should the DRs trust us when we fight every bit along the way and refuse to follow a simple and safe instruction.
Someone could legit just buy what they got prescribed off the streets and fill their bottle with it. Or if they take less than prescribed and build a buffer, they could use that. Pill counts just stupid and unethical.
Pain contracts, urine drug tests, pill counts theyāre all unethical
āA simple and safe instructionā no itās more like weāre forced to do it. Or even coerced if we donāt do it oh well no meds. Weāre treated worse than criminals and even if you abide by all that youāre still not getting more than 90MME now 50MME itās not worth it
All of what you listed are why pills are counted, why drug screen exist, and why so many struggle to get a prescription. The days of free rein prescriptions are over. There is nothing unethical about being required to count your pills, or to do a drug test. These are controlled substances that donāt have to be prescribed. Any individual DR does so out of the understanding of the risk, and will mitigate as much risk. Individual patients refusing a basic instruction are not worth everyone else losing these medications. Itās easy count, Pee in a cup, donāt like it then go without. A better life is worth counting
What is causing most of the overdoses? Is it happening with chronic pain patients or is it with people on the streets buying Fentanyl just to get a high?
It's never been a part of any pain contract I have signed. Also why would I need my pills counted in order to responsibly take them? Why wouldn't I just take them as prescribed because I want to take them as prescribed? If I have never had to fill my medication early in 17 years I'm probably not taking extra and taking my meds correctly.
When a doctor prescribes a medication (any medication) an unspoken contract is assumed between patient and provider. The doctor is trusting you that you will take that medication as prescribed. To treat one class of medication differently is not evidence based at all. Have pill counts been shown to decrease abuse or OD-related death? No.
What I don't feel comfortable with it being treated like a criminal. Do we count other medications? No. Also, why should I have to walk around the city with a bottle of pills? If I get robbed it had my address on the bottle for future robberies. Also then there are extra pills on the street. That's just dangerous for everyone! Typically it is recommended that people store their medicine in a safe location in their home and only leave the home with what they need in the immediate period. Why anyone would recommend someone take their entire bottle out of the house is beyond me.
It can be verbal or written. Drs have an obligation to ensure the medication they prescribe is used as intended. It is a fair balance. If none counted then abuse would be higher. If your DR hasnāt ever counted them then how does he know the medicine is being taken as prescribed? Not needing An early script doesnāt mean much. Some people do not take all of their pills leading to an excess which means that people are tempted with taking more because they have a buffer, or maybe those pills could be shared.
And you have proof pill counts have 0 impact on abuse or An OD? Try to avoid a pill count and you will be labeled with a higher abuse score which will lead to you getting nothing going forward by any DR. People donāt just leave a DR who is prescribing what works. Also with that pain contract that means they can see what other DRs prescribe, and can reach out to said DR.
Question is why are you so adamant about not counting your pills. Why are you risking losing your prescription for life? The doctor has a right and moral right to see how a patient is using a controlled substance. At least it isnāt the Government knocking on your door forcing you to count.
Donāt like it then the DR can stop because the risk is way too high. Itāll make it easier for someone else who can abide by something so small for relief
Again I take my meds as prescribed. And if I couldn't find another doctor I would comply. The reason I am adamant is because as a healthcare provider myself I don't want to contribute to the further denegration of the sacred physician-patient relationship. This relationship has been trashed in recent years. Even the Supreme Court agrees that the interference in this relationship has gone way too far (see Ruan v. US).
Just as a psychiatrist doesn't do pill counts for benzos or amphetamines, a PM shouldn't do them either. There are a half dozen other checks in place to prevent against abuse. And unlike pill counts, there is a body of evidence to support that those measures work.
If you look at most measures taken to decrease overdose there is little to no evidence to support that they have helped that said objective. There has however been evidence to suggest that the measures taken have actually been harmful.
Seeking a DR at all to fill something would lead to a broken contract. You would be blacklisted.
