Controlled Substance Prescriptions

[Guest guest]

Here is a question: how to deal with a request for Methadone

prescription. A new patient calls, and requests a call-back before

scheduling appointment, so that she won't waste a trip. She explains

that she is suffering chronic pain, despite surgery (diskectomy and

fusion procedure, for cervical disc disease), 6 years ago. She has

been to the Chronic Pain Management consultants (45 minutes drive from

our little town), and has tried numerous drugs, and is now relying on

Methadone. She is disabled by her pain, and driving to that chronic

pain clinic is a hassle. A few months ago, she pushed the Chronic Pain

Management specialist to agree that the patient would only need to

drive that far once a year, and that the responsibility to write the

Methadone prescriptions could be carried by the patient's local family

doctor (a member of a group practice, here in our small town.)

Actually, most of the time those prescriptions would be written-out

by hand on paper prescription, by that family doctor, and just left

for the patient at the reception desk; the patient would just stop

over to the F.P. clinic and pick-up her prescription right there at

the desk, without needing to fork-out a co-pay, or waste time with

scheduling appointment, waiting in the waiting room, bothering with

the nuisance of vital signs, interval history, or exam ...

Now, she has learned that the family doctor in that scenario is

leaving our town. So, the patient (who used to see me, like 11 years

ago, when I used to work like a cog in that same machine), calls and

says how much she always used to like me, and please wouldn't I help

her, the way Dr. X. was helping her ...

My answer was that I would be happy to see her again in my little

solo office, but I would need to review her records, and repeat the

history/physical about her pain, and I would generally require visits

every time she needed a new prescription for Methadone. That hit a

stalemate.

So, to get back to the general question: if a Schedule II Controlled

Substance is regulated with rules that disallow telephone

prescriptions, FAX'ed prescriptions, or refills, and instead requires

that every single prescription must be hand-signed in ink by

prescribing physician, doesn't that imply that the physician is

seeing that patient that often ? ...

Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list-

serve with a new computer, and typing speed finally fast enough to

pose a question; sorry if this issue has already been addressed by the

I.M.P.'s ...