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Some of the rules around prescribed controlled substances seem to have no legitimate purpose in actually "preventing addicts from getting it" though. Not US, A

Some of the rules around prescribed controlled substances seem to have no legitimate purpose in actually "preventing addicts from getting it" though. Not US, Australia, but wouldn't be surprised if same rules apply there – suppose you are prescribed 50mg Vyvanse. You start to feel like 50mg is too much (the side effects are too bad), and you want to try 40mg instead. Can the pharmacist dispense you 40mg instead of 50mg? No. Because it is a controlled substance (or "Schedule 8" as it is called in Australia), the pharmacist can only legally dispense the exact thing you were prescribed – they'll tell you to go back to the prescriber and get a new prescription. If it wasn't a controlled substance, the pharmacist would have more flexibility; in the past, I've gotten pharmacists to dispense prescription drugs without a prescription because I hadn't got around to getting a new script – something they are legally allowed to do (at least here in Australia) for non-controlled substances. They can't do that again and again – it is important the prescriber is kept in the loop – but as a short-term once-off, it does no harm. But going back to the prescriber involves getting another appointment, taking the time out of one's day to attend it, paying for it, etc. In the end one might just decide to put up with the side effects–which is a clearly less than optimal health outcome. Or, one can be reduced to trying to cut the dosage one's self – open the capsule, dissolve the contents in a measured quantity of liquid, then measure out the liquid – which will seem like too much effort to bother with. I can understand how someone who is prescribed 50mg asking for 60mg or 70mg could be a sign of a developing addiction, but asking for less than one is prescribed is the complete opposite of how an addicted person behaves. So why isn't it allowed? Because the rules only have a rather diffuse relationship with preventing addiction (or other health harms). I think, to a great extent, the rules have come to exist for their own sake, not for the sake of anyone's health.

DontchaKnowit 4y ago
Couldnt agree more. Also, try telling your doc ypu cut open the pill and took less. Id say 3 out of 10 docs in the US will immediately terminate their primary care relationship with you and refuse you any further prescriptions. Might even put you on a "list" for being a drug seeker. At the very least they will be pissed. (Most docs are megalomaniacs that cannot fathom a patient being as intellectually capable or informed as them, or having agency over their own bodies, but im off on a tangent now) Other regulations that hurt legit patients more than "drug seekers" : you cannot transfer a script between pharmacies, so if the pharmacy is out, you have to have your doc cancel the script and send to a diff pharmacy, a process which can take several days at worst. Some pharmacys say they are not legally allowed to disclose their stock over the phone, so you may need to repeat this process many times. If you are in a different state, pharmacys will not fill your script from your home state, so good luck traveling anywhere if your script ends during your travels. And some docs/pharmacies will let you fill early to avoid this problem, but they may label you a drug seeker and put you on a list.
- daniel-cussen 4y ago
  [dead]
- skissane 4y ago
  > Most docs are megalomaniacs that cannot fathom a patient being as intellectually capable or informed as them, or having agency over their own bodies, but im off on a tangent now I don’t know what most American doctors are like. But my mother, brother, late grandfather, uncle, aunt, and two of my cousins are all doctors. (My uncle used to work in the US, but an Australian doctor working in the US probably isn’t very representative of the average American doctor.) I often mention this (without as much detail), in part because I suspect it makes them treat me better. Plus I’m unafraid of medical jargon, which probably helps too A lot of my personal complaints are about the system and its rules, not the people who work in it, the vast majority of whom have absolutely zero input into what the rules are
  - DontchaKnowit 4y ago
    Ive just had very poor experiences with doctors. They always seem to think they know more than me, but never really even listen to what I have to say. For example I went to a derm once because I had a spot which looked like cancer for nearly a year. I went in, explained and asked for a biospy. He refused to even look at it, gave me a script for doxycycline to treat me acne (which I did not even mention) and sent me home telling me to come back if the spot was atill there in 8 months. When I came back and he looked at the spot he admonished me for not coming in sooner to have it biopsied. This is just one example in a long line of medicial professionals refusing to listen carefully to what I have to say. They always think they know better
  - DontchaKnowit 4y ago
    Oh for an even better example - My mom gets pneumonia fairly frequently and gets very severe cases of it. She is an absolute tank who could be on deaths door and would look normal. She currently is extremely ill with pneumonia. She went to her doctor last week and told them she was coming down with it, and explained to them that everytime she gets pneumonia she has to have X Y and Z medications in order to treat it. The doctor refused to prescribe them, gave her a much much weaker antibiotic and no steroids, and sent her home instead. She came back two days later after not feeling better and they sent her home again. She finally came back a 3rd time and waz given meds X and Y but not Z. Still not better, she went a 4th time and was given X and Y again without Z. She has fought tooth and nail to be properly treated and has STILL not been given the meds that she knows will help her. She is currently on hour 35 of sleep in 48 hours and is still sick as a dog. This is just routine for american docs in my experience. Perhaps I live in a medical care desert, but this is just not even remotely unusual. Doctors ignore your cincerns, fail to address them, and then when you play thr squeeky wheel in order to get some grease, act like you are a burden on their ability to care for other patients.
Khelavaster 4y ago
...So ask your pharmacist to compound it into a liquid, and reduce the dosage on your own...
- skissane 4y ago
  Compounding adds cost and turnaround time. Not all pharmacies do it. Rules saying all repeats have to be filled by the same pharmacy can prevent compounding if that pharmacy doesn’t do it But there is no rational reason why a pharmacist shouldn’t be legally allowed to dispense a patient with a prescription for a controlled substance with a lower dose than prescribed. Prohibitions on them doing so are just pointless bureaucracy which have nothing to do with preventing addiction. They achieve nothing except harming patients
- DontchaKnowit 4y ago
  There is no pharmacist near me that will perform this, as far as I know. And I actually only learned that this was possible from a comercial I saw yesterday (Im out of town currently) weirdly enough.
bick_nyers 4y ago
US here. Once had a pharmacist not fill a script for Vyvanse because my doctor's instructions were "take half tablet daily as needed". These were chewables with perforation marks on them, but apparently it didn't explicitly say on the Vyvanse instructions that you could split them or not. In the US, when purchasing Vyvanse with cash (most insurance won't cover it), the price is dictated by number of pills, NOT by the dosage of those pills. So, it is half the cost to get 15 pills that you take a half of daily versus a standard 30 day supply. I think the 30 day supply was somewhere in the realm of $400 by the way. Vyvanse patent expired last month, so hopefully a generic product comes out soon!