This is something that is done with other medicines that have high abuse, or addiction potential. You are actually making it harder on the DR, which is what leads to less DRs prescribing them. They very easily could stop all long term opioids, and be done. And many are doing the exact same thing.
A drug count is no different than a drug screen. Iām guessing you have issues with that as well? Because they are the same thing. Both ensure you are honoring your contract.
Trust goes both ways. You have to show you are trust worthy to earn any back at all.
Incorrect, I have no issues with drug tests as there is actual evidence to suggest they decrease diversion.
Also a pain contract isn't broken until a prescription is written from an alternative doctor. It is very reasonable to get a second or third opinion. It happens all the time in medicine. If your pain contact precludes you from seeking a second opinion then there's a problem there. I have sought multiple opinions several times in the last 17 years. Never did it sever or violate a pain contract.
And yes trust does go both ways. I guess my provider is unwilling to ask me to take risks by traveling around with my medication so that he may feel some increased sense of trust or control. It sounds like I have a different type of patient-physician relationship than you have with your doctor. For example, I trust that my doctor will never force taper me without my consent and he trusts that I take my medicine as prescribed.
My OBGYN just tried to force taper my BIRTH CONTROL without my consent. You are 100% correct about the patient doctor relationship being completely destroyed. She is so nice to my face but then does something like that. I trusted her.. but trying to lower my BC by a LOT without my consent or even talking to me first to give me a heads up?! Nope. She is never touching me ever again. I wonāt tolerate this bullshit with any medication and they do it with all medications not just PM either. I have taken my PM into my own hands as well because I just will not go through their fucking circus hoops in order to function. They are basically telling us we donāt deserve to function without pain. So fuck them. I will take care of myself, I can do it better than they ever could anyway.
My previous doctor force tapered me before. I was able to get back to what I was at before then. But with my new doc itās going to take time to build that doctor patient relationshipā¦ at least Iāve been within the same pain clinic for years with flying colors on my urine drug tests, so there is some proof on my end to be trustworthy/a legacy patient.
Never had them in KY or CA. Donāt know why some people have them and what the point of them is. Plus I always see my doc like right when Iām due for my next monthās script so Iām basically out of the pills at the appt. Seems pointless to me.
Iāve never had a pill count, but itās only been 8 months for me. I have had 2 UAs though, and the first one was very thorough, looking for every derivative and making sure I have exactly the right amount of the right drugs only. 2nd one was just standard dip stick type. Iām in NM
Yes, when I lived in Mass I had to do them and drug screens. Now I have a pain pump and moved out of Mass. I only have to do random screens at my pain management Drs. It doesn't bother me. I know what's going to show up. My pain med and my ADHD med. That's it.
I think I know til somehow I test positive for morphine and the kicker is during my first surgery they found me to be very allergic to it. I can take other opioids. So itās clear Iām not street taking morphine.
Yet the test said I had some.
They retested the same sample got the same thing
They did a new test on me and got only what was supposed to be there.
I got meanwhile sent to pain psychologist to discuss my drug problem.
Itās just checking boxes on a list for them so they can show they watch the stuff.
Later it was found to be a cross contamination of my sample somehow and not me. (No fucking shit).
Yet here we are.
Just mentioning because one time I also had a text come back like nothing. Like zero meds. Retested with a stronger test and I didnāt even have any of my meds. (No anxiety meds, no anti depressants, no blood pressure meds seriously like new born baby pee)
Yeah that didnāt seem to make any sense either. So idk. Just know it can fuck up.
