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Pain management and trip out of county shenanigans
by nmsu1999, Aug 12, 2009 11:23AM
Greetings,
I apologize my first post is a question, but here we go...
My wife has Krohn's disease, so after months and years on diagnosis she's on pain management program and pretty serious meds:
1. morphine sulfate instant release (MSIR) - 2 pills 15mg a day
2. morphine sulfate extended release (MSER) - 2 pills 30mg a day
3. promethazine - 1 pill 25mg a day
We're about to go abroad (to Russia, to be exact). Basically, both of us need to go for 30 days due to some important documents to take care of, and there are only certain dates we can start the process, so we've planned on going Sep 10 - Oct 9.
The problem is that her pain management doctor is only willing to give the prescription to be filled on the 1st of each month, for 30 days. I.e. she can fill 30 days of meds on Sep 1st and it will run out on Sep 31st while we're in Russia, which means she'll be without any meds for 10 days, which just won't work with her pain.
We've tried talking to the doctor, who says there's absolutely no way she can prescribe the pills for 40 days and there's no way she can prescribe it for 10 days for Sep 1-10 and then for 30 more days starting on Sep 10th. There's also no way to refill it in Russia (according to at least 3 doctors over there; plus there's a pain management contract you can't get it anywhere else, anyway). So, basically, the doctor response is "You're SOL, I'm just following the law" and I don't feel this is right.
Can anyone advice if there's something that can be done? I realize when someone has a chronic and serious condition, there are some limitation in terms of what you can and can't do, but it just seems bizarre there is no way to get meds for 30 days starting in the middle of the month once, when you can get it for 30 days starting on the 1st of the month.
Any advice is greatly appreciated!
I apologize my first post is a question, but here we go...
My wife has Krohn's disease, so after months and years on diagnosis she's on pain management program and pretty serious meds:
1. morphine sulfate instant release (MSIR) - 2 pills 15mg a day
2. morphine sulfate extended release (MSER) - 2 pills 30mg a day
3. promethazine - 1 pill 25mg a day
We're about to go abroad (to Russia, to be exact). Basically, both of us need to go for 30 days due to some important documents to take care of, and there are only certain dates we can start the process, so we've planned on going Sep 10 - Oct 9.
The problem is that her pain management doctor is only willing to give the prescription to be filled on the 1st of each month, for 30 days. I.e. she can fill 30 days of meds on Sep 1st and it will run out on Sep 31st while we're in Russia, which means she'll be without any meds for 10 days, which just won't work with her pain.
We've tried talking to the doctor, who says there's absolutely no way she can prescribe the pills for 40 days and there's no way she can prescribe it for 10 days for Sep 1-10 and then for 30 more days starting on Sep 10th. There's also no way to refill it in Russia (according to at least 3 doctors over there; plus there's a pain management contract you can't get it anywhere else, anyway). So, basically, the doctor response is "You're SOL, I'm just following the law" and I don't feel this is right.
Can anyone advice if there's something that can be done? I realize when someone has a chronic and serious condition, there are some limitation in terms of what you can and can't do, but it just seems bizarre there is no way to get meds for 30 days starting in the middle of the month once, when you can get it for 30 days starting on the 1st of the month.
Any advice is greatly appreciated!
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We are certainly glad to have you here.
I am so sorry your in such a predicament. Do you have a PCP?
Ask him/her if they would be willing to give her a ten day supply with your wife's PM doctors okay of course.
The problem with your wife's PM doctor writing a 40 day supply or another ten day supply id the DEA rules set in place. Now the doctor is allowed to write up to three months post dated prescriptions according to the DEA.
A few years ago the DEA stopped this but I believe it was last year or so they have said the PM doctors are allowed to do this again.
Most doctors do not because they will lose the co pay every month if they were to give you three at a time.
Even if your wife's doctor agreed to do this it would do you no good as they can't be filled in Russia.
I suggest asking your wife's doctor if you can allow someone you trust to pick up her prescriptions on the first of September when they are due and then have that person whom you trust to fill and mail them to your wife. If you do this make sure and talk to your pharmacist too so he/she will fill them for your wife to be sent. You could also have the scripts mailed to your pharmacist and then have them mail them directly to your wife.
Use first class or express mail where it has to be signed for by your or your wife.
My Dad used to have his doctor mail his meds to him when he was out of town so I know you can do this if your wife's doctor is willing to do it.
If nothing else then she can try going w/o what she can each day up until you leave and this will leave her with a few extra pills.
If she can get by just on one extended release a day and maybe save her break thru meds when she can this will help her as she will at least have some left on the first.
It is really not good at all for her to be w/o her meds as it can cause very serious problems. I would try what I suggested and also talk to the doctor again and explain and make certain the doc knows she will be OUT of medications and that if she has any problems because of this the doc will be at fault for abandoning her patient by leaving her with no meds and no options to get any either.
Be very careful how you say this as you do not want to make the doctor angry and drop her all together. Just explain that your worried about the implications of your wife running out of her meds.
I do wish you and your wife the best of luck. Please let us know what happens and keep us updated. I do really hope things work out.
Having someone picking up the meds and sending it overnight is a good idea, but it won't work as you are not allowed to ship drugs to Russia in any form. Even taking it with you on a plane is a headache as you have to write it all down in the 'declaration form' for customs and you have to bring the prescription and a proof of purchase with your name of it; if you don't do all that, it's considered the same as smuggling cocaine, from taking it away and getting fined if you're lucky to getting prosecuted.
We do have a PCP and the idea of getting some extra meds from PCP is good, we will try that. I guess we'll have to talk to the PM doctor to get her okay, as my wife had to sign a contract that she won't be using any meds from any other doctor while on pain management. It basically restricts you from going anywhere else, but we'll see if PM doctor will give permission to do that.