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Thread: Pharm. Steve: Where to Fill Injectable Pain Meds?

  1. #1
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    Question Pharm. Steve: Where to Fill Injectable Pain Meds?

    My pain doctor prescribes injectable Dilaudid for my severe intractable pain. I've been using it for several years and it works quite well for excruciating pain. My pain doc understands all of this. However, it has become increasingly difficult to find a pharmacy that stocks injectable pain meds or is willing/able to order them.

    Hence my problem: I have a perfectly valid prescription from my pain doctor, but if pharmacists tell me they are unable to order the Dilaudid injectable, how am I supposed to get my medicine?

    I'm in California. I used to go to 'W' chain pharmacy, which turned out to be a nightmare. Around 2009, they started to arbitrarily place limits on meds (separate from the FDA limits), insisted on 'status reports' from my doctor before they'd fill my meds, and more problems than I can list. My pain doc advised me to change pharmacies, and I did.

    I now fill my meds at a grocery store pharmacy, and the service is a million times better than the way I was treated by 'W'.

    The only med that I do not fill at my main pharmacy is the Dilaudid injectable. It seems that chain pharmacies do not want to stock or even order injectable pain meds, and if they do, they are subject to 'quantity limits' and other red tape. Or they can't get it from their distributor, etc.

    I've been getting my Diluadid injectable at an independent pharmacy near my doctor, because indy pharmacies are apparently the only ones that will stock or order these meds.

    However, I just found out that the indy pharmacy I've been going to for years is closing. Over the years, I've witnessed as one indy pharmacy after another has closed down. The last indy near me closed a few years ago. The indy I've been going to is 30 miles away, but it's worth the drive. They give me a 12-week supply, and I coordinate that with my doctor's visits.

    Does anyone know if there are recent FDA restrictions on pain meds? My pain doc has recently voiced concern over FDA restrictions, and for the first time ever, last month the pharmacist at the indy mentioned possible 'quantity limits' due to regulations or distributors (I'm not sure which). I was shocked to find out that this indy pharmacy that's been around forever has now closed. The pharmacist there knew my pain doc really well, so I was always treated very well and never had any problems.

    Pharmacist Steve---What's a CP patient to do when the chain pharmacies won't or can't order a medication and all of the indy pharmacies in the area have closed down? Of course, I'll ask my doctor at my next appointment. Would a mail order pharmacy work? I've never used one before and have reservations about doing so. What about a hospital pharmacy? Or do they not cater to the general public?

    I'm so disappointed in the FDA for making it so increasingly difficult for CP patients to get our meds. I guess the FDA doesn't care that they are forcing people in severe chronic pain to drive all over the place trying to find a pharmacy that will fill our meds. Does anyone know why all of the indy pharmacies are going out of business? This is bad news for CP patients.

    Thanks for any advice,
    Eva

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  3. #2
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    Eva, I can't answer all your questions but I live in Indiana and know the law has changed so CPers must use a Pain Management doctor for prescriptions and the FDA has cracked down on doctors prescribing pain killers. I have known my GP for a number of years and I asked him about why it was getting so hard to get pain medication. He said the FDA has increased oversight and pressure doctors to reduce the number of pain meds they prescribe.

    It certainly seems like the FDA and state gov'ts focus more on making it harder for the abusers to get pain meds while ignoring the difficulty CPers have getting needed pain relief. The catch-22 is even PM doctors are pressured to reduce the # of pain meds they prescribe so we are hurting when doctors decide it isn't worth fighting any more. Eva I hope you find a pharmacy soon that will stock you pain meds.
    1979 spinal issues, 1993 lumbar microdisectomy L3-4, 1996 360 3 level lumbar fusion L2-5, 1999 open thoractomy fusion T8-9,
    2002 C3-7 herniations and T4-7 herniations, 2004 total disability, a new limited life

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  5. #3
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    I would definitely try a hospital pharmacy. I've always known them to be open to the public. Often they are used by folks picking up prescriptions when being discharged from the hospital, but often there are doctor's offices at hospitals so patients fill there for convenience. Plus they stock the more unique items like what you need since they are a hospital (or could order it). I've never used a hospital pharmacy, but when my usual local chain can't get what I need, the independent across the street from the hospital always can.

    Your doctor may also know who will fill the prescription if he has other patients on injectable meds, but I imagine even within a pain clinic its rare. Did you ask the independent who is closing where they suggest to go? They should have a good idea of the local pharmacies, and may be willing to call them for you to ask (its a bit strange for a patient to call and ask about a med like that).

    Also, I would imagine the chain pharmacies literally can't order it, ie. its not in their database to order from (its happened to me with a couple really odd meds, like Relistor injections). You can see if mail order would do it, but I'm not so sure they would do injectables (although I do know they do Schedule IIs). However, I'll say that unless I literally couldn't afford or get my meds any other way, I'm just not comfortable with the idea. I'd at least want them to be sent signature required...not sure if they do that or not. I'd just be scared of them not showing up but them saying they were sent. With an as needed med, assuming you had a bit extra, it isn't as bad as a long acting pain med or a heart med or something you literally couldn't do without though, but still, a risk and potential hassle.

    I'm also seeing things get tough for pain patients. I was forced into a trial of Suboxone and thankfully allowed to switch back to Methadone when it was a disaster, but I'm at 1/3 my previous dose. For the first year I did ok (only slight increases in pain), but for some reason the last couple months have been rough for breakthrough pain. Its too much of a risk for clinics to prescribe high doses and/or to prescribe to patients who they can't clearly show have a need. I can see they would rather unfortunately make some folks suffer vs. risking everyone in their clinic having to try to find another doctor.

    I even know that in my area the clinic I go to is one of the few willing to do opioids long term for chronic pain and consider higher doses. At most other clinics in the area, when they get a new patient on long acting opioids, the first thing they do is taper them off (or at least way down). I've been to most of them for initial consults and was very disappointed with their treatment plan. I'm hearing of lots of people having forced dose reductions and even being taken off pain meds (plus I imagine few folks are being started on them). I think its not only from the FDA but from state governments, insurance, etc. I'm all for due diligence to assure opioids are a last resort, but they should be available to someone with a true need. Best wishes.
    Kate
    Constant headache for 10 years and other chronic health issues

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  7. #4

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    Most doctors prescribing injectable dilaudid for chronic pain will eventually lose their license since they clearly are not keeping up with the state of the field of pain medicine. I would plan for a sudden cessation of available treatment by this doctor, since it is very likely the DEA or state will eventually find him and pull his license.

  8. #5
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    Mark = this even true at the VA - twenty years no prob, now a taper? Things happen
    Alex44
    Skypilot

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