Pain Advocacy Coalition

www.painadvocacycoalition.com/

Pain  Advocacy Coalition is a loose knit collaborative group of patients who live with intractable pain. We are your co-workers, neighbors, friends, and family members. We are a collaborative group of former police officers, former nurses, researchers, technical writers, social media consultants, medical assistants and other varied professional backgrounds. We all share one common bond, we live with chronic pain daily, and many of us use opioids as a treatment modality to help us manage our pain effectively. We are not a volunteer organization. We are a tribe of individuals who are crowd-sourcing a solution to a common problem impacting our lives via collaborative tools. We are inviting the pain community to participate.

The medical administration of opioids for analgesia are utilized in tandem with other medical treatments, individualized to the patient’s needs, and are implemented only when other treatments are not successful for relieving pain. The use of prescribed opioid analgesia permits us to successfully participate in activities of daily living and to meet our obligations.

Opioids, when used as an analgesic, allow us to redeem some quality of life from intractable pain. Often, we experience only partial relief from analgesics. We are not able to participate in our lives at the same capacity as we once did prior to becoming pain patients. However, without opioid analgesics, many of us would decline further, experience decreased mobility, increased pain, decreased productivity and other negative outcomes.

The “opioid crisis” and the implementation of draconian policies by Center for Disease Control (CDC) that restrict prescribing opioids for legitimate pain patients have mobilized the pain community to coalesce and address the negative impact these policies have had on our community.

The Pain Advocacy Coalition grassroots movement is dedicated to addressing the “opioid crisis” by:

• raising public awareness about the impact of pain on patients, both acute and chronic
• bringing transparency to the negative impact the Center for Disease Control’s guidelines have had on the pain community and their healthcare providers
• challenging the status quo and empowering pain patients to utilize collaborative tools and platforms
• participating in a national conversation about our healthcare decisions that previously the pain community has largely been excluded from
• restoring the patient- physician- pharmacist relationship
• preventing detrimental special interest and government interference in the provision of medical care
• challenging stigma, discrimination, profiling, narrow narrative and marginalization that contribute to the obstacles and barriers that pain patients experience
• challenging the media to to offer the public balanced reporting about the “opioid crisis” including equal time outlining the impact to pain patients (acute/ chronic) and the medical community at large
• challenging the methods by which data is obtained, research is conducted, how research is funded and how statistics are being utilized to make individual medical decisions from a board room, a legislative office, third party administrator’s office or an oversight office

We intend to bring transparency to restrictive policies that are not thought of as patient-centric, but are more accurately described as profit driven. For a more expansive examination of this complex issue, check out the Pain Advocacy Coalition’s Platform.

For an expanded look at the issues pain patients across the country are facing check out this recent news report by I-team reporter George Knapp and his fellow reporters courtesy of LasVegasNow- KLAS-TV-8 report published on December 1, 2017.

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This bullshit with the DEA is getting totally out of hand! I had to go see my psychiatrist today and without me saying anything he brought up the fact that most of his peers are getting afraid to write for any controls and most definitely will not prescribe benzo’s anymore out of fear of the DEA coming down on them. He told me in his line of medicine benzo’s are a common medicine to use in conjunction with other medicines and he can’t believe his peers are stopping writing for them out of fear!

Jeff Walsh, DEA Asst. Special Agent, sits down with WESH 2’s Matt Grant to discuss issues patients are having getting legitimate prescriptions filled.

The above video is from Feb, 2015 and the reporter ( Matt Grant) from WESH TV in Orlando did a couple of dozen pieces on pharmacists in FL refusing to fill controlled med prescriptions.  Agent Walsh states that the DEA wants pts who have a legit medical need for being prescribed controlled substances that they should be able to get them.  Is there a DISCONNECT between those within the DEA who are in administration and those that are “out in the field” as to the real focus of the DEA ?

