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.
I 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.
The 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 day 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!