Red flagged by doctor.

[Minusxx]

Hi,

Didnt know where to post this, but last March I was told by a doctor in the ER I was red flagged. Although I have been able to get scripts for pain meds through my dentist because I have had tons of dental work done in the 4 months. What I have read about being flagged is that you are not even to be able to obtain a script or have a pharmacy fill it for you. So was I really flagged?  I have chronic pain issues two bulging disc in my back and fractured ribs that have never healed from a past surgery. I was going to the ER bc it was cheaper for me then then seeing my doctor. I do see a pain doctor now and get injections. It's very hard for me to get an appointment with my doctor.

[Tuckamore]

Hello and Welcome to the Pain Management Forum.

I may be reading your post differently. Help me if I'm missing something. You say you've had extensive dental work done and have appropriately been prescribed opiates.

Due to your lack of funds you have gone to ER to be treated for chronic pain and they have ordered you opiates. Is that correct?

You are finally consulting a PMP that is doing injections to treat your pain. You are not obtaining opiates from anyone else right?

Why won't your PCP see you?

I may be very naive however I don't see this as doctor shopping. Most of us have a dentist, a PCP and a PMP. The kicker here is that most of us don't go to ER for treatment of our Chronic Pain - but I do understand why some of us are forced to do so if we don't have insurance to cover office visits.. It's a poor practice as you have found out.

I worked in ER for several years. We "Red Flagged" a patient when they were going from ER to ER to obtain opiates. Indeed we'd call or receive calls from neighboring ERs saying things like, "Jane Does" was in for the second time this month to obtain opiates for back pain. Has she been to your ER recently?"  - or we'd make the call. If Jane hadn't been to neighboring ERs she wasn't Red Flagged. If she was then the Red Flag was put on her record and we saw to it that all the local ERs knew.

Had you been to other ERs? If so that would get you Red Flagged. If not then in my opinion, provided you were not obtaining opiates from other facilities, doctors you were Red Flagged due to the current climate against opiate use - and the drug addicts that have ruined it for true pain patients.

Be cautious. I'll look forward to your comments.

Peace,
~Tuck  

[philnoir]

I believe that your ER doctor was making a point -- the emergency department is NOT an appropriate clinic for chronic pain treatment. If you return to his ER, you will not be served. The red flag is in your chart, probably in big capitol letters like this:

HISTORY OF OPIATE ABUSE AND DOCTOR SHOPPING. DO NOT PRESCRIBE CONTROLLED SUBSTANCES.

A dentist is not qualified to treat chronic spine pain. They treat the acute pain of tooth disease. Did you use deceit to get pills from the dentist? I hope not.

And I'm not clear -- are you seeing a spine doc who is prescribing chronic opioid therapy? Perhaps you're only getting injections. I hope so.

Have you signed a controlled substance agreement with is office? If so, you're in trouble with him/her.

Your behavior is called "doctor shopping," which means acquiring large quantities of controlled substances from multiple prescribers.

And, you haven't been very smart about it. Give it up -- you
have no talent for it, and you're in way over your head.

49 out of 50 states now have implemented prescription drug monitoring databases (PDMP) open to you doctors, dentists, pharmacists, and law enforcement. There's no way you're going to get away with this.

Not only can your present prescribers see your prescription history, but any future physician can also see documentation of your doctor shopping.

Are you an addict? You're acting like one, in full view of the practitioners you depend on for pain relief, and the pharmacists who will fill those prescriptions. You're going to have a hard time convincing your present doctors and any new prescriber that your are not a drug addict, regardless of your pain condition.

Here's a newsflash: Doctor shopping is against the law. The offense is called "fraud and deceit in the acquisition of a controlled substance."

"Shades of the prison house begin to close
Upon the growing boy. . . ."

Your doctor, dentist, or pharmacist may have to file a police report to defend their own license to practice.

Are shades of the prison house closing around you? Probably not, but if you do not cease and desist in this foolishness, you will end up in trouble, one way or another.

"Each AA member is to follow the 12 steps to the best of their ability or face jails, institutions or death."

Have you ever read those words?

We're all living under a "chilling effect" of regulatory persecution when it comes to controlled substances -- doctors, pharmacists, and patients.

This is no time to be a drug addict.

It's hammer time -- people who live in intractable pain to their best to manage pain within a flawed medical system. If they are persistent and lucky, they'll find a skilled and sympathetic practitioner who will treat them with all appropriate therapeutic modes, including opioid analgesics.

An estimated 5% to 10% of people in pain maintained on chronic opioid therapy succumb to addictive behaviors, for a variety of reasons.

DSM-IV defines the criteria for substance abuse:

Criteria for Substance Abuse

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
    
        Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
        Recurrent substance use in situations in which it is physically hazardous
        Recurrent substance-related legal problems
        Continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance

I believe, that while you've taken a few steps down this road, there is still time for you to redeem yourself. Writing us is a good first step, but I suggest that you use this crises as an opportunity for change.

Are you out of control -- probably not. If so, there are many sources of help, including the substance abuse forums here on MedHelp.

Do you have the will to change? I certainly hope so, for your own good, and for the good of everyone who believes in the compassionate treatment of people in pain.

Why do I care? Because when you play games like doctor shopping, you hurt us all.

I'll give you another chance. What are you going to do with it?

[jdshall]

While I agree with you that he needs to get on a scheduled regimen with a valid pain doctor, I am appalled at your assumption and multiple accusations that this pain sufferer is an addict and a devious one at that.  I think many a pain sufferer has enough trauma from situations that when he or she goes to a pain forum for advice, they don't expect to be verbally attacked.  Be kind.  

[backhurtz]

This is a 4 year old thread. I don’t believe the original thread starter is still here.

[AnnieBrooke]

I believe that red flagged simply means that you are supposed to get all your pain meds at the normal pace, not to try to get your prescription filled early and not to try to doctor-shop.  The systems are getting better for tracking this, so the pharmacists will know.  

It's probably best to see your doctor who is in charge of the discs issue and to talk to him about your meds, and to get on a standard protocol instead of patching in by going to the ER, the dentist, and a pain doc, and the red-flagging issue should die down after a while.