These physicians that has been treating pts for years or decades and all of a sudden decided that they are no longer going to prescribe control meds to their pts…

The Questions has to asked.. if a prescriber has been writing a particular medication for a pt for years/decades and now decides that the pt no longer needs that particular medication or any similar medication… Has the prescriber been guilty of malpractice and other issues for all those years the pt has been provided the medication or is the prescriber now walking down a path of malpractice by stopping prescribing the medication.

Was there NO CLINICAL PROOF for all those years the pt was taking the medication that it was really not needed ?  OR… is the prescriber now ignoring previous clinical evidence that the pt really had a valid medical necessity for the medication that they had been taking all that time and now refusing to treat the pt’s medical needs.  As we all know, chronic disease states typically don’t become “cured/improve” over time.

Those prescribers who are only reducing/eliminating controlled meds on pts that are/have been dealing with multiple disease issues … could be painting themselves into a corner for pt discrimination under the Americans with Disability Act, Civil Rights Act, pt abuse, medical battery for starters.  They are going to have trouble defending themselves in our court system with prefacing every statement with “in my professional opinion” to justify what they had done – or not done – for/to the pt.

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Theft at the Rx counter ?

After I made the above post, it got me to thinking just how many ways that  if a Rx dept staff was determined to divert medication from the Rx dept, just how it could be done while keeping the chances of getting caught to a minimum.

Anyone can go to just about any state’s Board of Pharmacy’s meeting minutes posted on the web and see where a Pharmacist or technician is before the board for diversion of controlled meds.

Clearly the Rx depts across this country are not completely full of a bunch of “saints”

I have had pts tell me about pharmacists doing everything from doing a partial fill .. claiming that is all they have on hand… to confiscating the pt’s prescription and claiming that they are destroying it and “tear it up” in front of the pt.

If a Pharmacist tells the pt that “half” of the amount the prescription is written for is all that is in stock and it is a “take it or leave it” situation. No pharmacy is going to have on hand 100% of the time the medication and quantity for every prescription that is presented.

Does it seem strange that the pharmacy only has “EXACTLY HALF” of what the Rx is written for ?  Some states may mandate it, but it is only the best thing for a pharmacist to do is to notify the prescriber that the entire quantity was not provided to the pt. So that when the pt shows up in a couple of week requesting another prescription, they are not viewed as a “drug seeker”.

After the pt pays for their “half” the Rx dept staff goes back and reverses the claim in the pharmacy computer and fill it for the original quantity and put the remaining “half” in their pocket to use/abuse or sell for “extra pocket money”.

The same thing could happen with the Pharmacist “tearing up the prescription” when it fact he/she is just tearing up something that looks like the pt’s prescription.

How can the pt protect themselves ?  If you don’t get a explanation from your insurance company about prescriptions that they have paid for on behalf of the pt.  wait for maybe a week after the day you were in the pharmacy and look at on line or call the insurance company when is the last time that they paid for the particular medication and the quantity the claim was submitted for… if a claim was submitted for a less quantity…then reversed and resubmitted for a larger quantity… or they paid for the med/quantity/date for the prescription that was supposedly “destroyed” by the pharmacist.

The pt should also ask their prescriber to run a report from the state’s prescription monitoring program and show what med/quantity/date was reported to that database. The should also verify with the prescriber that they were notified that the pharmacy only furnished a partial quantity for the particular prescription.

If the pt doesn’t follow thru on these issues… they could be end up being viewed as a “drug seeker” … wanting early refills, taking more than prescribed and other issues that could get the pt summarily discharged from the practice for things they did not do, nor had any knowledge of what had been done in their name.

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https://theintercept.com/2018/01/09/dark-side-fbi-dea-illegal-searches-secret-evidence/

Federal agents at the U.S. Drug Enforcement Administration speak in veiled terms about the secret DEA unit that shares intelligence from the National Security Agency and other organizations with law enforcement for use in criminal investigations. They call it the “Dark Side.”

