June 11, 2007 - 3:11am
Hey guys and gals!
I have a question on opiate refills... Doesn't it go something like this:
A schedule 3 narcotic such as Vicoden,Lortab, etc. can only be refilled like three times in a month? Or is it five times? I know some Drs. place limits on them and say they can only be refilled every thrity days, but somewhere I had read that the federal or state pharmacy rule was different (the 3 or 5 times/month thing).
Also I was wondering if anyone knew anything about Ultram (tramadol) refills and rules? I know it is unscheduled and supposedly "safe" but that it is still an opiate though atypical. I figure there has to be some limit to refills somewhere... I've been prescribed tramadol for a knee injury that I refuse to have operated on until I just have to! The stuff works remarkably well-of course it isn't as "enjoyable" as taking a stronger opiate haha- but it seems to work longer and without making me stupid. Apparently I can take it for a longer period of time too.The doc has been refilling it like crazy but I do wonder when he is going to stop and say, time for something else... Any ideas???
This is a little off subject but the SSRI function of tramadol does seem to exist as well! I'd read about it in an earlier post.It doesn't seem as strong in some ways as Zoloft- or maybe it acts on a different transmitter or something.(I'm not a nurse or medical professional-yet-so these are solely my opinions and observations...) I'd take Zoloft and feel happy but also feel as though I could kill someone with a smile on my face and go to lunch. It made me calm and collected but cold and calculating and without remorse at the same time, which was good for awhile as I was a very sensitive person who could cry and the drop of a hat. But I am off all anti-depressants now. Just notice an extra mood and energy boost with tramadol...
June 11, 2007 - 10:07am
#2
I don't know if it changes
I don't know if it changes from state to state, but from what I have seen the refills have nothing to do with "per month", it's more of an insurance related thing.
If you have a prescription for 90 tablets, and it states to take 3/day, then in theory, you shouldn't run out before the next month. If you go in after 1 week, and need a refill, that would equal out to taking 12ish tablets/day, and the pharmacy will not fill it. If it states to take every 4-6 hrs PRN, then it becomes a math thing. If 1 is taken every 4 hrs, you'd take 8/day, every 6hrs, 4/day. So, that same 90# script could be refilled after 11 days, 9 or 10 at the earliest.
I have been to the pharmacy and heard the pharmacist tell the patients that the med can't be refilled for X amount of days (and then listen to the patients say, "well, if I pay cash for it will that be any different".)
So, it's not really a per/month thing, it's more of a "when is the medicine supposed to run out" type thing.
As far as the Tramadol having an anti-depressant quality, the following can be found at http://www.ultram.com:
"Tramadol has been shown to inhibit reuptake of norepinephrine and serotonin....." Go to the website and read the first few paragraphs. I don't want to quote the whole thing.
Gtrplayer
PS- This is for Schedule IV-II drugs, I'm not sure about tramadol, but would assume it's the same thing.
June 11, 2007 - 12:33pm
#3
Actually, schedule II drugs
Actually, schedule II drugs cannot be refilled at alll. A new rx is required for every refill of a class II substance. The pharmacy has to actually have the rx in hand signed in ink by the doctor (if a P.A. prescribed it, it must also have the signature of the dr. oversedeing the P.A) This can be kind of a hassle for some but my doc just mails the rx to me or I can stop by the office and pick it up when its time to renew my rx. I just call the office a few days before my rx runs out(nore if a weekend or holiday is approaching) and I always receive my rx in the mail by the time I need to fill it.
As far as class III - V controlled drugs go, there is not limit to refills per month so to speak. Like said above, it depends on the written instructions of the rx and your insurance company. I do know that any refills on a class III-V rx must be filled before 6 months after the date the original rx was written. Say you got an rx for 90 norco 10/325 with 5 refills on it. You would have six months to use all 5 refills or they become void six months after the date the rx was originally written. I'm unsure about ultram/ultracet but I know any non-controlled substances have a year to fill any remaining refills and I once lost a bottle of 120 tramadol in the river while rafting 2 days after puicking it up and my pharmacy didnt even bat an eye when I asked for a refill the next day. I was told as long as its not a controlled substance, its no problem to refill no matter what the time frame. (whether insurance will pay is a different story) I hope this makes sense and helps you out in some way.
PDX
June 11, 2007 - 12:35pm
#4
You're right, JeckPDX, I
You're right, JeckPDX, I didn't notice I had hit II instead of III.
