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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by mair on March 15, 2007, at 15:56:39
I take a daily combination of 4 different drugs, one of which is Metadate. The local pharmacy allows me no refills for Metadate, and I have to physically present the paper prescription to the pharmacist along with my photo id. A phone call from my pdoc or a faxed prescription will not suffice. When I go the pick up the prescription it's never in the bin with all of the other prescriptions so the tech can never find it until she's checked on the computer. It's apparently always hidden in the back in some super-safe location. I have to show my id again to pick it up. I know the photo id part is maybe typical in some areas of the country for all prescriptions, but I live in a fairly rural area where it's not typical at all, and no one has ever asked me to show an id to pick up any of my other scrips.
The whole process feels demeaning and poses alot of logistical headaches, not the least of which is getting a paper prescription from a psychiatrist whom I otherwise never see and hardly ever talk to either. She has no staff, so I either have to email her or leave a message on her answering machine. Unless my message or email has explicit delivery instructions, I don't always know if she got the message or the email, for that matter, so there is always this uncertainty. She has to mail the prescription to me or leave it somewhere in the vestibule of her office for me to pick up. To minimize the inconvenience, she will usually give me 2 prescriptions at the same time, but this last time she put the same date on both of them. Thus when I presented the second prescription to CVS, they refused to fill it without getting her verbal authorization since the scrip looked to be a month old. On another occasion, I didn't find out until I went to pick up the prescription that the pharmacy didn't have on hand enough pills for the whole prescription. They told me that because it was a regulated drug, they couldn't give me a partial prescription. In that instance I had to really scramble around to get it filled by someone else before it had fully run out.
I'm a respectable-looking professional woman in my 50's who would fit no one's profile of a dealer or forger of prescriptions. This pharmacy has access to my whole drug history so they know I take this every month. There's nothing about this drug and my reaction to it which would make it obvious to me why they make it so difficult for me to get it. It's ridiculously expensive. I can't imagine taking it if it wasn't pretty necessary to my on-going mental health. But over the last 10+ years, I've had a very difficult time coming up with an even half-way effective combination of drugs to reasonably manage chronic major depression. Metadate has made a difference to my ability to work more productively. I wouldn't dream of changing it right now, but the process makes me feel so defensive and suspect - like someone is passing severe judgment on me because I have to take this drug.
I don't know how much of what I go through is CVS corporate procedure and how much is mandated by the FDA. Can someone give me a reasonable explanation about why I'm put through so many hoops?
mair
Posted by jealibeanz on March 15, 2007, at 16:18:28
In reply to Why is Metadate So Heavily Regulated?, posted by mair on March 15, 2007, at 15:56:39
Photo ID? Are you serious? That's odd.
I've had Concerta and Xanax filled at CVS. Nobody asks for ID. Maybe they ask my date of birth, but they should do that for everyone. My controlled scripts are always just in a normal bag in the boxes with everyone else's scripts.
Controlled drugs can't be phoned in or faxed. That's normal. In a lot of states you can't get refills. And yes, the script has to be filled within one month of being written, or it's no good. That's all pretty standard.
Posted by mair on March 15, 2007, at 16:29:21
In reply to Re: Why is Metadate So Heavily Regulated?, posted by jealibeanz on March 15, 2007, at 16:18:28
Thanks, but why is this drug controlled? I've had xanax prescriptions filled, although not recently. I never had to go through these types of hoops at all.
Posted by saturn on March 15, 2007, at 17:05:18
In reply to Re: Why is Metadate So Heavily Regulated? » jealibeanz, posted by mair on March 15, 2007, at 16:29:21
> Thanks, but why is this drug controlled? I've had xanax prescriptions filled, although not recently. I never had to go through these types of hoops at all.
Xanax is schedule IV, wherease metadate is schedule II.
Posted by Quintal on March 15, 2007, at 17:08:57
In reply to Re: Why is Metadate So Heavily Regulated? » jealibeanz, posted by mair on March 15, 2007, at 16:29:21
It's because of the abuse potential, stims are more tightly controlled than benzos in most places for various (not always strictly logical) reasons.