The Special Operations Division receives raw intelligence from the NSA’s surveillance programs, including from the mass surveillance programs revealed in documents provided by whistleblower Edward Snowden. DEA agents in this unit then analyze the surveillance data and disseminate leads to federal and local police nationwide. But the information comes with a catch. Law enforcement can’t use it to secure search warrants or in any way reveal the intelligence community as the source of their leads. Instead, they must find another way to justify their searches and broader investigations.

An egregious example of this law enforcement tactic occurred in 2004 when, through intercepted phone calls and their own subsequent surveillance, the DEA discovered that Ascension Alverez-Tejeda was transporting drugs from Los Angeles to Washington state in his car. To search the vehicle without revealing the phone calls as their original source, DEA agents set up an elaborate ruse.

Alverez-Tejeda and his girlfriend were stopped at a traffic light. As the light turned green, the car in front of them started to move and then stopped quickly. Alverez-Tejeda braked in time, but a truck rear-ended him. As Alverez-Tejeda inspected the damage, police arrived and arrested the truck driver for drunken driving. Officers instructed Alverez-Tejeda and his girlfriend to drive their car to a parking lot, leave the keys in the car, and sit in the police cruiser for processing. Just then, a car thief jumped into Alverez-Tejeda’s car and drove off. Police recovered the car, obtained a search warrant, and found cocaine and methamphetamine.

Other than Alverez-Tejeda and his girlfriend, every person involved in this piece of theater was a DEA agent or local police officer: the person driving the car in front of Alverez-Tejeda’s, the “drunk” truck driver, even the supposed car thief. While a federal judge ruled that the DEA hoax violated Fourth Amendment protections against unreasonable search and seizure, an appeals court overturned the ruling and described this abuse of Alverez-Tejeda’s constitutional rights as “relatively mild.”

The convoluted and secretive process of building a case to obscure the use of underlying intelligence, known as “parallel construction,” is meant to protect the intelligence community’s sources and methods, according to internal DEA documents. It also often deprives the accused of a fair shot at defending themselves in court because some of the evidence against them is not made public.

“The federal government is deliberately concealing methods used by intelligence or law enforcement agencies to identify or investigate suspects — including methods that may be illegal.”

The DEA’s Special Operations Division is one of several tools the government uses to hide the origins of criminal investigations nationwide, in potential violation of constitutional protections. In a report released today, “Dark Side: Secret Origins of Evidence in U.S. Criminal Cases,” Human Rights Watch documents the use of parallel construction by federal and local police agencies, finding the practice is used in the United States “frequently and possibly even daily.”

“A growing body of evidence suggests that the federal government is deliberately concealing methods used by intelligence or law enforcement agencies to identify or investigate suspects — including methods that may be illegal,” the report states. “It does so by creating a different story about how agents discovered the information, and as a result, people may be imprisoned without ever knowing enough to challenge the potentially rights-violating origins of the cases against them.”

Among Human Rights Watch’s findings:

• Traffic stops and vehicle searches are commonly used as the pretext for investigations in order to protect the true source.
• Government agents use parallel construction to conceal both high-tech methods, such as the NSA’s surveillance programs, as well as crude ones, such as illegal searches of vehicles and bags.
• Prosecutors assist law enforcement agents in concealing the origin of investigations by telling judges and defense lawyers that they are not required to find out if certain agencies, including the NSA, were involved in the case.

U.S. National Security Agency Director Michael Rogers delivers remarks arguing for the renewal of Section 702 of the Foreign Intelligence Surveillance Act at the Heritage Foundation Oct. 13, 2017 in Washington, D.C.

Photo: Chip Somodevilla/Getty Images

As Human Rights Watch has documented, parallel construction, and the internal government debate about its efficacy and legality, extend back at least to the mid-1970s. A panel of intelligence officials in 1976 lamented that if prosecutors disclosed the use of intelligence information to defendants and judges, secret surveillance “methods could be publicly revealed.” A 1983 CIA document suggested that drug agencies use intelligence information to power their investigations but that they protect that information by building “a firebreak in the evidentiary [trail] leading to sources and methods.”

