expert witnesses?
Had a patient 2.5 years ago who committed suicide on oxycodone I had prescribed. Was taking 6 5/325s of oxycodone per day for cervical and lumbar spondylosis. No history of suicidal ideation, scored 2 on the ORT, PMP always good, no early refills. Was a patient for ten years. Was getting botox for cervicogenic headache (rebound excluded) every 3 months. Seen by me (not NPs) every 3 months. UDS 1X per year and narcotic contract. Had one UDS 5 years ago that tested well below threshold of...
expert witnesses? (Source: Student Doctor Network)
Source: Student Doctor Network - March 2, 2020 Category: Universities & Medical Training Authors: hawkeye2009 Tags: Pain Medicine Source Type: forums
Just because you print out a coupon, doesnt mean I have to honor it!!!!
getting more and more people who wants to fill their oxycodone and adderals thru good rx coupons they print out online. Every day I have to have more and more arguments with people that we dont take good rx on their oxy!!
what do I have to say to make them understand??!!! any tips? (Source: Student Doctor Network)
Source: Student Doctor Network - July 29, 2019 Category: Universities & Medical Training Authors: pencilandpen Tags: Pharmacy Source Type: forums
Oxycodone and tapentadol
Hello!
Switching from 40 mg Oxycodone to tapentadol due to insuffecient effect. Does that seem reasonable or does it make more sense to increase dosage of oxycodone? I feel that the dosage of Oxycodone is fairly low.
Plan was to decrease to 20 mg Oxycodone and add 150 mg Tapentadol, with the intent of tapering Oxycontin further down the line.
Thanks in advance for any reply. (Source: Student Doctor Network)
Source: Student Doctor Network - July 9, 2019 Category: Universities & Medical Training Authors: LurenD Tags: Pain Medicine Source Type: forums
Chronic pain
90 year old patient with chronic low back (prior lami/fusion) and continued knee pain after TKA. I’m the 3rd PM doc she’s seen. She failed to follow up with the other PM bc she says nothing was helping. per chart review she’s been tried on multiple meds(meds all with side effects or no relief: gaba, Lyrica, cymbalta, savella, Tylenol #3, Vicodin, oxycodone) I’m hesitant to try TCA at her age and she has afibb. I tried her on Butrans but didn’t help. Compound cream slightly helpful. Starting...
Chronic pain (Source: Student Doctor Network)
Source: Student Doctor Network - April 28, 2019 Category: Universities & Medical Training Authors: Bsb2015 Tags: Pain Medicine Source Type: forums
DEA Raids Arizona Naturopathic Pain Clinic
DEA raids Tempe pain management clinic, 2 arrested
Authorities say two employees at a pain management clinic were arrested Thursday in a raid involving federal agents.
www.abc15.com
"The DEA identified the two suspects Friday as Naturopathic Medical Doctor Jelina Ip and her mother, Alane Ip. The two are accused of over-prescribing controlled substances, including oxycodone and morphine. The Ips face dozens of criminal charges including fraud schemes, illegally conducting an enterprise, illegal administration of a narcotic...
DEA Raids Arizona...
Source: Student Doctor Network - April 21, 2019 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
buprenorphine revisited
Back in March there was a brief discussion on this board about using buprenorphine off label for pain (sublingual). I know that butrans is available but it really only correlates to something like 80 mg/d of oxycodone at max doses I think.
Pain Physician has a special opioid edition with an article about using off label SL buprenorphine for pain. PP 2012 15:ES59-ES66
Then there are the Dr. Heit letters where the DEA says it's OK to use bup off label for pain, but I called our local...
buprenorphine revisited (Source: Student Doctor Network)
Source: Student Doctor Network - March 24, 2018 Category: Universities & Medical Training Authors: NEPain Source Type: forums
Exam Room 2: RSD following PRP
47 y.o. female book-keeper with right basilar thumb OA underwent non-image guided PRP injection 6 months ago. Felt excruciating and electrical sensation over dorsum of thumb during shot. Severe swelling at @24 hours in thumb and index finger. PCP did kenalog injection at 48 hours without improvement. Repeat kenalog injection at 2 weeks no improved. Oxycodone 15 mg QID and Lyrica initiated with little improvement. Referred to hand-surgeon who diagnoses "RSD Type 2" in right hand. Referred to...
Exam Room 2: RSD following PRP (Source: Student Doctor Network)
Source: Student Doctor Network - March 22, 2018 Category: Universities & Medical Training Authors: drusso Source Type: forums
Reporting Doctors
There’s one particular cash clinic doctor in my town that absolutely needs to be reported. Previous arrests for trafficking in oxycodone, no problem here’s a prescription for 120 oxy 30. Arrested just last month for possession of cocaine? No problem let me get my prescription pad. Who can we report this to who will actually do something?!