__________________________________________________
Illicit use
Some people abuse MPH by crushing the tablets and snorting them thus changing the typical theraputic delivery system. The "high" results from the rapid increased rate of dopamine transporter blockade due to quicker absorption into the bloodstream. When abused, the effect of Ritalin is similar to that of cocaine or amphetamine and such abuse can lead to addiction. When taken orally in prescribed doses, MPH has a low addiction liability and rarely produces a "high". Both the United States Drug Enforcement Administration (DEA) and the United Nations International Narcotics Control Board have expressed concern about the ease with which legally prescribed MPH is diverted to the illicit market.[33][34] According to the DEA, "The increased use of this substance [MPH] for the treatment of ADHD has paralleled an increase in its abuse among adolescents and young adults who crush these tablets and snort the powder to get high. Youngsters have little difficulty obtaining methylphenidate from classmates or friends who have been prescribed it."[35]
Volkow et al. (1995) found that the slow clearance of methylphenidate from the brain may discourage the repeated self-administration found in other addictions, reducing the addictive liability of methylphenidate.[36]
In some areas, particularly where other illicit stimulants such as amphetamines are not as common, methylphenidate is popular amongst intravenous drug users. While not all available tablets can be readily prepared for injection, the standard brand name Ritalin tablets can be dissolved easily in water, making them ideal for intravenous use. This can be quite dangerous, however, as many available methylphenidate tablets use talc as a filler. The intravenous injection of talc can result in serious health problems, particularly pulmonary granulomas, which can lead to pulmonary fibrosis and pulmonary hypertension. This often leads to problems breathing, and in some cases, death. [37]
A study conducted by the University of Michigan's Substance Abuse Research Found that in a survey of over 10,000 college students, up to 25% of them had used Ritalin non-medically. The demographic of these students also admitted they were more likely to smoke cigarettes and marijuana, as well as take cocaine, ecstacy, and other drugs.
Street names for Ritalin include: vernies, diet coke, kiddie cocaine, kiddie coke, vitamin R, R-ball, poor man's cocaine, rids, skittles, R-pop, baby blow, coke junior and smarties.
http://en.wikipedia.org/wiki/Metadate#Addiction
__________________________________________________Q
Posted by Phillipa on March 15, 2007, at 21:22:21
In reply to Re: Why is Metadate So Heavily Regulated? » mair, posted by Quintal on March 15, 2007, at 17:08:57
I believe the poster says she gets this drug filled monthly so I don't see what the hassle is. I know it's regulated more. But today for instance CVS had no problem filling xanax long acting from one pdoc and lunesta from another. No problem they said. Love Phillipa Don't and never will do illegal drugs or abuse my meds. I take what my pdoc prescribes.
Posted by med_empowered on March 15, 2007, at 21:28:02
In reply to Re: Why is Metadate So Heavily Regulated? » Quintal, posted by Phillipa on March 15, 2007, at 21:22:21
The ID thing is pretty standard for at least the first few months. I don't know why your pharmacies KEEPS making you do it, especially if its a small town and they know you by now. Has your local CVS gotten in trouble recently? A pharmacy around here used to have lots of errors (in checking IDs, giving the wrong meds/quantities, etc.), and now they're super-strict about ID checking and all that. Maybe you should visit a locally owned mom-and-pop pharmacy; they're usually competent AND nice(r).
Good luck.
Posted by mair on March 15, 2007, at 21:30:15
In reply to Re: Why is Metadate So Heavily Regulated? » mair, posted by Quintal on March 15, 2007, at 17:08:57
Thank you - the information is helpful. I guess I just hate getting lumped together with a bunch of teens - these drugs are too important to me to even think about giving them to someone else, and I guess at my age, and with a long-standing monthly prescription, I think I should be given the benefit of the doubt.
Maybe it's the difference that age makes, but from where I stand, the benzos look more appealing as drugs to be abused than do the stimulants. Maybe the kids love the highs, but I know tons of stressed, anxiety-laden adults who would love to have access to some of the drugs I've taken like xanax, and more importantly for me, klonopin.
mair
Posted by Quintal on March 15, 2007, at 23:25:50
In reply to Re: Why is Metadate So Heavily Regulated? » Quintal, posted by mair on March 15, 2007, at 21:30:15
I agree, I abused benzos for many years myself. Can't tolerate stimulants, they make me irritable and jittery, but many young people love them because they feel confident and energetic.