Indeed, the pioneers of parallel construction appear to be drug agents. Not all federal law enforcement agencies were on board at first. The FBI was skeptical that the methods the DEA used were legal, Michael Horn, the first special agent-in-charge of the DEA’s Special Operations Division, said during a 2015 DEA panel. “When [the FBI] started seeing some success, they … kind of changed their mind,” Horn said.

In a sophisticated form, parallel construction may involve the use of information from the NSA’s mass surveillance programs that is then re-obtained through the less controversial powers granted by the 1976 Foreign Intelligence Surveillance Act. When prosecutors present the information in court, they source it to traditional FISA, rather than the more controversial mass surveillance program. The Intercept reported in November 2017 that this occurred in the case of Fazliddin Kurbanov, who was convicted in Idaho on terrorism-related charges. Although classified NSA documents revealed that Kurbanov’s communications had been intercepted through PRISM, a warrantless mass surveillance program, the Justice Department claimed in court that he had only been subjected to warrant-based surveillance under traditional FISA powers.

“Defendants have no way of knowing their rights have been violated.”

In its cruder and likely more common form, parallel construction may involve information from mass surveillance, a highly sensitive informant, or an illegal search that is then disguised. In a case Human Rights Watch discovered, security video at a New Mexico bus station showed a DEA agent illegally searching luggage left on a Greyhound bus during a layover. When passengers returned, the DEA agent asked for consent to search a passenger’s bag, already knowing that it contained methamphetamine.

“Under human rights law, everybody has the right to a fair trial,” said Human Right Watch investigator Sarah St. Vincent. “And that means what it says, so when you have the government deliberately concealing investigative actions that may have been illegal, defendants have no way of knowing their rights have been violated.”

Even DEA employees seem to know something untoward is afoot in the Special Operations Division, the unit that passes intelligence to law enforcement. As Arthur Rizer, a former federal prosecutor who worked in the unit, told St. Vincent: “When we all left, we got little keychains of Darth Vader.”

Correction: Jan. 9, 2018
An earlier version of this story mistakenly attributed a quote from DEA official to an interview with Human Rights Watch. The quote, which appeared in an HRW report, was from a 2015 DEA panel.

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Walgreens did the same to me even worse they made me give back my Xanax in order to fill my Norco prescription. This was about a year ago. I’m 70 years old I just had serious shoulder and arm surgery it was the same day I came out of the hospital they would not fill my prescription unless I was present with my ID I went through the drive-thru my friend drove me I was in a great deal of pain you could see it on my face and that pharmacist was a dog to me I willingly gave them my Xanax which was I feel full prescription just to get my pain pills because that’s how much pain I was in. Thank God I found a pharmacist that delivers to me and doesn’t give me any trouble I don’t know what this world is coming too

The above was posted – as a comment – on my blog yesterday. Unless they have changed some major rule/law that I am not aware of… IT IS ILLEGAL for any healthcare professional to take/accept – be in the possession of –  controlled medication from a pt… even it is for the intent of them being destroyed.

Many pharmacies have installed “drop boxes” for pts to use to send their unused/unwanted meds out for destruction.

This issue being a year ago and this pt posted this statement anonymously leaving neither a email nor a name.. it  would be sort of hard for the board of pharmacy to follow up on.  Because my blog is ran under WORDPRESS… this pt’s post has the IP address displayed with the comment to the administrator of the blog … so I know which state she was in at the time of making the comment.

Pharmacists and Rx dept staff are not immune to having substance abuse problems. I had my own independent pharmacy for 20 yrs and we discovered one employee Pharmacists that was “shooting up” on the job and another had a spouse that had a substance abuse problem. I am aware of a local pharmacist that didn’t have a substance abuse problem but was caught stealing/selling Norco’s because she like to patronize a nearby CASINO.