DontchaKnowit 4y ago

Couldnt agree more. Also, try telling your doc ypu cut open the pill and took less. Id say 3 out of 10 docs in the US will immediately terminate their primary care relationship with you and refuse you any further prescriptions. Might even put you on a "list" for being a drug seeker. At the very least they will be pissed. (Most docs are megalomaniacs that cannot fathom a patient being as intellectually capable or informed as them, or having agency over their own bodies, but im off on a tangent now) Other regulations that hurt legit patients more than "drug seekers" : you cannot transfer a script between pharmacies, so if the pharmacy is out, you have to have your doc cancel the script and send to a diff pharmacy, a process which can take several days at worst. Some pharmacys say they are not legally allowed to disclose their stock over the phone, so you may need to repeat this process many times. If you are in a different state, pharmacys will not fill your script from your home state, so good luck traveling anywhere if your script ends during your travels. And some docs/pharmacies will let you fill early to avoid this problem, but they may label you a drug seeker and put you on a list.

daniel-cussen 4y ago
[dead]
skissane 4y ago
> Most docs are megalomaniacs that cannot fathom a patient being as intellectually capable or informed as them, or having agency over their own bodies, but im off on a tangent now I don’t know what most American doctors are like. But my mother, brother, late grandfather, uncle, aunt, and two of my cousins are all doctors. (My uncle used to work in the US, but an Australian doctor working in the US probably isn’t very representative of the average American doctor.) I often mention this (without as much detail), in part because I suspect it makes them treat me better. Plus I’m unafraid of medical jargon, which probably helps too A lot of my personal complaints are about the system and its rules, not the people who work in it, the vast majority of whom have absolutely zero input into what the rules are
- DontchaKnowit 4y ago
  Ive just had very poor experiences with doctors. They always seem to think they know more than me, but never really even listen to what I have to say. For example I went to a derm once because I had a spot which looked like cancer for nearly a year. I went in, explained and asked for a biospy. He refused to even look at it, gave me a script for doxycycline to treat me acne (which I did not even mention) and sent me home telling me to come back if the spot was atill there in 8 months. When I came back and he looked at the spot he admonished me for not coming in sooner to have it biopsied. This is just one example in a long line of medicial professionals refusing to listen carefully to what I have to say. They always think they know better
- DontchaKnowit 4y ago
  Oh for an even better example - My mom gets pneumonia fairly frequently and gets very severe cases of it. She is an absolute tank who could be on deaths door and would look normal. She currently is extremely ill with pneumonia. She went to her doctor last week and told them she was coming down with it, and explained to them that everytime she gets pneumonia she has to have X Y and Z medications in order to treat it. The doctor refused to prescribe them, gave her a much much weaker antibiotic and no steroids, and sent her home instead. She came back two days later after not feeling better and they sent her home again. She finally came back a 3rd time and waz given meds X and Y but not Z. Still not better, she went a 4th time and was given X and Y again without Z. She has fought tooth and nail to be properly treated and has STILL not been given the meds that she knows will help her. She is currently on hour 35 of sleep in 48 hours and is still sick as a dog. This is just routine for american docs in my experience. Perhaps I live in a medical care desert, but this is just not even remotely unusual. Doctors ignore your cincerns, fail to address them, and then when you play thr squeeky wheel in order to get some grease, act like you are a burden on their ability to care for other patients.

Khelavaster 4y ago

...So ask your pharmacist to compound it into a liquid, and reduce the dosage on your own...

skissane 4y ago
Compounding adds cost and turnaround time. Not all pharmacies do it. Rules saying all repeats have to be filled by the same pharmacy can prevent compounding if that pharmacy doesn’t do it But there is no rational reason why a pharmacist shouldn’t be legally allowed to dispense a patient with a prescription for a controlled substance with a lower dose than prescribed. Prohibitions on them doing so are just pointless bureaucracy which have nothing to do with preventing addiction. They achieve nothing except harming patients
DontchaKnowit 4y ago
There is no pharmacist near me that will perform this, as far as I know. And I actually only learned that this was possible from a comercial I saw yesterday (Im out of town currently) weirdly enough.

bick_nyers 4y ago

US here. Once had a pharmacist not fill a script for Vyvanse because my doctor's instructions were "take half tablet daily as needed". These were chewables with perforation marks on them, but apparently it didn't explicitly say on the Vyvanse instructions that you could split them or not. In the US, when purchasing Vyvanse with cash (most insurance won't cover it), the price is dictated by number of pills, NOT by the dosage of those pills. So, it is half the cost to get 15 pills that you take a half of daily versus a standard 30 day supply. I think the 30 day supply was somewhere in the realm of $400 by the way. Vyvanse patent expired last month, so hopefully a generic product comes out soon!