Too many prescribed meds?

[cinnamongirl1975]

.A doctor is prescribing the following, 3 years post back surgery to a 36 y/o woman:

60 mg morphine - 2 pills, 2 x day
30 mg oxycodone - up to 4 pills / day
350 mg soma - 3 x day
1 mg xanax - 3 x day
clonadine - off-lable use for withdraw
ambien AND trazadone for sleep
tramadol as needed

There is no requirement for psychiatric or addiction help.  there is no diagnosis for any medical condition other than "pain" at an undiagnosed source.  There has been very little reduction since surgery Aug. 2009.  

Any suggestions, other than reporting to the medical board?  She claims that since she doesn't "abuse" and takes as prescribed, there isn't a problem.  Please help! .

[Ben727]

Quite a bit of health care expertise in the comments here, and some great answers to your question. As a non-expert, non-professional who made pharmaceuticals his hobby for quite awhile, I will echo that the dosages are all fairly low, and add that the mix of drugs is a bit puzzling to me personally.

I could imagine (I guess) how a doctor would eventually come to this mix of drugs to "treat" someone, but I can't really see how any MD could justify this as an appropriate plan for long term pain management.

Three different opiates, a trank, a hypno-sedative, a muscle relaxer, and (where does this last one fit into the "treatment plan" I wonder), blood pressure medicine that also happens to ease opiate WD symptoms. I'd like to see this doctor get up at a conference and explain their thinking.

But as for your question, I think Vicki's answer is perfect (not taking away from the others, hers is just very concise).

[selfinduced]

If your questioning the amount of meds you've been prescribed , you are concerned and need a second even 3rd opinion. Not sure what your illness/injury is , but what your taking is alot of meds. Talk to a Dr. about lowering doses for a start, then possibly eliminating a few. I commend you as many would take the meds and run with them till their addiction gets worse. Let us know how you make out ok?

[mtdorashane]

I think u are right & i think u should be worried!!! my mother has MS and shes not on the amount of meds your talking about. Some crazy dr had me on 240 mg of oxy & 90 mg of methadone + 2 mg xanax every day.. At the time i truly thought i needed it ... its called addiction!!!  Until the person realizes they have a prob there is nothing u can do... Good luck with everything !!!!!

[vicki595]

Hi there-   I agree with every single word written by nurse girl.  You need to deal directly with the person taking these meds and ask your questions. There is an assumption of privacy always!  What is your relationship to her?

I will mention, if you decide to go behind her back and contact her doctor(s) or anyone other than her, it will most likely not turn out well at all.  Often it creates a larger problem.

The doses you've described are not large or unusual, especially after 3years.

[ashka747]

Nursegirl gave great advice. Unfortunately, in my profession, I see this kind of medical profile daily and it worries me, too. Are they all from the same doctor? I know when you go to a PM doc, you enter a pain contract. Some meds can be used for break-through pain, whereas the soma is a muscle relaxer. Xanax for anxiety. I don't know why they'd need anything for sleep because all of those meds combined would make me comatose!! Anyway, the problem lies with the patient. Just because the meds are prescribed doesn't mean they have to take them.

[nursegirl6572]

It's very difficult for you to judge for someone else, what is appropriate and what isn't.  A pain management clinic is typically going to Rx more powerful pain meds, and they have to go by the subjective assessment of the patient's pain, based on what they are being told.  If there are real medical conditions causing the pain, then it is acceptable for someone to be Rx'd meds for that condition.  The list you provided isn't really that unrealistic or excessive, especially if this patient has been a PM patient since 2009.  Most PM docs are pretty strict on their requirements, usually including urine screens regularly and a signed contract.  If the pt isnt breaking the rules, technically, the doctor isn't doing anything "wrong".

That being said, you're obviously concerned.  How do you know the PM doc recommended addiction help?  I find that hard to believe, as if the doc was suspecting abuse of meds, he/she would most likely either dump the pt, or take some sort of action, including not Rx'ing the meds anymore.  Addiction and pain management are kind of a conflict of interest, from a treatment standpoint.  Dependency is something all togther different, and quite frankly, expected for someone who is taking narcotics long term.  

If you have concerns, really your only option is to confront the person you are worried about, but understand only THEY can seek the help they need, if they need it.  Calling and reporting a doctor to a medical board based on your assumptions at this point in not fair at all.  You don't have all the information necessary to make that judgement.  This doctor very well could be prescribing these meds appropriately, based on their pain assessment, the medical information supporting a pain diagnosis and based on the patient following the signed contract.

Your problem should lie with the person you are concerned about at this point, not the doctor.  It's very easy for people to point fingers at docs for "over prescribing", and sure, some doctors are blatantly doing that.  Doctors walk a fine line being able to properly treat people who really NEED pain meds verus dealing with people who are drug seeking.  The people who are abusing meds and getting them from a doctor also bear a good bit of the accountability too, if not most of it.  That's just my opinion.

[Life360_Dave]

If your very concerned then have the clinic give you a source diagnosis as you mention above its undiagnosed source. Start there is this is where the road begins. This must be answered first.

[cinnamongirl1975]

Thanks for the thoughts.  This IS from a pain management center.  They cycle people through there like Walmart on Christmas Eve.  They have recommended addiction therapy and physical therapy and medical management but have not made it a condition for continued prescriptions.  It was just a suggestion.  at wits end here.

[Life360_Dave]

3 years back pain medication was the norm of the day and docs would just prescribe it to move on to the next patient in my experience. If she was to go to a new doctor today it might all be turned around and would send her to a pain managment clinic who would get to the bottom of this. The doc prescribing these to her is old school. Have her go to another doctor for reevalualtion but i bet she wont go as she has read the news about the epidemic going on.  Let us know