The DEA has apparently came this medical determination that the two medications (opiate & benzo) has no valid medical use and no pt should be prescribed these two medications together.  Of course, it would appear, to me, that the DEA has come to this conclusion because those people who like to abuse certain substances will take both a opiate and a benzo together and in very high doses … TO GET HIGH…

This, of course, has no relationship with the appropriate prescribing and dosing of these two meds to pts who have a valid medical necessity for them and who take them as prescribed.

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Costco Exposes Seattle’s Sugary Drink Tax With the Perfect Sign

www.digitalpoliticsdaily.com/2018/01/07/costco-exposes-seattles-sugary-drink-tax-perfect-sign/

On January 1, Seattle’s new ‘Sugary Drink Tax’ went into effect. Why? Seattle leftists want to dictate behavior and stop people from drinking soda because it can be unhealthy. So by taxing the soda, they are hoping to deter people from drinking it. But now, thanks to Costco, customers know exactly how much the city is soaking them for with the tax.

Costco in Seattle put up signs delineating exactly how the tax would cost people and Costco invited people to shop at its warehouse centers outside the city.

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http://www.sfgate.com/opinion/chopra/article/How-to-Be-Your-Own-Medical-Advocate-12480937.php

When the average person goes to the doctor, shows up at the ER, or enters the hospital, the possibility of controlling what happens next is minimal. We put ourselves in the hands of the medical machine, which in reality rests upon individual people—doctors, nurses, physician’s assistants, and so on. Human behavior involves lapses and mistakes, and these get magnified in medical care, where misreading a patient’s chart or failing to notice a specific symptom can be a matter of life and death. The riskiness of high-tech medicine like gene therapy and toxic cancer treatments is dramatically increased because there is a wider range of mistakes the more complex any treatment is. To be fair, doctors do their utmost to save patients who would have been left to die a generation ago, but they are successful only a percentage of the time.

Risk and mistakes go together, but the general public has limited knowledge of the disturbing facts:

• Medical errors are estimated to cause up to 440,000 deaths per year in U.S. hospitals alone. It is widely believed that this figure could be grossly inaccurate, because countless mistakes go unreported—death reports offer only the immediate cause, and many doctors band together to protect the reputation of their profession.

• The total direct expense of “adverse events,” as medical mistakes are known, is estimated at hundreds of billions of dollars annually.

• Indirect expenses such as lost economic productivity from premature death and unnecessary illness exceeds $1 trillion per year.

Statistics barely touch upon the fear involved when any patient thinks about being at the wrong end of a medical mistake. What the patient is all too aware of is the doctor visit that goes by in the blink of an eye. A 2007 analysis of optimal primary-care visits found that they last 16 minutes on average. From 1 to 5 minutes is spent discussing each topic that’s raised. This figure is at the high end of estimates, given that according to other studies, the actual face-to-face time spent with a doctor or other health-care provider comes down to 7 minutes on average. Doctors place the primary blame on increasing demands for them to fill out medical reports and detailed insurance claims. Patients tend to believe that doctors want to cram in as many paying customers as they can, or simply that the patient as a person doesn’t matter very much.

As a result there’s a new movement afoot to provide a personal advocate who stays in the doctor’s office with the patient. The advocate is basically someone who represents the patient’s best interests in any medical situation. The person might be a well-meaning relative who helps an older patient understand what’s going on, or who steps in to do attendant tasks like picking up prescriptions and organizing medical bills. But more and more one sees the need for an advocate who is professionally trained to buffer the mounting risks in a health-care system in which less and less time is spent between doctor and patient.

It would be up to an advocate to find out, and needless to say, this has created hostility from some doctors. Used to ruling their domain with absolute authority, few doctors want an overseer in the room asking questions, inserting their own opinions, and potentially finding fault. At worst, the specter of a malpractice suit looms. The movement for professional advocates, which is quite young, insists that looking out for a patient’s best interests is benign. The medical profession has its doubts.