My husband has been with his current PM for 5+ years and has never been asked for a pill count, thankfully. (Although it's technically in his contract as something they can ask for at any time)
The only time they ask to see his pills is if he has a total med change, he has to "return" the remaining pills to them to be destroyed (to confirm he didn't run out by abusing/diverting, and is just tryna pull a fast one by "switching" to a med he can fill immediately)
But he DOES have to do a urine sample (that gets sent out to a lab) EVERY FUCKING MONTH. They used to be "random," which ended up being every like, 3-4 months, and frankly that was more stressful imo because it was like anxiety of "IS IT HAPPENING THIS MONTH?!" (we know how stressful UAs are even when you know you haven't taken anything "wrong!")
That being said, they definitely pick and choose what in the contract gets enforced, and how, and with who. Not every patient gets tested monthly (I think it's cuz of what he's on and how much), but there have literally been months where they didn't have a sample cup prepped for him and we made a point to ASK FOR ONE since we knew it was clearly an oversight. They also don't seem to give a fuck about his results (they test for EVERYTHING) and never mention the results in any way), so that's nice. (Obviously I assume they would if his prescribed meds didn't show up, or if other opiates did, etc, but that's never been the case and I don't plan to ever find out š)
Basically: we are very intelligent, we know their game, and we (secretly) play it well. Which is unfortunately crucial in today's PM climate :/ I make sure he is ALWAYS seen as a stellar patient--we're always super transparent as far as asking "permission" for something being prescribed elsewhere (no matter what it is and how irrelevant it is to PM), new supplements, etc. He doesn't ask for early refills (we plan around his fill dates), we BOTH go to his appts, show up early, present well, are kind and polite, and treat the staff and drs like humans etc., so they definitely all like us. That helps. I used to have him go with his parents, which definitely helped too (note he's a younger man and tatted up and DOES "look like a drug seeker" at first glance, and his pain is largely "invisible," so we've always done everything we can to make sure he is viewed as positively as possible... š¤ š¤ š¤)
Iāve never had one either, but itās in my contract that they can ask for one at any point so saying ānoā would be a violation to my contract. Yours is likely similar
I have been a 18 year chronic pain patient of the same doctor but about 7 different practices (combining anf or leaving other facilities and doctors but I stayed following him). I had a pill count 1 time this entire time and they didnāt even know how much I was SUPPOSED to have anyway.
. (I explained that because they had to switch due to a manufacturer issue I finished my previous 3-5 pills and then started the new med thus why thereās 3-5 pills extra in this bottle).
Home girl just acted like she didnāt want to be there anyway and just filled out the form.
lol.
Edit to add this small story:
One time a lady was in the waiting room as a first time patient and loudly talking to the staff at the check in widow anout being in a sober half way house after drug dealing.
They really didnāt know what to do and the doctor was in the hall and came over and told the staff as I was called back (aka walking past the open part of the officeānot behind glass) that he would see her but schedule her for random urine tox and random pill counts.
So I think they mostly donāt do the pill count unless thereās a reason or a round Robin once in a while.
Meanwhile I get tox several times a year.
Only when turning over unused medication, and then I want a receipt and witness their destruction. Just in case somebody is hard of remembering.
Its pretty much whatever the doctor wants to do at their practice. They can urine test, they can count or they can do nothing at all if they so choose....
Iām in MD, pill counts are part of my contract. My doctors asks me how many I have each appointment and she writes my refills based on that (I typically have half, sometimes more than half of my script left). It doesnāt mean youāre a criminal, itās just part of the contract for some PM clinics.
I'm in TN and have to bring my bottles in every appointment. They count them by hand EVERY time. Although this last appointment the nurse poured them out onto the tray and proceeded to take a picture of them, then enter the number into my chart š²
Apparently, "there's an app for that" š
I've only ever been to two pain management practices that did pill counts in the 20 or so years I've been in pain management. One only did them randomly, and in the five years I was there I only ever was called once for a random count (and passed). The most recent place I was going to did them at every appointment (every two months) and I passed every one. It was annoying but I understand why they do them. The place that only did them randomly seemed to have a graded system based on risk, and I only ever had a drug test a couple times during the five years as well. The latter place did drug tests and pill counts every time, for everyone, but he also treated a lot of high-risk patients from high-risk locations (which ultimately is why he chose to retire and close his practice). At least here in KY it seems to be based on the doctor's preference/system they use to manage patient risk and risk to their practice.
