First, let me say I never do drugs (except what my doc prescribes) and I very rarely drink alcohol.

Last Friday I had a ortho appt for my knees. After that, I had labs scheduled for liver function, cholesterol levels, etc. Between the two appts I stopped by the restroom because I was about to bust. Then, when I show up at the lab, they tell me I have to give a urine sample for a drug screen. Well, I told them that I had just went, and couldn't give them a sample now. They told me to drink some water and hang out until I could. Normally that wouldn't be a problem, but my in-laws were visiting from Austin, TX last week and we had plans for the rest of the day with them. They were sitting at my house waiting on me get back from the VA. So, I told them I didn't have 2-3 hours to sit around because of the plans we had. I asked them if I could re-schedule and they told me to call the appt line and set it up. I tried that on the way home, but 30 minutes later when I arrived at my house I still hadn't got a human on the line so I hung up.

Fast forward to yesterday. I called the appt line again, and set up my labs for this morning. I show up at the check in desk this morning and I am told that no labs are scheduled and that I am flagged for violating my pain management agreement. Well, it's not a complete surprise. So I call to set up an appt with my new PCP to get this straightened out and I am told that it is rare that they reinstate a pain management agreement after it has been violated, but it is up to my PCP. The nurse on the phone also said that I was supposed to get a phone call the day before informing me that they were doing a random drug screen. I never got a call, and would not have used the restroom between the appointments if I had.

This is frustrating as hell, because I am not a freakin junkie or a alcoholic. I just had a busy schedule that one, single day (usually I am totally free to do whatever). Has anyone had any experience in this arena? I am about to blow a major gasket.

rental,
Can you scan and post a copy of the Pain Management Agreement?
Also, why did the idiots not tell you they only need about
20 drops of urine?
carlie

x
x
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Get a decision in writing --then APPEAL! You would be doing us all a service by addressing their blatant fascism. ~Wings

Rental

You can appeal any medical decision the VA makes regarding your treatment. The first step is to call the patient advocate and explain the situation. I would also do as you were saying and talk to the PCP. I bet this happens all the time. I have a pain management contract also. If you drank a beer the day before the piss test that would be enought to violate your contract. I have had nothing but trouble with VA pain management. I got into a jam with them just for complaining about side effects of morphine they gave me. I do know there is a formal process to appeal any medical decisions the VA does, but they hide this, and the patient advocates try to never invoke it (causes paperwork and worries the boss). Sometimes you just cannot give water on demand. I have never been violated, but it is just a matter of time.
I have a civilian pain doctor as a backup. When I complained about the morphine Pain Management said I had to get off all my VA pain meds. I started with patient advocate and then called the medical director's office to complain, and start appeals process. You make a written appeal to the head of the medical director's office. It never got that far. It all got worked out in the end. Sometimes I believe the VA is just looking for an excuse to kick us off the program. The people running VA pain management seem to believe that every vet is getting drugs from VA and selling them on the street. The VA wants to know that you are taking the drug and not so much that you are taking other things. The assumption is not so much that you are a drug addict as a drug dealer.

thanks all. i'm gonna wait and see what happens with the pcp appt next week. If it goes south, well, ...

I unnahstand. They sent me a lab appointment with no info, so I called and asked "Do you need blood? urine? is this a fasting lab?"

Turns out it's urine for My Pain Management agreement- nice to know, cuz I wouldn't ordinarily hold my pee for a cross town drive

(I wonder if this is because I requested a medical marijuana letter from my doc? In Oregon I could get a MM card for $25 with a letter from my doc; it's $200+ without one).

Thanks for the tip off.

I did exactly the same thing, but instead I went to the front desk and got a cafeteria voucher. I ate lunch drank a couple cups of coffee. I was ready for the dribble.