Maybe it's just a peculiarity of that particular pharmacy? I know what you mean, it must be annoying to be treated like that given your stature, but the pharmacy could just be playing safe to protect itself from any possible litigation or investigation? I suppose they have to have one rule for all or they would be accused of favouritism etc. and that wouldn't look too good either?
Q
Posted by Racer on March 16, 2007, at 0:33:57
In reply to Re: Why is Metadate So Heavily Regulated?, posted by jealibeanz on March 15, 2007, at 16:18:28
>
>
> Controlled drugs can't be phoned in or faxed. That's normal. In a lot of states you can't get refills. And yes, the script has to be filled within one month of being written, or it's no good. That's all pretty standard.Here in California, prescriptions for scheduled drugs are only valid for seven days. That's right -- seven days. AND the pharmacy, if they don't have it in stock, cannot tell you when they'll get it in. Therefore, you have to call around to find a pharmacy which can fill the scrip right away, since otherwise the drug may not be delivered in time to fill the scrip.
Since my pdoc writes a scrip for what's really more than a month's worth at a time -- to get around the no refills part -- it can be a challenge to fill the dang things. Our local Walgreen's does not carry that much Ritalin, so it's always a case of calling all the local pharmacies, many of which won't answer the question, in case I'm about to show up with weapons or something.
Oh, yeah, and I'm middled aged, too.
Posted by jealibeanz on March 16, 2007, at 5:06:25
In reply to Re: Why is Metadate So Heavily Regulated?, posted by Racer on March 16, 2007, at 0:33:57
Xanax is schedule IV? I probably knew that. But anyway, in heavily regulated states, like mine, it needs to be written monthly... no refills.
Posted by mair on March 16, 2007, at 8:04:48
In reply to Re: Why is Metadate So Heavily Regulated?, posted by med_empowered on March 15, 2007, at 21:28:02
I used the mom & pop pharm up the street for about 8 years. I left them for multiple reasons: 1) it seemed that they never stocked enough of some of the drugs I take so I was always getting partial prescriptions and then having to go back later for the remainder; 2) it was almost impossible to ever get a parking place; 3) they had very regular hours so I couldn't pick up prescriptions late in the day or on Sundays when I had more time and was more likely to find a parking space; and 4) maybe even most of all, I was always getting put on hold and the people who owned it when I decided to leave had instituted without a doubt the MOST OBNOXIOUS voice recorded message on loud volume for all those minutes when I was on hold. It made me want to scream every time I was forced to listen to it.
I hated leaving because I'm not a fan at all of chains, and in particular CVS. But they moved into town with a decent sized parking lot, more reliable inventory, and with a refill ordering system that was all touch tone and pretty easy to boot.
I've given some consideration to talking to the chief pharmacist about how I'm treated, but like any chain, it seems that there are different people working there every few weeks. I'm sure they'd tell me that they don't have the ability to buck corporate procedures.
mair
Posted by mair on March 16, 2007, at 8:29:58
In reply to Re: Why is Metadate So Heavily Regulated?, posted by Racer on March 16, 2007, at 0:33:57
There are 2 CVS stores in my area, about 8 miles apart. Because I don't have an overabundance of time and can't stand to wait, I usually drop off the prescription and go back later (even a few days later) to pick it up. (the store I use is not in the town where I live and work so it's not like I'm driving by it 10 times a day). I showed up late one afternoon to pick up the scrip I had ordered 2 days earlier and was told that they were low on inventory and that since they couldn't fill the whole prescription, they couldn't fill any of it. I was annoyed because by that time I was totally out of the drug and in the intervening 2 days no one bothered to call me. They have my phone #s on file. Most everything was closed then except for the other CVS store in my area. They called and confirmed that the other store did have sufficient inventory to fill the whole of the scrip. I asked them to tell them (the other store) to get started filling the scrip so I wouldn't have to wait once I got there. They said that didn't work it couldn't be filled without personal presentation of the paper scrip, which they had and were giving back to me. I pointed out to them that they could fax a copy of it to the other store with a note saying that the paper scrip would be delivered when I came to pick the scrip up. I got sort of a sullen look and a vaguely equivocal nod. Of course when I arrived at the other store 20 minutes later, no one there had even heard of me and they had received no directions to fill the scrip I had.
They were busy - I had to wait about 45 minutes, probably longer than I should have because I spent the time wandering around the store and no one bothered to call my name when it was done even though they knew I was waiting for it. I got home really late and very surly.