I guess it's time for me to start referring to them as "Schedule 3..etc"
Gtrplayer
June 11, 2007 - 3:04pm
#5
I would like agree with the
I would like agree with the people above about how the prescription is written would justify when the Rx can be refilled. But I would like to add that when the doctor writes the original Rx he/she can only put a maximum of 5 refills on CIII & CIV drugs and no refills on CII.
June 17, 2007 - 10:20pm
#6
Here is the skinny from the DEA manual
Records must be maintained by the practitioner of all
dispensing of controlled substances from office
supplies and of certain administrations. The CSA
does not require the practitioner to maintain copies
of prescriptions, but certain states require the use of
multiple-copy prescriptions for Schedule II and
other specified controlled substances.
The determination to place drugs on prescription is
within the jurisdiction of the FDA. Unlike other
prescription drugs, however, controlled substances
are subject to additional restrictions.
Schedule II
prescription orders must be written and signed by
the practitioner; they may not be telephoned into
the pharmacy except in an emergency. In addition,
a prescription for a Schedule II drug may not be
refilled; the patient must see the practitioner again in
order to obtain more drugs.
For Schedule III and IV
drugs, the prescription order may be either written or
oral (that is, by telephone to the pharmacy). In
addition, the patient may (if authorized by the
practitioner) have the prescription refilled up to five
times and at anytime within six months from the date
the prescription was issued.
Schedule V includes some prescription drugs and
many narcotic preparations, including antitussives
and antidiarrheals. Even here, however, the law
imposes restrictions beyond those normally
required for the over-the-counter sales; for
example, the patient must be at least 18 years of
age, must offer some form of identification, and
have his or her name entered into a special log
maintained by the pharmacist as part of a special
record.
DEA "Drugs of Abuse" 2005 manual Downloaded from the www.naabt.com website in pdf format and copied and pasted here for your convienience.
June 18, 2007 - 2:11am
#7
I've found that alot of the
I've found that alot of the rules are not strictly followed, I remember clearly reading that schdule II drugs should never have more than 30 doses unless it a severe chronic conition (i.e. cancer) but I've seen people without real "proof" per say of a chronic condition be prescribed 120 oxy ir's. I think so much of the terminology is so vague and unclear.
"arrheals. Even here, however, the law
imposes restrictions beyond those normally
required for the over-the-counter sales; for
example, the patient must be at least 18 years of
age, must offer some form of identification, and
have his or her name entered into a special log
maintained by the pharmacist as part of a special
record..."
I remember picking up 90 hydrocodone 7.5/650's for a coworker before and just walking in and saying "I'm here to pick up a prescription for so and so" they handed it to me, I signed and handed them the cash and that was it.
I thought it was a little too easy. What if I knew the name of someone that had a script of oxycontin 80mg waiting there, would they just hand them over if I got the right name? To me this is a little scary (especially since my name is a very common name).
-----
Tuna
June 23, 2007 - 6:04pm
#8
How long ago was it that you
How long ago was it that you picked those up? The laws now say that positive ID has to be shown to pick up any controlled substance. You may have been able to pick it up given these guidelines under certain circumstances such as: when the script was dropped off, ID was shown, so when it was picked up the pharm did not ask again for ID.
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
June 23, 2007 - 11:08pm
#9
I have never been id'd to
I have never been id'd to pick up a narcotic (which I do regularly at different pharmacies) except for once in a bad neoghborhood. I pick up oxycontin 2o and 40mg, roxicodone 5 and 15mg and diazepam 5 and 10mg and all they ever do is ask me my birthday, address, or phone number (one of the three, not all). This is the case whether I go to the drive thru or pick it up at the pharmacy counter. I am a 23 year old male also so its somewhat unusual for pharmacists to see such a young man pick up such strong narcotics. I have picked up for friends, relatives and even an alderly neighbor once and have never been asked to show ID except for 1 time out of well over 100. Not sure if the Oregon laws are different or if it is a national FDA/DEA thing.
PDX
June 23, 2007 - 11:13pm
#10
It was probley about 6 or so
It was probley about 6 or so months ago that I picked it up for my co-worker. I don't think i've ever seen anyone ID'ed while picking up a prescription, even when they are picking it up for someone else. I just find it especially stange because (at the time) I had never been in that specific pharmacy nor did I know anyone working there and I'm only 19 years old and picking up a fairly large script of hydrocodone.
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Tuna
June 23, 2007 - 11:23pm
#11
For what it's worth, the
For what it's worth, the pharmacy I use knows everybody on a first name basis, and as such, usually just writes down your driver's license # the first time you drop off a controlled prescription. I know that the first time I had to pick a controlled script up was in early 2000. To this day, I have not been asked for ID at my pharmacy, since I've gone to the same one all of my life.