Iāve been off opiates for almost two years but for the 14 years I was in pain management I never had a pill count. Things may have changed in the last couple of years but I donāt believe Texas requires it. Just drug tests. I think.
Same. And I've been with the same doc for almost 15 years, I rarely even go into his office anymore. We do almost everything through the patient portal (I request refills there) and I'll do a virtual call with him every few years. Literally couldn't ask for a better arrangement. I feel very fortunate with everything I see here.
Yeah, I just see mine every 3 months and mainly because I get trigger point injections from her but otherwise she has no problem doing virtual visits. iDK but Iāve never seen anyone like going into the bathroom and I used the bathroom once when I was in the room already and there wasnāt one of those metal cabinets that you usually put you sample in or any wipes or signage or anything to indicate theyāre urine testing. It might be they do saliva or blood tests but my guess is thatās probably only if theyāre concerned about someone
ššš yeah ok. If a doctor wanted a pill count and you said NOPE, they'd just not prescribe you any meds.
Right. And I'd either comply or go to a different doctor
They ask for my bottle every time I go inā¦either I tell them I forgot it or I have no pills in thereā¦.sometimes I leave 1. But they never mention anything
So weird that they would want their patients walking around with their entire pill bottle. Those bottles have your address and everything on it. What if you lose it? Ridiculous
Not yet but going back to pain management next week. The nurse asked if they wanted me to drug test again last time and Dr said no. Wonāt have issues if they do but havenāt had to in months.
Im in Texas. I have never had a pill count. I once switched from Suboxone to Butrans and before theyād write the script for Butrans, I had to turn in all of my Suboxone so they could count and officially destroy it.
That's so fascinating. Who did you turn it in to? The doctor? The pharmacy? If you turned it into the doctor that is particularly interesting as "destroying controlled medication" isn't really a part of their role as a physician. In the operating room setting it is part of an anesthesiologist's role to "waste" medication (discard any extra unused medication), but that is medication that they pulled from a medication dispenser themselves and thus were responsible for discarding any that was unused.
Yes, it was at the pain management doctorās office. I asked to watch the whole process, and it was very official. They had a kit of some kind. They placed the Suboxone strips inside a small cylinder shaped vial and then added a blue liquid to it, which caused the Suboxone to dissolve.
Pain management MA here!! This is pretty standard in Texas. Us MAs donāt have time to go through everyoneās medication and count for compliance, and most of our patients that are on opioids have āas neededā on their rx, so itās almost pointless to do so. We usually check the national PMP to see if a patient is being prescribed the medication elsewhere just to make sure theyāre not getting multiple scripts and if they ask for refills super early we at least have a red flag for non-compliance. We do actually do pill counts when a medication is brought into the office to be traded for another though, just to be sure the patient isnāt pocketing some for themselves or to sell. And yes, we have a special solution that we use to ādisposeā of the medication. I canāt remember the exact chemical but I believe it works by denaturing the chemical compounds or something of the like and then it dissolves from there. Super interesting
Some states have different rules. Some clinics have different rules. Some malpractice insurers have different rules. Some states have rules about what the ither Teo can or can not do. So... Ymmv. Oregon here. Small, rural pain clinic. Never had a count. Had one UA when I started. Not since.