Here's a quick update:

Had a appt with the PCP yesterday. I explained the situation, and she was receptive, but decided to berate me anyway. That pissed me off and I snapped. I told her that if the VA would have called me like they were supposed to this wouldn't have happened. She speaks up and says that she is the one who actually sneaked the random test in on top of my regular scheduled labs. She said she wasn't required to call me if I was coming in for a scheduled lab. I don't know how valid that statement is. She further told me that I should have EXPECTED a urine test because they always do it with labs. At that point I had her check my lab records to see how many times I've had a urine test since 2007. Of course, I already knew the answer was once. She was flabbergasted to find that out. Then she asked if I would mind taking a drug screen right then. I told her that would be fine, then we whipped all my pills out of my wife's purse and told her to count them in the name of full disclosure.

After all of that, she has the nerve to tell me that she has the ultimate, final decision on this. I snapped again and reminded her that she was just a PA and in actuality needed a MD to sign off on everything that she does, and that moreover, I know that there is a formal appeals process to this matter. That seemed to take the wind out of her sails a bit. So then I went and tinkled in a cup for them and left. She said that she was going to get the ball rolling that day, and that I should expect a phone call soon. Well, I haven't heard from her yet, and now it is the 4th of July holiday at the VAMC, so I won't hear anything until at least the first of the week, but that is expected.

gruntdaddy: I wasn't really thinking about the whole thing when I was there originally. I just needed to be done and get out of there at that moment. What is really throwing me off is that the lady that seems to be in charge of the vampire squad told me to call the hospital and reschedule it, like it wouldn't be a problem at all. This is the one and only time I will jump through their hoops, though. If the screw me around here, I will either drop what little narcotics I take for something non-narcotic, go outside of the VA for my pain management, or self medicate. I'm not the good little patient that complies with a bunch of BS. I try to live my life on the straight and narrow, and I refuse to be looked at like a drug seeker, drug user, or drug dealer.

It's ON!!!

Raise the roof on these jokers..........I stopped going to the VA for these same reasons. These VA docs think they are god, but most could not hack it in the real world. What very few good docs they have get burnt on the BS.

F**k'm, raise hell......go to the top of the VAMC food chain.

Rental I can tell you that the problem you have is not unusual. What I need to know is how do we get some relief from these opressive Doctors? Me I suffer from Artheritis and IVDS and both knees. I had my Doctor out on vacation last week and since I am also under contract (Which I Hate) I go by their rules. My back has given me fits with spasm and a lot of extra pain. I had been in the bed for the most part of a week it was bad when my back goes out. I call in to speak to them on their phone lines and I am told since my Doctor was on vacation I should take some Tylenol. I was so mad. I have no recourse other than firing them for violation of the pain agreement? What should or who should I call? I am at the point of being a snowbird and taking off to another country this fall as the winter kicks my tail and the way valid SC bad back veterans are all under the evil eye. I hope it works out but to be honest it is just as bad on the outisde. I am serioulsy looking to move to the Phillippines this fall where my buddie lives he says that a lot of veterans are able to buy their meds a whole hell of a lot easier there in the Pharmacys there than it is to get proper treatment here. Any ideas or advice I look forward to hearing from anyone. Have a good day......

Rental,
Since im intolerant to morphine & methadone the VA was prescribing Oxycontin 20mg CR & Oxycontin 5mg for breakthrough pain.
For somereason they stopped supply the 20mg CR & recomended I go to a private Dr & get a prescription. After locating a Dr I notified the VAMC that I was recieving the 20mg CR from him.
Not long after this I get assigned to a new outreach VAMC clinic near my home.
First thing this new Dr does is accuse me of violating pain management aggreement & getting pain meds from two different sources without notifying the VA.
He cut off "all" my prescriptions, removed all my diagnoses from the records & it took months of paying out of pocket to get it straightened out after filing a complaint against him with the VAMC.

Don't let them jack you around. Take it to the VAMC Director ASAP.

I deal with the pain on my own and as long as I have health insurance I will stay away from the VA.

x
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Rental, call the Director of the VA Ethics Committee in D.C. I've spoken with her in the past, and she was friendly. The Ethics Committee can make a study case of your issue. ~Wings

Carlie,
Here's a Pain Management Agreement I 'came across':

PMA Agreement

You can click on each page and enlarge it to read.