However; when I pick up medications for relatives at a different pharmacy, I always have to show my drivers license. I personally have no problem with this law. I think that narcotics should have a "chain of command" to them. I know that if I had a prescription called in, or if I had inadvertently thrown out a Rx bottle with refills on it and someone else called in the refill, I'd be a little ticked off that some person I did not know could go in and pick my medicine up so easily. But, that is the benefit of going to a pharmacy that consists of one pharmacist, and one pharmacy technician. They all know all of my family, and would be very skeptical of someone else picking up any of my medicine.
Gtrplayer
June 24, 2007 - 1:04am
#12
what you are talking about
what you are talking about did happen to me. I threw out my old bottle for #75 klonopin 1mg (one months supply) with 3 refills (well 2, I guess since I'd just refilled it but that is beside the point) and about 2 weeks later I got a call from my doctor asking why I was trying to fill my medicine 2 weeks early. In her words "the pharmacist had faxed her asking if it should be a QID dosing schedule after receving a refill request after a week and a half on a TID dosage." I was not only embarrassed but had to explain that I still had plenty of my script left and wouldnt need a refill for another 2 weeks or so and someone must have pulled my empty rx bottle ot of my recycle bin, saw the medicine and that there were refills and were going to try and refill it as me. My dr. promptly cancelled all the refills and when I really needed a refill she just called it in. I did have the pharmacy note that anyone picking up an rx for me needs to show photo ID and now on all my rx bottles its says seee patient ID per rph. It probably happens all the time but it is definitely not mandatory to show ID to get your meds in Oregon.
PDX
June 24, 2007 - 11:31am
#13
It is my experience, though
It is my experience, though new to this situation, is as follows...
I have recently been prescribed oxycontin 20mg. The first prescription was for #60 - 1 every 12 hours , which is a 30-day supply. After a week I was back to see the doctoc for an injection and I told him that the relief from the medication lasted about 8 hours, so he said it was okay to take one pill every 8 hours, which I subsequently did.
His policy on refills is that you must receive a faxed form for opiate prescriptions. It is his policy that you fill out the form/questionnare and return it to his office by fax, it is then reviewed and you are called to be told that your prescription is ready to be picked up or not.
I did this and then brought my prescription to the pharmacy. Mind you, the doctor had originally written the #60 as a 30-day supply but then verbally changed the prescription to 1 every 8 hours from 1 every 12 hours a week after it was written.
Since my prescription ended early, according to the records of the insurance company, the pharmacist had to call in an override for my new prescription of the oxycontin to be filled and the cost be covered.
So in my case, it was a matter of the insurance company not covering the prescription because according to their records it was being filled 9 days early. It was a matter of the pharmacist calling the insurance company to get an override so that I could receive the meds at my covered cost. Otherwise, the prescription would have cost me $240 instead of the $5 copay.
I hope I shed some light on the situation. By the way, the first time I picked up the prescription they did ask for identification. Thanks.
June 25, 2007 - 2:38am
#14
that's one thing i don't
that's one thing i don't have a problem with right now since I do not have any insurance- although I'd much rather deal with that than having to pay over $200 cash every month! I have had insurance say it was too early though when I did have it.
I go to my doctor every three months, and at that time he writes 3 scripts,a script for every month; he gives me one, puts the rest in a lock box, and exactly one month later I come back to pick up another, and the same the next month. Sometimes i pick it up a couple days early, and just recently, my doctor gave me the refill about six days early.
I took it to a pharm I have only gone to twice, and the pharmicist would not fill it. He said it was too early and I had to wait a few days. I told him if my doc gave it to me then it is obviously okay, but he still would not do it. He also said he didn't feel comfortable filling it because the date on the bottom was the same as the previous month. I explained that he wrote them all at the same time and puts it in a lock box and every month I pick one up, but it was like he didn't believe me.
The only reason why I am going to the new pharm is because paying cash for my script is about half as much at the new pharm! It's almost worth it to stay at my old one (CVS) though because they know me and never have problems, and they are so much nicer!!! They don't question me as to why I have a lot of narcotics, and why I need them, and recount how many I need per day. They don't question the doc's judgement like Kroger did!
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
June 25, 2007 - 2:40am
#15
oh, and, from what I know
oh, and, from what I know of, here in Indiana, it is the law to make people show ID before handing out controlled substance medications. There is even signs at the pharm about it. I go to CVS and even though they know me, I am still ID'd everytime. I like their policies to protect the customer.
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
Oops. I just realized I misspelled Vicodin. Just wanted to set that straight...misspellings make me crazy. Guess it's a touch of OCD.haha