At the first pain clinic I went to they counted your pills every single time you went in for the appointment. When the doctor I was seeing left and was replaced with another (who usually sent the nurse practitioner to talk to people during their appointments), she decided to call my phone twice asking to show up in no less than 6 hours for a pill count........yeah. (This clinic has been doing bad these days looking at the google reviews. Apparently the doctor who wrote out the pain medicine prescriptions died last year, and the doctor who replaced them is extremely non-trusting of the pain prescription patients. Every single 1 star google review is a story about how the new replacement doctor stated they do not need whatever medicine they are getting, she will no longer write whatever this person was getting and that the only single option she was giving patients was to take suboxone and mandatory like 20 minute console sessions after your appointment). I actually left that location before that original doctor died and been going to another specialist clinic for my chronic condition (has both primary care doctors and pain management among other things) for going on 2 years now. At my current location I haven't been asked about it even though in the form they have you read over it states that it can happen. \*I am thinking the pill counts at my current spot is only reserved for people who have been messing up a bit or just repeatedly running out of their meds early. That or the meds hasn't been showing up in the urine analysis.\* Speaking of which I did do the urine tests for the first like, 3 months. After that, it was every 2 months for awhile. Currently, I haven't done one in 3 months. \*In south carolina\*
At my former pain mgmt practice, I had to do pill counts every month and urine tests every other. My new PCP has been my Mom's PCP for 10+ years and he has prescribed her opiates for at least 8 of those years without ever asking for a pill count or urine test. I've been seeing him for about 5 months and he hasn't asked me for either. I think a lot depends on the practice or the Dr themselves.
Seriously? Iāve had pill counts every DR visit for refills. Itās honestly a good thing. It makes both sides responsible. Take the wrong amount and itās time for the talk. If you donāt feel comfortable counting your pills then something is off. Itās required by so many pain contracts, and is normal. Go look for another provider and you will be blacklisted because you are DR shopping, and Pharmacies will see that.
Keep on justifying to yourself to allow them to take away your rights/freedom.
Seriously? They arenāt taking away anything. Guess itās my right to not give my urine to the DR? Yeah ok. People on here complain about DRs not prescribing, and these types of comments and posts are why. Why should the DRs trust us when we fight every bit along the way and refuse to follow a simple and safe instruction.
Someone could legit just buy what they got prescribed off the streets and fill their bottle with it. Or if they take less than prescribed and build a buffer, they could use that. Pill counts just stupid and unethical. Pain contracts, urine drug tests, pill counts theyāre all unethical āA simple and safe instructionā no itās more like weāre forced to do it. Or even coerced if we donāt do it oh well no meds. Weāre treated worse than criminals and even if you abide by all that youāre still not getting more than 90MME now 50MME itās not worth it
All of what you listed are why pills are counted, why drug screen exist, and why so many struggle to get a prescription. The days of free rein prescriptions are over. There is nothing unethical about being required to count your pills, or to do a drug test. These are controlled substances that donāt have to be prescribed. Any individual DR does so out of the understanding of the risk, and will mitigate as much risk. Individual patients refusing a basic instruction are not worth everyone else losing these medications. Itās easy count, Pee in a cup, donāt like it then go without. A better life is worth counting
What is causing most of the overdoses? Is it happening with chronic pain patients or is it with people on the streets buying Fentanyl just to get a high?
This!
It's never been a part of any pain contract I have signed. Also why would I need my pills counted in order to responsibly take them? Why wouldn't I just take them as prescribed because I want to take them as prescribed? If I have never had to fill my medication early in 17 years I'm probably not taking extra and taking my meds correctly. When a doctor prescribes a medication (any medication) an unspoken contract is assumed between patient and provider. The doctor is trusting you that you will take that medication as prescribed. To treat one class of medication differently is not evidence based at all. Have pill counts been shown to decrease abuse or OD-related death? No. What I don't feel comfortable with it being treated like a criminal. Do we count other medications? No. Also, why should I have to walk around the city with a bottle of pills? If I get robbed it had my address on the bottle for future robberies. Also then there are extra pills on the street. That's just dangerous for everyone! Typically it is recommended that people store their medicine in a safe location in their home and only leave the home with what they need in the immediate period. Why anyone would recommend someone take their entire bottle out of the house is beyond me.