If you are going to use the VA then it is good idea to be really nice to your PCP even if they are a PA. If you have good insurance and you don't want to use the VA then tell them to go to hell. I use them because I get pills for free and I have gotten a hell of a lot of testing done that costs thousands of dollars on the outside. My PCP did all this for me. She got me SC'ed for CAD and a few other things. You have to swollow your pride and just act dumb and smile. You can trigger their helper response by pretending to be the pathetic vet who is earnestly dumb, but seriously ill. I told a pharmacist to go &&^% himself, but that was a mistake.

The VA is a Pain in the butt when it comes to pain management. Without any pain management I live in a 8-9 level pain. I went to the VA with pain medicine already prescribe by my other doc. Violins here, was broke and just started the claims process, actually on medicaid at the time and we lost that. So I had to deal with the VA for Pain meds.. It took me 6 months for them to prescribe the meds I was already taking ( and they were not narcotics ).. And the Pain management nurse at my hospital is nice, but I just want to punch her in the face. She just tells you sorry, I cannot help you, it is VA policy.

Once I got service connection for my back.. The deal changed alot.. I no longer ask, I tell them what I want. And if they say no.. I just go over their heads.. I am nice about ( YES ALWAYS BE NICE ).. And I only do it with the Pain Management nurse, now I tell her it is my POLICY not to be in pain.

My point here is.. if you are service connected for the condition causing the pain., then you should be able to overturn the decision very easy.. If it is not service connected then you might have a fight.. Just make an appointment with your PCP, explain exactly what happened.. Your situtation acutally happened to me, except I did wait the 2 - 3 hours.. But you know where you failed to live up to your end, and you had a reason. If the PCP says no, then say I want to talk to your supervisor, or the doctor..

If this does not work, go to your neurologist or orthapetdic, ( i don't know what your medical problem is ).. and explain it to them.. they will probably be more sympathetic and will either prescribe it or help you get it overturned.. ( this has worked for me ).

When I first went to the pain clinic I asked them for vicodin and for mobic. They said "NO" to both. They gave me morphine instead. Am I crazy or are they crazy? I could not stand the morphine or the methadone so I got percoset and they will probably take that awayf from me now. All the pain clinics both private and the VA are a pain in the ass. Either they are drug dealers who only take cash or they are so afraid of the DEA they won't prescribe what you need.

Airborne: I wish it were that easy, but they are all on a power trip it seems. I have appealed to the chief of staff and director of the hospital, so we'll see. I am service connected for the condition that causes the pain, and have been so for the last 15 years.

OH, I also looked at the VA's own pain management literature last night, and they have neither a medical or a legal leg to stand on here. They have completely mis-handled this situation. Failure to submit to a piss test is not reason for immediate cessation of opiod therapy, per their own written material.

I got an appointment at the VAMC at 4:30pm next week. I know they are going to want piss. I am going to drink a quart of orange juice to be on the safe side. I have had to wait for a few hours to pee when I could not do it on demand. I have been on the program for years with no violations, but they still want to catch me doing something so they can kick me off the program to save money and get the heat off their backs. You know many in government think all narcotics are baaaadddd. In Florida there is an uproar about prescription drug abuse, so we sufferers take the blame for crooked doctors and drug dealers.

Rentalguy
I am sure you will get back on the program. I would get a private pain doctor in the meantime.

I'm still considering the option of stepping down to a non-narcotic. I just don't know how I would tolerate the pain in the winter. I had finally gotten myself stable with the pain/spasms, but I don't know if it is due to the narcotic, or from not working for almost a year now. I do know when I over do it just a little bit, it puts me down for a day or two.

John:

I got a pill that will make you piss like a racehorse. I think the brand name is Lasis. I usually take one in morning and than its off to the races with severe urgency I might add.

I've been working thru the pill catalog for over 2 years with my PCP & neurologist.

They prescribe a new pill and it buys them a couple/few months to see if it works and increase the dosage when it doesn't.

Seems like the Last thing the gummint wants is for someone to possibly cop a buzz off something they prescribe. Looks like it varies by doctor and location.

Meanwhile my pain continues unabated. People with a lower tolerance woulda been screamin by now. I'm not sure what to do.

