prescription bottles

This summer I heard from a caregiver who was facing a terrible issue. The restrictions on narcotic painkillers required that the patient present their paper prescription in person at the pharmacy and present an ID for each refill. This patient lived far away from the nearest pharmacy and required a special medical transport, meaning that filling a prescription for painkillers for cost this seriously ill patient and her caregiver hundreds of dollars and an entire day. I was horrified that the laws that were put in place to protect us had gone so terribly wrong.

Recently, I had a first-hand experience falling afoul of the opioid pain medication restrictions. My wife was released from the hospital earlier than expected, along with a prescription of painkillers. Her dad was there to take us home and make sure she was settled in at home before he left for a business trip. We left the hospital at 7:30 pm, giving us plenty of time to stop at the pharmacy on the way home.

shutterstock_208347919I stopped in at her regular pharmacy, where I was told that they didn’t stock narcotic painkillers, but I could leave the prescription there and pick it up in a week. She was supposed to take her next dose in 4 hours, so that wasn’t going to work. The pharmacist said he couldn’t tell me what pharmacy in the city might keep anything in stock, but he listed off the different pharmacies that would be open until 9 pm. I tried calling a couple pharmacies, but they all refused to tell me if they had the medication in stock. I left a message with the surgeon’s answering service, but the only thing I learned from that was that she couldn’t be readmitted. Things were not looking good.

I went back to the pharmacy counter and explained that my wife had just been released after having surgery. Driving from one pharmacy to another until we found one was not a realistic solution and didn’t have much longer before they were all closed for the night. The pharmacy tech was very understanding and even called the other pharmacies in the chain, to no avail.

The doctor on call got in touch with me as we were on our way to another pharmacy. He was unaware of the narcotics restrictions – couldn’t we just get the generic? (No, they didn’t have that, either.) Couldn’t we just try in the morning? (We don’t have a car and she needed the medications that night.) He offered to call in a new prescription. (The law requires a paper prescription.) He offered to talk to the pharmacist, but that couldn’t do anything to change the regulations regarding prescription medications. The doctor said he’d call me back again. The fourth pharmacy didn’t have a narcotics license.

The fifth pharmacy finally was able to fill her prescription. The pharmacist was nice enough to fill the prescription for us just past the closing time. We were very grateful and relieved. It’s a good thing her dad had offered to drive us home! I can’t imagine being able to get a taxi to take us around like that, drive so carefully, or how much it would have cost.

shutterstock_145354636The doctor called back while I was waiting and explained that we should have been given the prescription before her surgery. Typically, if a patient is given a new prescription in the hospital, they’re also given a days worth of pills. If we hadn’t been able to fill the prescription, we could have driven an hour back to the hospital to pick up a days worth of pills and tried to fill the prescription the next day, taken her to an ER and explained the situation, or taken her home and given her the medications we had on hand. All of those choices sounded pretty awful.

Her surgery took place at an excellent hospital with a world-class surgeon. All of the staff was incredibly helpful. The pharmacy staff I spoke with did their best to help. Things still slip through the cracks. Prescription drug laws differ dramatically by country and state, but now I’m familiar with the rules for the US.

Common narcotic restrictions

  • Limited to a 30-day supply or 100 pills, whichever is less, with no refills
  • Patients in nursing homes or institutions may only have a 7-day supply
  • Prescriptions cannot be called in, a paper prescription must be presented
  • Patients must be seen in-person by the doctor for each prescription or every 6 months
  • Prescriptions may be void after 7, 30, 60, 90, or 120 days
  • Prescriptions without the patient and doctor’s full information may not be honored
  • Dosage must be noted in both numbers and words
  • The patient must pick up the medication in person and show ID in 22 states

This means you may need to transport your patient to the doctor and then to the pharmacy in person each month they require pain medication. This can lead to significant co-pays and transportation costs. Some states allow exceptions to requirements for certain requirements, such as allowing prescriptions to be called in for an emergency or waiving the requirement for physical examinations of stable patients who are housebound.

You can view each state’s requirements here. Watch out, though – sometimes pharmacy techs make up laws. I’ve experienced that when attempting to fill prescriptions in Brooklyn.

One last note: if you accept a partial prescription, you will need to acquire a new prescription for the balance and it could result in your loved one being flagged in the prescription monitoring system.

If your loved one is going to be taking prescription narcotics, be prepared to work within the new requirements. Knowing the rules ahead of time can save you a lot of trouble!

Written by Cori Carl
As Director, Cori is an active member of the community and regularly creates resources for people providing care.

