October 17, 2009 - 2:31pm
Hi all, this may seem like an unusual question but I really don't know the answer. I have been seeing the same psychiatrist for a little over two years and have been seeing a pain specialist for about the same amount of time. With each Dr. my dx is well established and my meds for each have been the same for a long time. My Psychiatrist sees me every 3 to 4 months with plenty of refills and charges me $100.00 per visit. My PM doctor sees me every 28 days (Schedule II) drugs and charges me $150.00 per visit. My psychiatrist is a well known Dr. who has published over 50 books, many of which can be purchased in bookstores and Amazon. In addition to psychiatry he has a sub specialty in Neurology and is an addiction specialist also prescribing Suboxone and Methadone to addicts. He is aware that I see another doctor for spinal pain and take Oxycodone and Levorphanol but other than that we never discuss my PM issues. The other day as I was leaving his office I found a prescription in the hallway for one of my psychiatrists other patients. Not trying to be nosey but I looked at it and the prescription was for #180 OxyContin 40 take 1 or 2 tablets three times a day for chronic pain. I don't know any details for the prescription but I can only assume he is treating the person for chronic pain(I turned the script into the office by the way). OK, here is what I am thinking if he treats chronic pain then I could ask him to treat me, not only is he $50.00 cheaper per visit he is only 2 miles from my house as compared to 17 miles one way to my PM clinic. My question is psychiatrist allowed to treat chronic pain i.e. writing multiple schedule II prescriptions. The only reason I am asking is I live in South Florida and I believe they are going to start tightening up down here soon and I want to keep everything on the up and up and the prescription that I found was for an excessive amount of OxyContin (my opinion only). I know the question sounds stupid but if it can work out for me I would save me a bunch of time and money. I just don't want to burn any bridges with my current PM doctor and keep everything legal. Any responses would be appreciated. Thanks, sorry for long post and I hope everyone has a wonderful day!!!!!!!!!!!!!!
October 17, 2009 - 4:29pm
#2
Here's what my suspicion
Here's what my suspicion would have been if I found that script based on what you said...You said that your psychiatrist treats patients with addiction. Perhaps the person the script was written for a patient of your doctor's who had an addiction problem to Oxycontin of like 400mg a day or something bigger than the 240mg that your doctor is prescribing. Sometimes people just prefer to titrate down their doses, especially if they have legitimate pain issues. I mean, you never know. Alternatively, some people have depression that is caused by the pain they have, which then just causes more pain from being distressed, etc. So in some cases, to stop the depression, you have to stop the pain. Sometimes certain PCP's or other doctors won't prescribe a schedule medication if another doctor is already prescribing a controlled medication (like Xanax), so maybe the psychiatrist is working in conjunction with this person's PCP to write those scripts. There are probably other explanations as to why this person is getting this particular script as well.
Your psychiatrist might be willing to prescribe your pain medications, but if you already have pain medication through a specialist I'd stick with that. Kind of like don't mess with what's already working. But, I guess at the same time, there's no reason why you can't ask. I wouldn't mention the script you found. I'd say something like, "My mom said that her psychiatrist also prescribes her pain medications so only 1 doctor is handling all of her controlled medications, and it saves her money. Is that something you ever do?"
October 17, 2009 - 5:05pm
#3
This probably isn't helpful,
This probably isn't helpful, but you say your psych specializes in psychiatry with a subspecialty of neurology. My boss specializes in neurology with a subspecialty in psychiatry. I believe it is due to their certifying board. My boss is double board cerfified as Diplomate, American Board of Psychiatry and Neurology and Diplomate, American Osteopathic Board of Neurology and Psychiatry. If your psych is board certified, I could guess he is Diplomate of American Board of Psychiatry and Neurology. Therefore, they can practice both, but apparently doctors have a preference as to their specialty. So, since your doctor is probably board certified in neurology, he could in theory, practice neurology and therefore treat you for pain, but I would imagine it just comes down to his preference. But pain management is usually a different specialty altogether.
So, I guess what I'm trying to say is, "I'm not sure. I don't know". 
So, how helpful was that? LOL.
October 18, 2009 - 12:32am
#4
if he can rx suboxone an methadone
seems he could write any other pain med., just a opinion not based on any fact. Woodstock
October 21, 2009 - 11:30pm
#5
I don't see any reason why he
I don't see any reason why he couldn't... the PM place that I'm going to right now has a full time psych doctor and a full time pain doc, each prescribes their respective meds seperately, but in cooperation with each other.
October 22, 2009 - 2:07am
#6
It Depends . . .