Don't you wonder about where they find some of the people who work in these places? Regardless of how all of this sounds, I'm pretty easy to get along with; I don't brow beat the staff, and didn't in this instance. But not only did they demonstrate no sympathy whatsoever about not having enough of the drugs on hand and not calling me up right after I had dropped the scrip off, so I could start making other arrangements for getting it filled, they acted like it was my problem and that my request for their help was a genuine imposition.
mair
Posted by Quintal on March 16, 2007, at 11:38:13
In reply to Re: Why is Metadate So Heavily Regulated? » Racer, posted by mair on March 16, 2007, at 8:29:58
My local pharmacy is in my village and within walking distance from the doctor's surgery, so I always go there for convenience. They are friendly and helpful but very slow. It's a common joke around here among regular customers that you're wise to bring a flask and sandwiches if filling multiple prescriptions. My uncle takes many meds for heart disease and often has to wait in excess of an hour, only to find half of his prescription unfilled, and an IOU note for the remainder. So it can take nearly a week to get your full prescription.
Q
Posted by med_empowered on March 16, 2007, at 12:17:39
In reply to Re: Why is Metadate So Heavily Regulated? » mair, posted by Quintal on March 16, 2007, at 11:38:13
maybe you should have your doc switch you to adderall. Seriously: when I used CVS for ritalin of various types (focalin, ritalin sr, so on and so forth), I was always getting the whole "well, we don't have a lot here, but at this other store 20 miles away they do..." routine.
Then, I switched to adderall. Amazingly, everyone seems to have it, all the time. CVS, Eckerds, whatever. If I was staying with a friend, I could even go to a pharmacy next to them and fill it there--no problems. I think now that Adderall is so common for ADHD and lots of other stuff, its in abundance.
Posted by Racer on March 16, 2007, at 12:54:34
In reply to Re: Why is Metadate So Heavily Regulated? » Racer, posted by mair on March 16, 2007, at 8:29:58
I had oral surgery, and then a week later had massive dental work. You can imagine, right?
So, I take my prescription for painkillers to the local Walgreens, latish on a Friday. We went to the local Walgreens that can usually fill my Ritalin prescription, rather than the one my husband usually uses.
The clerk called us to the counter, to tell us that they couldn't fill the prescription, because it was schedule II and the prescription called for "Percodan 5/325" and there was no such thing. They suggested I stop by the dentist's office for a properly written prescription. I pointed out that I had just had massive dental work -- I could barely talk, so you'd think they'd maybe figure out something was going on -- and that it was past office hours on a Friday. I further suggested the woman look at the office address, to see that it was about an hour and a half away. She suggested I call and get a prescription for Vicodin called in. I pointed out that my file should say I can't take Vicodin, and that if I could take Vicodin, didn't she think that's what the dentist would have written it for? Sorry, there's no such thing as "Percodan 5/325."
I went home, and looked at Rxlist.com. Turns out it should be 4.8355/325.
The next day, my husband took it to the usual Walgreens, which filled it with no problem. The label said "4.5/325." There's no such thing as that, either.
Sometimes, I swear they do that wretchedness because they can. Just to feel powerful. Sure didn't make me feel good about using that pharmacy.
I'm sorry you had to deal with that.
Posted by mair on March 16, 2007, at 12:56:04
In reply to Re: Why is Metadate So Heavily Regulated?, posted by med_empowered on March 16, 2007, at 12:17:39
what are the side effects?
Posted by mair on March 16, 2007, at 13:51:37
In reply to Nope, I can beat that one » mair, posted by Racer on March 16, 2007, at 12:54:34
Racer - you must have felt great that night w/o any pain killers.
Your story does trump mine - I could probably well have skipped a few days of metadate.
This is not a pharm. story but a dental surgery story. Years ago, my husband had dental surgery and we stopped by the local pharmacy on the way back from the hospital to pick up a scrip of pain meds. Of course there was no parking, so I pulled into this narrow alley between the pharm. and another small building, put my flashers on and went into the store to pick up the scrip, leaving my husband in the car. (he also had a bad hamstring pull so he was both miserable and disabled) Even though the scrip had been called in, it wasn't filled when I got there and I was in much longer than I intended. When I came out, my husband told me that some tenant on the building next door came out shortly after I'd gone into the store and told him to move the car because we weren't supposed to park there. Mind you, this tenant was going nowhere, so parking in the alley was causing him no inconvenience. My very numbed up husband explained that he had just had surgery etc. and that the car would be moved as soon as I got out. (stupidly, I had grabbed the car keys when I went into the store so my husband couldn't move it). The guy gave some surly reply and disappeared back into his apartment. He came out about 10 minutes later and started screaming at my husband about how the car had to be moved instantly and how he was headed back into his apartment to get his baseball bat.