DEA diversion control website is useless, I doubt they even read what is submitted there. (Source: Student Doctor Network)
Source: Student Doctor Network - March 22, 2018 Category: Universities & Medical Training Authors: rx1983 Source Type: forums
OxyContin no longer promoted
OxyContin maker's culture change starts today: No more promoting opioids - USA TODAY OxyContin maker's culture change starts today: No more promoting opioids — USA TODAY
Personally I don’t see what is so phenomenal about this, do they even need to market? Proabably more of a cost cutting measure than some kind of corporate moral decision. (Source: Student Doctor Network)
Source: Student Doctor Network - February 12, 2018 Category: Universities & Medical Training Authors: owlegrad Source Type: forums
Multimodal anesthesia
Have you all been using multimodal anesthesia? If so, what? My current choices are listed below.
In pre-op holding:
Acetaminophen 975 mg PO
Celebrex 400 mg PO
Gabapentin 600 mg PO
At the start of anesthesia:
50 mg/kg MgSO4 IV
On certain cases I will add 10 mg dexamethasone to the bupivacaine for the local.
Patients complained about nausea when I've used OxyContin pre-op so I stopped.
I think what's made the most noticeable drop in post-op pain...
Multimodal anesthesia (Source: Student Doctor Network)
Source: Student Doctor Network - December 15, 2017 Category: Universities & Medical Training Authors: NatCh Source Type: forums
What do you think of this verbiage??
From PCP referral paperwork...Patient takes oxycodone 15 mg TID, works at gas station. Family hx of alcoholism. Single mom. Also has fibro. How do you appraise the providers medical decision making to refer a patient who declines pain management to a pain clinic? Is this patient-centered care with justifiable shared decision making? Would the patient attest to receiving "high value," quadruple aim care responsive to her personalized needs?
What's your next move?
View attachment 226579 (Source: Student Doctor Network)
Source: Student Doctor Network - December 13, 2017 Category: Universities & Medical Training Authors: drusso Source Type: forums
Abuse deterrent C-II
Just to be clear...are any of the C-II opioid generic abuse deterrent? My knowledge and research suggests NOT and FDA are in the process of releasing a guidance for the mftrs to make such. On the similar note, I wonder then why we can substitute Oxycontin with oxycodone ER since Oxycontin is abuse deterrent and the generic is NOT ? (Source: Student Doctor Network)
Source: Student Doctor Network - October 5, 2017 Category: Universities & Medical Training Authors: ZakMeister Source Type: forums
Opioid Refugee Squatting in SNF; Refuses Discharge
Situation: 56 year old morbidly obese female with bilateral hip AVN status post bilateral THA with multiple medical comorbidities (RA, COPD, DM, HTN, and Crohn;s disease) admitted to SNF for post-acute care rehabilitation. Post-op course complicated by DVT and difficult to control pain. Acute care hospitalist RX's FNT TD 150 mcg/hr and oxycodone 30 mg Q 4 hrs PRN BTP prior to transfer to SNF. POD #21 patient now ready for DC to apartment with home health.
Background: You...
Opioid Refugee Squatting in SNF; Refuses Discharge (Source: Student Doctor Network)
Source: Student Doctor Network - September 24, 2017 Category: Universities & Medical Training Authors: drusso Source Type: forums
Fentanyl
fentanyl deaths rising, but "experts say no one is paying close enough attention." fentanyl is 50-100x more potent than morphine, and u add oxycodone to the mix. its amazing how ppl on here are defending these deadly combo.
Fentanyl deaths rising in Central Texas, going untracked (Source: Student Doctor Network)
Source: Student Doctor Network - September 18, 2017 Category: Universities & Medical Training Authors: sosoo Source Type: forums
Delaware Law Exam, Question please help URGENT
Delaware Law states that C2 "may be dispensed up to 100 dosage units or a 31 day supply whatever is the greater." Could you explain this and the whatever is greater part. And what constitutes a dosage unit. As an example, could I fill Oxycodone 3 tabs once daily for #300 tabs. It is a 100 day supply but if 3 tabs are 1 dosage unit then that equal 100 dosage units which is greater than a 31 day supply. Or should I simply be viewing 1 tablet as 1 dosage unit. Several pharmacists have told...
Delaware Law Exam, Question please help URGENT (Source: Student Doctor Network)
Source: Student Doctor Network - July 26, 2017 Category: Universities & Medical Training Authors: viper2ko Source Type: forums