Does your PMD do anything more for you than write you a Class II Rx once a month? If that's all you need him for and your pain is adequately reduced by your current Rx then I can't see any reason why you shouldn't ask your psychiatrist to help you save some $'s and write you the same Rx along with the ones he already writes you. However, if your PMD is actually treating you with an eventual and definable goal in mind rather than simply providing you with a palliative for intractable pain, I'd advise you to stay the course. As long as it's working, obviously.
October 22, 2009 - 4:01pm
#7
That's it Quincy...........................
I stepped on a landmine in Vietnam in April 1969 and without going into detail it rearranged everything inside my body. So the pain is pallative the dosage has been established for several years. My PM writes my schedule II narcotics and my psych doctor treats with Prozac 40mg a day and Xanax 6mgs a day. So, there is no goal to PM ,therefore my psych could write for Levorphanol 12mgs a day with Oxycodone.Thanks to all for the advice I think I'm gonna ask there can only be one of two answers. Have a great day to all !!!! Greg
October 22, 2009 - 7:08pm
#8
Doctors, doctoring and medicine
Unless I missed something, all doctors should be able to RX any and all meds that a PT may need.
This " it not my job" would never have cut in any field I ve worked in.
There are a finite number of aproved meds for anyone condition, is it to much to ask your doc to go read his PDR
on the med, you are suggesting?
October 22, 2009 - 7:54pm
#9
Sort of on this topic...I've
Sort of on this topic...I've heard of some insurance companies placing limitations on paying for prescriptions based on what type of doctor wrote the order. For example, a person is prescribed Keppra for seizures and the prescription is written by his PCP. The insurance company will refuse to pay for it unless it is written by a neurologist.
Even if the doctor's are allowed to write for some meds, insurance companies will try place limitations on it.
Obviously if you don't have insurance this is irrelevant...
October 22, 2009 - 9:15pm
#10
Never heard of insurances
Never heard of insurances requiring specific doctors to write specific meds, that was very interesting to learn Oneir, thanks. My PCP writes for everything unless he is not extremely familiar with it, like certain psych. drugs. He will do anything he can before a referral.
October 25, 2009 - 12:11am
#11
My insurance (united
My insurance (united healthcare) wouldn't pay for provigil written by my PM doctor. The letter mentioned that the medicine was for treating drowsiness caused by antidepressants. I take an antidepressant but my PCP prescribes it. The PM PA actually suggested asking her to prescribe it or to see a psychiatrist to get him to try. I don't know yet if the insurer will cover it if they write it but I know they wouldn't cover it from the PM.
October 25, 2009 - 11:39am
#12
If he sees neurology
If he sees neurology patients, (practices neurology) as well as psychiatry patients it may not be out of his "relm of practice" to treat chronic pain. If he just saw psychiatry patients it might be considered out of his relm of practice to treat chronic pain and prescribing potent pain medications might be disapproved of by the medical board and the DEA.
October 25, 2009 - 11:54am
#13
Hi MissP . . . Q here
I was diagnosed with ADHD at the age of 47, I'm almost 55 now and I've been taking AdderallXR 20 mg for all but 1.5 years of that time. I've never needed a change in dosage and I've never had the slightest urge to abuse them. My only concern with these stimulant/smart pills is that they should never be Rxed to adolescents or, most definitely, children. Also, they should never be Rx'ed by any Dr. besides a board certified psychiatrist or psychopharmacologist. These people are the only ones that I let treat me for my mental issues and I go back every three months for evaluation. I am currently on 3 psychotropic drugs, Xanax, Adderall, and, a real life saver for me, Cymbalta for both Clinical Depression and it's norepinephrine action that significantly helps with my perception of pain. Though this is an off-label use it is Rx'ed on-label for Diabetics who have peripheral neuropathy.
Cymbalta is an SSNRI, a Selective Seratonin Norepinephrine Reuptake Inhibitor. The new analgesic, NuCynta, presents itself as an analgesic partially through its non-selective action on norepinephrine reuptake and judging by numerous negative responses here it's "scattergun approach has caused more pain than it relieves.My point is that if you're gonna be Rx'ing psychotropic drugs like NuCynta you should have a degree in psychiatry. A good and pleasant Sunday to all . . . Q
October 25, 2009 - 1:12pm
#14
Unfortunately for people like
Unfortunately for people like Quincy, who best should be treated evaluated and treated by a psychiatrist, the way insurance is structured you may often find you can only get your psychotropic drugs from you PCP. This may be because of financial incentives for the doctors to not refer to specialists, or the inability of patients to pay the higher copays for mental health coverage (the Mental Health Parity Act not withstanding as it is not fully in effect yet). Treating ADHD and uncomplicated major depression does often fall under the realm of practice of the primary care provider.
