[Noah930]

I haven't read the whole thread [ducking] but a couple recent posts have mentioned how it's harder to get narcotics for legitimate pain recently. Each state is going to be different, but now that we have this "opioid epidemic," we now have all sorts of regulatory agencies looking over our shoulders--both as patients and as doctors. The end result being that it's more difficult now to get any narcotics.

California has CURES. It's a state database for all narcotic prescriptions. Before a provider prescribe a narcotic, the provider is supposed to check with CURES to see what other narcotics (if any) the patient has been receiving over the past 12 months. Don't do it, and the provider risks having the medical board revoke their license. So big brother is watching both patients and providers.

On a weekly basis, I get letters from insurance companies regarding a narcotic prescription I wrote for a patient, and reminding me about this opioid epidemic. I get letters from insurance companies asking me to justify the need for opioids for patients. Weird, as I don't get it for every patient--seems hit or miss which insurance companies (adjusters?) care and which don't. [Of course, if they took the time to read the notes/dictations/records I include with every prescription, they'd have their answers. But heck, it's easier to send out a form letter to ask a question, than it is to look for the answer.] Once in awhile I get mandates from insurance companies instructing me to sign patients up for "pain contracts" and to do toxicology tests.

Just this past month, California has changed the requirements for prescription pads, due to this opioid epidemic. The safety features (to prevent forgeries) have been updated. This is causing some degree of mass confusion amongst providers and pharmacists, as we were informed of this via email--get this--the week between Christmas and New Years. For a new set of rules that went into effect on Jan 1st. Of course no one had the new prescriptions ready to go with only 3 days' notice. There are also regulations that limit the number of narcotic pills that can be prescribed in any one prescription.

The frustrating part of all this is that we go from one knee jerk reaction to another. Instead of using best judgment, the focus is on compliance with regulations. Unfortunately, when you try to apply one set of rules (formed by bureaucracy) to all situations, you find that there are often people who get left out.