Oh, here's the list best as I can figure:
Naproxen Gabapentin Amitriptyline Topiramate Pregabalin Hydrocodone Capsaicin Methadone Duloxetine Prazosin - Allergic reaction: severe lightheadedness Vicodin

Pete-
Be very careful with Lasix. It will also deplete your potassium! If you start having heart palpitations and/or leg cramps those are signs that your potassium levels are too low...and a sign to get to your doc ASAP! Seriously low potassium can kill. It's put me in the hospital more times than I care to count.

rentalguy,
you can save yourself allot of stress over this by making an appointment with mental health & having a "Psychiatrist" evaluate your pain & prescribe what you need. A Psychiatrist takes president over the others since "PAIN" is considered a mental disorder. They have to except the recommendations by the Psychiatrist. Been there done that.

If your PCP is not relieving your pain, they are in violation of the AMA's guidelines of the Hippocratic oath.

They must "relieve" your pain.

here's a question you might want to ask board members like, Berta, Wings, Carlie or Delta.

If your pain is not being taken care of & it increases or causes, depression, anxiety & stress & makes you ill from it, is there an 1151 claim you can file as a result?

Maybe I will drink a quart of beer. That will send me running, and I will tell the VA exactly what I think of them. Beer and percoset go great together to uninhibit my shy nature. You can forwarad email to my new address at the Orient County Jail in Tampa.

FTCA claim for sure. I don't think I would benefit much from a 1151 claim, and I would rather have someone outside the VA determine the validity of this, if it ever comes to that.

This is an excellent idea....

I do not use narcotics any more, longterm they will do alot of damage ( intestinal and stomach problems. ) I use Tramadol, Neurotin, and Anxiety meds...

Today I get Baclofen in the mail. We cancelled this muscle relaxer a couple of months ago and switched me back to cyclobenzaprine at my request. This was my first visit with the new PCP. The second visit is when they cancelled my pain meds. I am totally confused now. I am going to put in a message for her to call me, but I since she never returned my call the other day, I doubt she will this time either. No instructions to stop the cyclobenzaprine. No instructions on how to taper off the darvocet. Nothing to replace the darvocet with. Do I take both muscle relaxers together? If I do will I have a accidental overdose? I'm getting effin pissed!!!!!!!!!!!!!

My wife has a failed back surgery and for years they tried to treat it with stronger and stronger narcotics, to the point it made her a staggering zombie. She was becoming suicidal because her pain was increasing, and they were making her sign pain management agreements and a couple of her doctors had notated 'drug seeking behavior' on her medical record. When we moved, we finally met with a doctor who thought that maybe, just maybe, something was being missed. She tried treating my wife for fibromyalgia using Lyrica and another medication to prevent breakthrough pain. My wife is no longer a zombie, and has her life back.
I mention this because she has successfully switched from heavy narcotics prescribed for the wrong diagnosis, although she still takes something for pain.

My method of communicating with my doctors, is to make them smile and laugh. They are much nicer that way, although sometimes they tell me to be more serious. If I have a problem with the VA, I have no problem with name dropping while speaking with the patient representative. Due to the fact that I try to volunteer and be politically active as much as I can, I end up knowing quite a few people. So by mentioning that I am not in the habit of letting things die down and will go outside the VA gets lots of attention. Of course, I make sure I am 100% correct that something untoward has occurred, before making any statement like that. Luckily, most of my complaints have been Finance-related snafus. Although there was the time that a VA employee poked me in the chest to make a point, and I bent back his finger and dropped him to his knees until another employee arrived, and then I made the employee apologize in front of them. There were witnesses that I did not make contact first, but I wouldn't have responded that way otherwise. Did you know there is a list of 'dangerous' veterans the VA Police keep, so they can respond in numbers? I still say I am not dangerous, I just don't like being poked!

rentaguy,
im no PCP or pharmacist so I wouldn't begin to tell you how to taper off or switch meds.
Your PCP "SHOULD" have contacted you personally & done that already.
I can tell you they came close to killing me with toxic doses of meds. If you die from it, they could care less.
You need to contact the pharmacy & let them know what your PCP is and isn't doing & ask them what to do.