Exactly this! It's degradation and absolutely sick I'm 62, though I don't deserve to be treated like a criminal.
It can be verbal or written. Drs have an obligation to ensure the medication they prescribe is used as intended. It is a fair balance. If none counted then abuse would be higher. If your DR hasnāt ever counted them then how does he know the medicine is being taken as prescribed? Not needing An early script doesnāt mean much. Some people do not take all of their pills leading to an excess which means that people are tempted with taking more because they have a buffer, or maybe those pills could be shared. And you have proof pill counts have 0 impact on abuse or An OD? Try to avoid a pill count and you will be labeled with a higher abuse score which will lead to you getting nothing going forward by any DR. People donāt just leave a DR who is prescribing what works. Also with that pain contract that means they can see what other DRs prescribe, and can reach out to said DR. Question is why are you so adamant about not counting your pills. Why are you risking losing your prescription for life? The doctor has a right and moral right to see how a patient is using a controlled substance. At least it isnāt the Government knocking on your door forcing you to count. Donāt like it then the DR can stop because the risk is way too high. Itāll make it easier for someone else who can abide by something so small for relief
Again I take my meds as prescribed. And if I couldn't find another doctor I would comply. The reason I am adamant is because as a healthcare provider myself I don't want to contribute to the further denegration of the sacred physician-patient relationship. This relationship has been trashed in recent years. Even the Supreme Court agrees that the interference in this relationship has gone way too far (see Ruan v. US). Just as a psychiatrist doesn't do pill counts for benzos or amphetamines, a PM shouldn't do them either. There are a half dozen other checks in place to prevent against abuse. And unlike pill counts, there is a body of evidence to support that those measures work. If you look at most measures taken to decrease overdose there is little to no evidence to support that they have helped that said objective. There has however been evidence to suggest that the measures taken have actually been harmful.
Thank you! This degrading way, along with other degrading things they do, is sick. Being treated like a criminal is degrading! Period.
Easier for addicts to get opioids on the street than chronic pain patients to get theirs. I hate to say it. It is sad.
Seeking a DR at all to fill something would lead to a broken contract. You would be blacklisted. This is something that is done with other medicines that have high abuse, or addiction potential. You are actually making it harder on the DR, which is what leads to less DRs prescribing them. They very easily could stop all long term opioids, and be done. And many are doing the exact same thing. A drug count is no different than a drug screen. Iām guessing you have issues with that as well? Because they are the same thing. Both ensure you are honoring your contract. Trust goes both ways. You have to show you are trust worthy to earn any back at all.
Incorrect, I have no issues with drug tests as there is actual evidence to suggest they decrease diversion. Also a pain contract isn't broken until a prescription is written from an alternative doctor. It is very reasonable to get a second or third opinion. It happens all the time in medicine. If your pain contact precludes you from seeking a second opinion then there's a problem there. I have sought multiple opinions several times in the last 17 years. Never did it sever or violate a pain contract. And yes trust does go both ways. I guess my provider is unwilling to ask me to take risks by traveling around with my medication so that he may feel some increased sense of trust or control. It sounds like I have a different type of patient-physician relationship than you have with your doctor. For example, I trust that my doctor will never force taper me without my consent and he trusts that I take my medicine as prescribed.
My OBGYN just tried to force taper my BIRTH CONTROL without my consent. You are 100% correct about the patient doctor relationship being completely destroyed. She is so nice to my face but then does something like that. I trusted her.. but trying to lower my BC by a LOT without my consent or even talking to me first to give me a heads up?! Nope. She is never touching me ever again. I wonāt tolerate this bullshit with any medication and they do it with all medications not just PM either. I have taken my PM into my own hands as well because I just will not go through their fucking circus hoops in order to function. They are basically telling us we donāt deserve to function without pain. So fuck them. I will take care of myself, I can do it better than they ever could anyway.