The upshot, for now at least, is that patients who want an advocate must play the role themselves. At the heart of the problem is passivity. When we surrender to medical care, whether at the doctor’s office, the ER, or the hospital, we shouldn’t surrender everything. Poking and prodding is intrusive. Undergoing various tests can be stressful. The minute we walk in the door, we become largely anonymous—a walking set of symptoms replaces the person. There are doctors and nurses who take these negative effects seriously and who go out of their way to offer a personal touch. They should be saluted for their humane compassion in a system that focuses more on impersonal efficiency.

You may like your doctor and feel that he cares, but this doesn’t rule out being your own advocate. Quite the opposite—the inherent stress in medical treatment is what you want to counter. First comes the stress of worry and anticipation, what is commonly known as white-coat syndrome. We all remember how afraid we became as children thinking about getting a shot from the school nurse or how scary it was sitting in the dentist’s chair even before the drill was turned on. Studies have verified that anticipating a stressful situation can cause as great a stress response as actually undergoing the stress. In one study subjects were divided into two groups, one of which gave a public speech while the other was told that they were going to give a speech but actually didn’t. Both groups became stressed out, but the researchers wanted to measure how well they recovered from the stress

Knowing that you are going to be in a stressful situation, there are a number of ways to feel more in control:

• Be informed about your illness. Don’t relinquish your opportunity to find out exactly what is wrong with you. This doesn’t mean you should challenge your doctor. If you feel the need to inform your doctor about something you saw online, you aren’t being confrontational, and most doctors are now used to well-informed patients.
• If the illness isn’t temporary and minor, contact someone else who is going through the same diagnosis and treatment as you. This may involve a support group, of which many exist online, or simply talking to another patient in the waiting room or hospital.
• If you are facing a protracted illness, become part of a support group, either locally or online.
• Keep a journal of your health challenge and the progress you are making toward being healed.
• Seek emotional support from a friend or confidant who is empathic and who wants to help (in other words, don’t lean upon someone who is merely putting up with you).
• Establish a personal bond with someone who is part of your care—nurses and physician’s assistants are typically more accessible and have more time than doctors. Ideally, this bond should be based on something the two of you share—family children, hobbies, outside interests—not simply your illness.
• Resist the temptation to suffer in silence and to go it alone. Isolation brings a false sense of control. What actually works is to maintain a normal life and social contacts as much as possible.

Following these steps will go a long way to achieving the goal of patient advocacy, which is to serve the patient’s best interests at all times. But there remains a difficult unknown, the possibility of a medical error.

Seeing the doctor involves personal interaction, and it’s important to reduce any possible friction. Here are a few pointers:

Do

Be involved in your own care.

Inform the doctor and nurses that you like to be involved.

Ask for extra information when you need it.

Ask for a questionable event, like a pill you aren’t sure is the right one, to be checked with the doctor.

Tell somebody if you have gone out of your comfort zone.

Remain polite in all of the above.

Praise the doctor and nurses when it’s called for. A show of gratitude doesn’t go amiss

Don’t

Don’t act hostile, suspicious, or demanding.

Don’t challenge the competency of doctors and nurses.

Don’t nag or whine, no matter how anxious you are. Reserve these feelings for someone in your family, a friend, or a member of a support group.

Don’t pretend you know as much (or more) than the people who are treating you.

Don’t, when hospitalized, repeatedly press the call button or run to the nurses’ station. Trust their routine. Realize that the main reason patients call a nurse is more out of anxiety than out of real need.

Don’t play the part of a victim. Show your caregivers that you are maintaining a normal sense of security, control, and good cheer even under trying circumstances.

Probably the most important finding about medical mistakes is that they are frequently caused by lack of communication.

In our new book The Healing Self we delve into patient advocacy in more detail as well as covering the expanding role of self-healing, which is going to only become more important in the coming decades.

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www.drphil.com/videos/how-opioids-and-heroin-affect-the-brain/

It is estimated that 2 million Americans 12 or older are addicted to prescription pain relievers. According to the CDC, deaths from prescription pain killers have more than quadrupled since 1999, with 91 Americans dying every day from an opioid overdose.