October 25, 2009 - 10:04pm
#15
Could you please clarify the above statement Dr. Lois?
I'm sorry but I really can't make heads nor tails of your reply. The first sentence is especially cryptic. What is your intended meaning by the statement "Unfortunately for people like Quincy,who best should be treated evaluated and treated by a psychiatrist, the way insurance is structured you may often find you can only get your psychotropic drugs from you [sic.] PCP." I'm not picking at the grammatical errors or the typos Dr. Lois, I honestly cannot understand what you mean. Are you saying that I'm a special case and therefore require a specialist while others will do just fine by simply taking the drugs without any sort of psychological aid or evaluation from a psychological professional?
There have been numerous studies that have compared the efficacy of anti-depressants when they are administered along with a regular one hour evaluation session at intervals ranging from once a week to once every 6 months against the results obtained by simply administering the drug with no more than a cursury explanation of the Product Information (PI). The results have been almost unanimously in favor of a little talk along with the pill. Even in intervals as long as 6 months the subjects that had an hour long evaluation session with their psychiatrists showed more improvement than the "Pills Only" group. I don't have the test results at hand but I think that these results belong in the realm of common sense, wouldn't you agree? Depressives respond to talk therapy along with anti-depressant drugs better than they do when they simply take the drugs alone, and that's a fact in my book.
Those of us adults that suffer from ADD or ADHD like myself should always be regularly monitored . . . who knows what kind of mischief I'd get into without the avuncular advice of my dear Dr. M. He is a Saint as far as I'm concerned (Do Jews have Saints? lol). Seriously though, things like Provigil (Modafinil), Ritalin (Methylphenidate), and Adderall (mixed amphetamine salts) are highly addictive and are commonly abused and diverted. Every patient, even one like myself that has never requested an increase in dosage, needs to be evaluated once every 6 months at the very least.
As far as having your PCP treat you for psychological disorders, I can understand that choice only if the patient's HI doesn't cover a psychiatrist and the patient is unable to find one that bills on a sliding scale. Mine does and so do the majority of the Mental Health professionals I've known as friends and customers. My HIC, Blue Cross Blue Shield, covers both his fees and all of my psychotropic meds. I really like my PCP but I'd never want to use him in place of a psychiatrist, just like I wouldn't ask him to treat my cats . . . it's really not his job.
October 25, 2009 - 10:59pm
#16
Good points, Quincy. I just
Good points, Quincy. I just wanted to mention that I'd never heard of Provigil until recently. My PM referred me to a pain counselor, whom I see once a week, for an hour. We're working with the book "managing pain before it manages you". We generally talk non-narcotic strategies of pain management: education about bio-chemistry of pain, benefits of pain diaries, recognizing triggers, breathing, mindfulness, meditation, and -tomorrow- hypnosis. She is a licensed counselor, not a person with authority to prescribe. But she also monitors (my perception of) my pain meds' effectiveness and makes suggestions. When I mentioned incidents like falling asleep in the parking garage for 20 minutes after turning the car off and my inability to think well enough to do my job, she told me about provigil and suggested I talk to the pm about it. At that point, in an attempt to retrieve my brain and improve it's function (I couldn't remember legal docs I'd drafted, etc, at work - I'm a lawyer in name at least) I'd switched from gabapentin to lyrica, tried several muscle relaxants over months and months, and been on cymbalta at the pain & depression dose for 6 months at least. So I wasn't seeking a stimulant for the heck of it. At the PM doctor, they asked how it was going with the counselor. That's when I mentioned her suggestion. I just wanted to clear that up. Cymbalta definitely changed my condition for the better, pretty dramatically. Within a couple of days, my daily, near-constant teariness stopped and I became a lot less irritable. But, 4+ months in, when the counselor did her 4 visit evaluation (including a couple of objective tests), I scored really high for depression and in the high 90s (%) for anxiety. Let me mention that I already do meditation and restorative/therapeutic yoga. I've been working on easing my anxious tendencies for a long time. I had panic attacks back in 1993-4 and haven't had any since (knock on wood).
October 25, 2009 - 11:10pm
#17
have others had severe depression anxiety & trouBle thinking?
I'm typing on my iPhone & I couldn't finish my post above.
I should mention that I don't feel that depressed or anxious. I feel stressed out - by pain, lack of income, private disability denial, possible foreclosure, etc etc. But on the other hand, I just got married, the wedding & our honeymoon were awesome - lots of resting, my husband is awsome & totally gets my pain stuff, my family is supportive, our church is great, and life is good. With all that good stuff i'm not as obsessed with what is wrong with me. I still want to know but it doesn't consume me.