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9 Comments

  1. We were under palliative care and was having the problem with getting pain med. Mom is with hospice care and now have no problems getting the med thankfully

    Reply
  2. This is what’s so sad. Not recognizing there’s those of us that cannot function in a way that gives value to our lives. It took four yrs of my husband & my doctor trying to convince me I needed to be on pain med before I relented. After six spine surgeries, a crushed nerve, (permanent nerve damage) and two implants in my back for the first time I’ve noticed questions being asked that do make me feel uneasy by my pharmacy—their not my neurosurgeon!! Years of trying to tell yourself, I’m ok, I’ll just fight it wears you down. My husband was being woke so much in the middle of the night by my screams, (it hit after about 3-4 hours of sleep) that it was effecting him also. I give my blood every 4-5 months, see my doctor regularly, and pee for them in their pretty little cup every few months. Now I need my pharmacy to harass me??? Thanks all you druggie’s out there for making us all look like criminals!! If you had a taste of the pain a lot of people go thru without help from pain med maybe it would serve you right.

    Reply
  3. Exactly why I got mom lined up with palliative care. Nurse practitioner comes to her, I got much more effective medication and much more. I felt like a criminal just trying to address mom’s pain, navigating all the rules and getting flagged through sheer ignorance. No more. It’s a blessed relief.

    Reply
  4. I hear you. Our situation wasn’t as bad, but similar enough that it was/ is a very frustrating process for helping our 98 yr old mother. Way unnecessary bureaucracy when trying to help a loved one in pain

    Reply
  5. There are similar laws in Canada, and they vary from province to province. When we were living in Saskatchewan and visiting Alberta, my husband (with terminal rectal cancer metastasized to lungs, brain and bones) needed to up the dose to keep up with the pain. It was impossible to get this done without hauling him out of the apartment, into a car and going to the ER – all which would have increased the pain tremendously. I did my best to use what we had, which means I played around with the dose, until we were back into our home province and could get our hands on what he needed, By that time I was pretty confident I could play around with what he had with few side effects. It was an eye opening experience that’s for sure.

    Reply
  6. I am a woman in my 50’s diagnosed w Neurofibromatosis, Fibro, OA, Psoratic OA, Severe C-Spine and Spinal stenosis,CFS, ME, IBS, UC, CAD, Celiac etc.. I take ONE narcotic.. I fight very hard to keep myself strong and able to move around.. I MUST go to my doc and get script for Norco every month, I have it filled at Walmart.. This past month my due date was the 25th.. On the 23rd I went to get it and they were “out”.. I went again the 24th, still out.. Just like the month prior.. I rushed to Walgreens and paid twice as much becuz my info was not in system.. It is appalling that the answer to those of us who suffer and keep fighting to b healthy should have to go to these lengths.. The drug(s) are not the problem, the addicts are.. With the internet and other means getting illegal drugs is readily available.. For those of us who are truly in need, we have to suffer.. Why?? Thanks for being here!

    Reply
  7. I’m a Pharmacist. And a person with 20 years of recovery from a pain killer addiction. So I see this issue from both sides of the aisle. I can tell you with 100% certainty and without any hesitation, that the new DEA rules on CII and Hydrocodone Rx’s only hurts patients. It has in no way caused a lessening of addicts or helped the cause of recovery. Addiction is a brain disease, it has nothing to do with the substance. Letting the government make rules on Pharmacy law is like letting a pedophile run a nursery school. The medical community needs to rise up against the stupidity.

    Reply
    • You hit a nerve.I’m on disability and have ostio and rumatoid arthritis
      I have never filled a prescription early.I don’t have the money to go to a pain specialist.So I guess it’s Cartel1DEA 0

      Reply
  8. Ten days ago I when I was in California I was given a prescription for a Fentanyl patch for my dad. He typically picks up his pain medication at Walmart, so I took the paper prescription there. The pharmacist told me they were out of Fentanyl patches and may not get any more in due to the fact that they were being abused so much. My comment to her was, “so my dad has to suffer because of what others do.” She said, I’m sorry, afraid so.” I moved on to Walgreens and they would not fill it either, because the doctors name was not at the top of the prescription. even though it’s a town of less than 10,000 and they knew the doctor. Last chance was Safeway. They had no problem with the prescription other than it was for one Fentanyl patch and they could not dispense just one patch. In the end I had to go back to the hospital and plead my case to the doctor. Dad needed his pain medication, and in the end got it. As for me I live in the state of Kansas and lost my wife a while back to cancer–I have to go to a pain control management center just to get 0.5mg of Xanax taken only at bedtime. My general practitioner wants me on them, but will not administer them. And this is where the pain medication dispensing is headed throughout the country. The unintended consequences to breaking this nations addiction to pain killers we be apparent to those that really do qualify and need the drugs quickly. Sadly, many folks are going to suffer.

    Reply

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