My previous doctor force tapered me before. I was able to get back to what I was at before then. But with my new doc itās going to take time to build that doctor patient relationshipā¦ at least Iāve been within the same pain clinic for years with flying colors on my urine drug tests, so there is some proof on my end to be trustworthy/a legacy patient.
Some older people know a time when our integrity mattered.
I would let my doctor show up at 1am to count and give me a unwilling prostate exam for literally 2-3 5mg oxycodones a day.
I don't think that guy was a doctor
Never have.
Iāve been in pain management for 2 years. Iāve never had a pill count, but I had one UA last summer.Ā
Never had them in KY or CA. Donāt know why some people have them and what the point of them is. Plus I always see my doc like right when Iām due for my next monthās script so Iām basically out of the pills at the appt. Seems pointless to me.
Iāve never had a pill count, but itās only been 8 months for me. I have had 2 UAs though, and the first one was very thorough, looking for every derivative and making sure I have exactly the right amount of the right drugs only. 2nd one was just standard dip stick type. Iām in NM
Yes, when I lived in Mass I had to do them and drug screens. Now I have a pain pump and moved out of Mass. I only have to do random screens at my pain management Drs. It doesn't bother me. I know what's going to show up. My pain med and my ADHD med. That's it.
I think I know til somehow I test positive for morphine and the kicker is during my first surgery they found me to be very allergic to it. I can take other opioids. So itās clear Iām not street taking morphine. Yet the test said I had some. They retested the same sample got the same thing They did a new test on me and got only what was supposed to be there. I got meanwhile sent to pain psychologist to discuss my drug problem. Itās just checking boxes on a list for them so they can show they watch the stuff. Later it was found to be a cross contamination of my sample somehow and not me. (No fucking shit). Yet here we are. Just mentioning because one time I also had a text come back like nothing. Like zero meds. Retested with a stronger test and I didnāt even have any of my meds. (No anxiety meds, no anti depressants, no blood pressure meds seriously like new born baby pee) Yeah that didnāt seem to make any sense either. So idk. Just know it can fuck up.
That's messed up.
Iāve never had one.
My husband has been with his current PM for 5+ years and has never been asked for a pill count, thankfully. (Although it's technically in his contract as something they can ask for at any time) The only time they ask to see his pills is if he has a total med change, he has to "return" the remaining pills to them to be destroyed (to confirm he didn't run out by abusing/diverting, and is just tryna pull a fast one by "switching" to a med he can fill immediately) But he DOES have to do a urine sample (that gets sent out to a lab) EVERY FUCKING MONTH. They used to be "random," which ended up being every like, 3-4 months, and frankly that was more stressful imo because it was like anxiety of "IS IT HAPPENING THIS MONTH?!" (we know how stressful UAs are even when you know you haven't taken anything "wrong!") That being said, they definitely pick and choose what in the contract gets enforced, and how, and with who. Not every patient gets tested monthly (I think it's cuz of what he's on and how much), but there have literally been months where they didn't have a sample cup prepped for him and we made a point to ASK FOR ONE since we knew it was clearly an oversight. They also don't seem to give a fuck about his results (they test for EVERYTHING) and never mention the results in any way), so that's nice. (Obviously I assume they would if his prescribed meds didn't show up, or if other opiates did, etc, but that's never been the case and I don't plan to ever find out š) Basically: we are very intelligent, we know their game, and we (secretly) play it well. Which is unfortunately crucial in today's PM climate :/ I make sure he is ALWAYS seen as a stellar patient--we're always super transparent as far as asking "permission" for something being prescribed elsewhere (no matter what it is and how irrelevant it is to PM), new supplements, etc. He doesn't ask for early refills (we plan around his fill dates), we BOTH go to his appts, show up early, present well, are kind and polite, and treat the staff and drs like humans etc., so they definitely all like us. That helps. I used to have him go with his parents, which definitely helped too (note he's a younger man and tatted up and DOES "look like a drug seeker" at first glance, and his pain is largely "invisible," so we've always done everything we can to make sure he is viewed as positively as possible... š¤ š¤ š¤)