“People sometimes think that an addiction is psychological. But we’re not talking about a psychological addiction here. We’re talking about an addiction that affects a number of structures [in the brain],” Dr. Phil says.

He is joined by Dr. Charles Sophy, who is board certified in adult, child and adolescent psychiatry, and family practice, and is the medical director for DCFS in Los Angeles, to explain how using opioids and heroin affect the brain.

“Any drug that you’re putting in your body is changing the chemistry of your brain, which will affect parts of your brain,” Dr. Sophy says. “Frontal lobe is the part that does executive functioning, judgment, insight, impulse control.”

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A couple of days ago I posted this blog 

#Walgreens: pharmacist told me he can no longer fill it (opiate) because I do not have cancer

“Hello Steve do you know who I contact to complain about filling my prescription? For the last 2 years I have been filling my prescription at Walgreens and the pharmacist told me he can no longer fill it because I do not have cancer. I am 60 yrs old have had 2 back operations my prescription is oxycodone 30 mg two times a day it’s crazy what he told me. Thanks”

On comment by a person whose ID’d  suggested that they have a PharmD degree … got me thinking… of the “excuses” Pharmacists are using to support their “medical decisions”

“Wow. As a pharmacist, I can assure you there is A LOT MORE to that story. It’s far more likely that the MD who wrote the RX is under DEA investigation or the MD is practicing outside of the scope of his/her practice (family practice MD who’s trying to function as a pain specialist, etc). And you are correct – there’s nothing you can do to force the Pharmacist to fill a script. Just the same way that a MD cannot be forced to write you a prescription, a pharmacist cannot be forced (or coerced) into filling a script.”

‘the MD who wrote the RX is under DEA investigation“… last thing that I knew about our legal system is that any us citizen is “innocent until proven guilty” I know one physician that has been “under investigation” for abt FOUR YEARS… this physician still has a license in good standing and still has a DEA license in good standing.  But this physician to is having trouble with some local pharmacists refusing to fill the controls this prescriber writes… to the best of my knowledge .. these same pharmacists do not have a problem with filling this prescriber’s prescriptions that are written for NON-CONTROLLED medications.

“MD is practicing outside of the scope of his/her practice (family practice MD who’s trying to function as a pain specialist, etc)“….

I wonder if these same Pharmacist challenge a GP/FP’s prescribing within their scope of practice for treating any pt with any number of health issues where there is a specialist that deals with a specific disease state… some particular examples.

If a pt is diagnosed with diabetes, should the pt then be referred out to a endocrinologist ?

If a pt is diagnosed with asthma or emphysema should be referred to a Pulmonologist ?

This list can go on and on ad nauseam

Some years ago I got a call from a Dentist who specialized in treating TMZ, myofascial trigger point pain and the like, he was also an associate professor at a large west coast dental school, but his prescriptions for non-controlled medications for the appropriate treatment of the disease issues that he was treating was being challenged by some local pharmacist for him prescribing “outside his scope of practice”… when in reality these Pharmacists only saw the initials behind his name indicating that he had a DENTAL DEGREE and JUMPED TO THE CONCLUSION… based on that slim amount of information that he was “outside his scope of practice”

And I agree with this poster that THERE IS A LOT MORE TO THIS STORY…  if what this pt said in the email to me is true.. that the pt had filled the same prescription at the same Walgreens for TWO YEARS from the same doctor… and this Pharmacist ignored this fact that what he was dealing with was a opiate dependent pt…  The dose was within the CDC’s guidelines as upper limit of MME’s  Pharmacists will require pts to wait until there is only 2 to 0 days of medication left from the previous prescription… so this pt being denied his routine opiate (Oxycodone) prescription could end up in a full blown COLD TURKEY WITHDRAWAL within a few hours not to mention UNTREATED ELEVATED CHRONIC PAIN.

All healthcare professionals have a “scope of practice” … who is in charge of making sure that Pharmacists do not exceed their scope of practice?

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