Fortunately I showed up right after this. My husband has a street fighter side to his persoanality which is usually well hidden under a veneer of professional respectability. He was trying to avoid his natural impulse to start screaming back. Maybe it helped that he couldn't talk worth beans.
I have a british friend who flippantly refers to people she has no use for as a "waste of space." How true!
mair
Posted by Phillipa on March 16, 2007, at 20:41:08
In reply to Re: Why is Metadate So Heavily Regulated?, posted by jealibeanz on March 16, 2007, at 5:06:25
Xanax and benzos in general all benzos in NC are good the scripts for six months and then there is a date upon refills can't be refilled usually a year. That's here. love Phillipa
Posted by yxibow on March 16, 2007, at 21:15:35
In reply to Re: Why is Metadate So Heavily Regulated?, posted by Racer on March 16, 2007, at 0:33:57
> >
> >
> > Controlled drugs can't be phoned in or faxed. That's normal. In a lot of states you can't get refills. And yes, the script has to be filled within one month of being written, or it's no good. That's all pretty standard.
>
> Here in California, prescriptions for scheduled drugs are only valid for seven days. That's right -- seven days. AND the pharmacy, if they don't have it in stock, cannot tell you when they'll get it in. Therefore, you have to call around to find a pharmacy which can fill the scrip right away, since otherwise the drug may not be delivered in time to fill the scrip.
>
> Since my pdoc writes a scrip for what's really more than a month's worth at a time -- to get around the no refills part -- it can be a challenge to fill the dang things. Our local Walgreen's does not carry that much Ritalin, so it's always a case of calling all the local pharmacies, many of which won't answer the question, in case I'm about to show up with weapons or something.
>
> Oh, yeah, and I'm middled aged, too.
Schedule II prescriptions are valid for 7 days and corrections must be made in that period and cannot be made casually by a pharmacist, and there are other rules as well. Schedule IV prescriptions do not fall under this category here in California. Schedule III prescriptions have some of the drug reporting qualities of Schedule II but to the best of my knowledge can be written for 6 refills as C-IV.
This all comes from legislation removing "triplicates" for "tamper proof pads", as if anything was possibly 100% tamper proof, for C II-V. DOB, address, etc, must also be written on the prescription.
But it makes money for the few approved script makers under this legislation on the order of about 5c per script. They are blueish and bare similar qualities to tamper proof cheques. This does not apply to Rx unscheduled substances which may be written on prior materials.
Posted by Phillipa on March 16, 2007, at 21:22:15
In reply to Re: Why is Metadate So Heavily Regulated? » Racer, posted by yxibow on March 16, 2007, at 21:15:35
Not here my xanax, valium, lunesta whatever is a white piece of paper and when I worked as an RN in NC and Virginia I called all the prescriptions in to the RX all scripts. Love Phillipa
Posted by yxibow on March 17, 2007, at 2:35:16
In reply to Re: Why is Metadate So Heavily Regulated? » yxibow, posted by Phillipa on March 16, 2007, at 21:22:15
> Not here my xanax, valium, lunesta whatever is a white piece of paper and when I worked as an RN in NC and Virginia I called all the prescriptions in to the RX all scripts. Love Phillipa
And not all states are the same... This was recent legislation acted in several stages, 2004, 2005, and 2006 increasing reporting and eventually tamper proof pads eliminating triplicates. I've never been to a big box store though with a tamper proof pad for C-IV so I don't even know what issues arrive. I much prefer "mom and pop" places where they know my name, maybe things cost slightly more or not, usually copays are set, but maybe there are costs not 100% covered, etc.
I know that some locations of a store that starts with C and ends with S can be wonderful and quick to go to for a cheap self-pay nonscheduled generic and others can be aggressively corporate and you're standing in long lines and they * up things. This is partially due to their buyup of old stores that start with S and end with N in the west, or in California.
This is the end of the thread.
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