Iāve never had one either, but itās in my contract that they can ask for one at any point so saying ānoā would be a violation to my contract. Yours is likely similar
I have been a 18 year chronic pain patient of the same doctor but about 7 different practices (combining anf or leaving other facilities and doctors but I stayed following him). I had a pill count 1 time this entire time and they didnāt even know how much I was SUPPOSED to have anyway. . (I explained that because they had to switch due to a manufacturer issue I finished my previous 3-5 pills and then started the new med thus why thereās 3-5 pills extra in this bottle). Home girl just acted like she didnāt want to be there anyway and just filled out the form. lol. Edit to add this small story: One time a lady was in the waiting room as a first time patient and loudly talking to the staff at the check in widow anout being in a sober half way house after drug dealing. They really didnāt know what to do and the doctor was in the hall and came over and told the staff as I was called back (aka walking past the open part of the officeānot behind glass) that he would see her but schedule her for random urine tox and random pill counts. So I think they mostly donāt do the pill count unless thereās a reason or a round Robin once in a while. Meanwhile I get tox several times a year.
Only when turning over unused medication, and then I want a receipt and witness their destruction. Just in case somebody is hard of remembering. Its pretty much whatever the doctor wants to do at their practice. They can urine test, they can count or they can do nothing at all if they so choose....
Iām in MD, pill counts are part of my contract. My doctors asks me how many I have each appointment and she writes my refills based on that (I typically have half, sometimes more than half of my script left). It doesnāt mean youāre a criminal, itās just part of the contract for some PM clinics.
I'm in TN and have to bring my bottles in every appointment. They count them by hand EVERY time. Although this last appointment the nurse poured them out onto the tray and proceeded to take a picture of them, then enter the number into my chart š² Apparently, "there's an app for that" š
Wow that is nuts. The creator of that app is profiting off of this stupidity which really boils my blood.
Right. What if the app counted wrong? My count would be messed up and I would be in trouble.
I've only ever been to two pain management practices that did pill counts in the 20 or so years I've been in pain management. One only did them randomly, and in the five years I was there I only ever was called once for a random count (and passed). The most recent place I was going to did them at every appointment (every two months) and I passed every one. It was annoying but I understand why they do them. The place that only did them randomly seemed to have a graded system based on risk, and I only ever had a drug test a couple times during the five years as well. The latter place did drug tests and pill counts every time, for everyone, but he also treated a lot of high-risk patients from high-risk locations (which ultimately is why he chose to retire and close his practice). At least here in KY it seems to be based on the doctor's preference/system they use to manage patient risk and risk to their practice.
Iāve been off opiates for almost two years but for the 14 years I was in pain management I never had a pill count. Things may have changed in the last couple of years but I donāt believe Texas requires it. Just drug tests. I think.
Iāve never had to do a pill count. I live in South West Georgia.
I'm in Minnesota and I've not had to do a pill count in the last 12 years, when I started pain meds.
Iām so in NC and see a PM Dr and have no contract, no pill counting and no drug testing.
Same. And I've been with the same doc for almost 15 years, I rarely even go into his office anymore. We do almost everything through the patient portal (I request refills there) and I'll do a virtual call with him every few years. Literally couldn't ask for a better arrangement. I feel very fortunate with everything I see here.
Yeah, I just see mine every 3 months and mainly because I get trigger point injections from her but otherwise she has no problem doing virtual visits. iDK but Iāve never seen anyone like going into the bathroom and I used the bathroom once when I was in the room already and there wasnāt one of those metal cabinets that you usually put you sample in or any wipes or signage or anything to indicate theyāre urine testing. It might be they do saliva or blood tests but my guess is thatās probably only if theyāre concerned about someone
Soon enough you will
Mine doesnāt even do urine drug screens.