All that said, any advice? I'm seeing a rhuemayologist for am evaluation of whether I have fibromyalgia on 11/3. I have a call into the rec'd shrink to see about an appt. Thanks, y'all. MrsP
October 26, 2009 - 6:10pm
#18
YAY Cymbalta!!!
I'm glad to hear about your success with Cymbalta. I still have my low periods like the one you wrote about but I always bounce back. Before I asked my psychiatrist about anti-depressants, I did my homework and figured that Cymbalta would do it for me. I had let myself spiral sooo far down that I was having suicidal ideations every 15 minutes on average, not good when you're fighting an aggressive cancer. The Cymbalta worked like a charm . . . it did take about 5-6 weeks to take full effect but the frequency of the ideations began dropping a bit by the end of the third week. Like you reported, it also helped with my perception of my pain.
I should have mentioned seeing a counselor as well as a psychiatrist or instead of. Though they can't Rx drugs most PCPs will write a scrip based on their suggestion. I think that they can provide every bit as good supervision and talk therapy as a psychiatrist and a lot of times better, since they're usually not as busy. I also should have mentioned that the Adderall helped me immensely when I was on a rather high dose of Oxycodone. It really helped to cut through the "Oxy Haze" that I think some people consider euphoria. It's just fuzz-brain to me. The provigil was designed for narcoleptics and is now the "GO Pill" of choice for our long distance USAF fighter pilots, no kidding. Now that I use Fentanyl as my primary analgesic I don't have the fuzz-brain any more.
Do you think that it's beneficial to be seeing a "talk Doc" along with taking the Cymbalta? Does the supervision seem to help you stay on track? I know that Dr. M sure helped me when we first started dealing with my ADHD, it was heavy on the hyper part, WHEW!!! Thanks for your input as always, MissP . . . Q
October 26, 2009 - 9:56am
#19
Miss Priss, I'm not an expert
Miss Priss, I'm not an expert but just based upon my work experience, it seems to be very difficult to get Provigil (or its newer form Nuvigil) auth'd by any insurance co (not just UHC). In my experience, it seems that the only conditions it is approved for is for shift workers or people with narcolepsy or cataplexy. My doctor/boss has prescribed it on numerous occasions, to people with chronic fatigue or fatigue associated with certain conditions such as Multiple sclerosis, etc. I've written some of the most eloquent letters trying to get this drug authorized and not once has it been approved. Good luck. I hope you are the exception!
October 26, 2009 - 10:31am
#20
There are different forms of
There are different forms of Narcolepsy. Mine is sccondary due to CP, AS/PSa, RA, Fibro, CF, MDD, Apnea, etc..along with the meds used to treat the various conditions. I have had no prob. with it being covered. No letter of neccesity or anything. It's all how your diagnosis is coded on the records. I have employer(hubby) provided BC/BS PPO and Medco for scripts. Now plans vary so that doesn't mean much. He is a UPS driver and from what I hear the have the best ins. plan in the nation for their employees(large Co. provided anyways). It shouldn't be a problem for him/her to get it approved if they really want you to have it. I find if MD's don't really want you to have the med, they will half heartedly try and then say "oh well, the ins. said no, moving on". If they want you on it, they know how to code it to get it approved.
October 26, 2009 - 6:24pm
#21
Moms, do either of you think
Moms, do either of you think that it would be easier to get an Rx for AdderallXR than the Modafinil/Provigil/Nuvigil? It comes in a generic now and I think that the lowest dose is 10 mg. As I've said before, I've been using the 20 mg capsule for almost 7 years now and am still very happy with it.
Amom, what are your thoughts on Nuvigil? Does it tahe care of your drowsiness they way you want? I needed help with focus at work and just in general . . . your textbook Hyperactive Personality skipping from one subject to another, moving way too fast and driving everybody crazy. AdderallXR took care of that without any speedy side effects. Please let me know about the Provigil, they just did a cover article on these and other such "smart drugs" in the Nov. '09 issue of Scientific American, I found a lot of what I considered to be incorrect anecdotal info in that article. That's why I want to know a little more abot Provigil. Thanks, Moms . . .
Q
I didn't read your entire post, but I can say they can script anything as long as they have the license for it. That is if they hace a license to prescribe for 2,2n,3,3n. Some doctors won't have the ability to prescribe some categories of controlled substances.
Now I greatly doubt any psychiatrist will prescribe you anything for chronic pain just because they lack the expertise and training to do so. Sure you can bring in a bottle of something that you have had filled before but it would be a great stretch for one to script a refill.