It's your life. Don't let them take it from you.

Finally got a call from my PCP's nurse. Went something like this:

Nurse: we got your message, and we have already sent you a letter. Did you get the letter?

Me: Yes. So do I keep taking the cyclobenzaprine, and start taking the baclofen, too?

Nurse: What cyclobenzaprine?

Me: The cyclobenzaprine that my pcp prescribed two months ago, at my request, during my first visit with her.

Nurse: Oh. I don't know. I will write a note and ask her. We will get back to you next Monday.

Me: OK. I also do not want a EMG, and I will not accept a appointment for one.

Nurse: Why?

Me: Because I have severe muscle guarding which will cause false readings, and which cause me to not be able to lie still long enough for the the test. A EMG will not change the course of treatment, either, because the neurosurgeon has already said that I am not a candidate for surgery at this point in time. All of this is in my medical records.

Nurse: I am writing all of this down to pass along to her.

Me: I also need some directions on how I should taper off of darvocet.

Nurse: Your pcp said to just stop taking it. There is no need to taper.

Me: If I miss a dose, I get headaches and nausea, but you're telling me it's ok to just stop taking these pills?

Nurse: Yes. I've never heard of any withdrawals from darvocet.

Me: Even after I've been taking it for two years?

Nurse: OH! I'm going to put you on hold and ask her.

Me: Ok.

Nurse: Your pcp said she didn't realize that you had been taking it for that long. She says you need to do this...to taper off.

Me: Ok. Thank you. I can't believe that she didn't know that I had been taking darvocet for that long. It's all in my records. She does review my records, doesn't she?

Nurse: (silence)

Me: The reason I'm on darvocet is because I failed the stronger narcotics. That's why Dr. XXX decided to just leave me on the short acting narcotic, because it kept me stable. The neurosurgeon agreed with this course. Even the VHA's literature regarding long vs short acting narcotics said it doesn't matter which is prescribed, so long as the patient's pain level is stable.

Nurse: (silence)

Me: I'm not trying to be a jerk, and I know I screwed up on this deal...even if it is silly in my mind. I am not opposed to switching to a non-narcotic, but I had hoped she would have given me something to replace the darvocet with since she has definitely discontinued it.

Nurse: I will pass all of this along to her. We will get back to you on Monday or Tuesday.

Me: Ok, but one more thing.

Nurse: Yes?

Me: Please have her take a little time and review my records before you guys call me back. All of this stuff is right there in your computers. You just have to look for it.


And that was about it. I doubt anything good is going to comeout this. I have the appeal working it's way to the Chief of Staff and Director of the hospital. I will take it higher than that if I must. Someone is going to get crucified for this piss poor medical care!

Well at least you got their attention

I got a letter over the weekend telling me that I had a appointment for a EMG. I called this morning to cancel it. The clerk said it was giving him a hard time to cancel, but he finally got the system to accept it. I wonder what kind of sh**storm this will bring. I am still waiting on their return phone call.

Rentalguy

You should not have to go cold turkey on the darvoset. If you want to taper off and can handle the pain then all right. The non-narcotics may not work for. I think I would quit fighting with the VA and go to a private pain doctor to get my narcotics. I bet they won't pull all this crap on you. Pain meds are cheap because they are all generics.

Got a feeling that's what's gonna end up happening, John. A interesting side note, though. I saw a story on the local news tonight that told a new state law that went into effect 1 july. Apparently, if I go to a private doc now, and I do not tell him about this incident, and I seek a narcotic, I go to jail if he finds out. This region is the worst in the country for prescription drug abuse. They sure make it tough for the ones who really need it. I didn't hear anything from the PCP today,either. If I don't stop stewing over this, I have a feeling something bad may happen.

Hmmm....I would tell the private pain doctor about all your problems with the VA. Let him prescribe something for you. I don't think you committed some horrible crime by not peeing in a bottle on demand for the VA. The private doctors don't require that. I bet they will be glad to get your business. What the state is looking for is people who doctor shop to buy load of drugs in order to sell them. Those guys are easy to spot. We are not in that category.

I am going to a private Doc my hydrocodone that was due July 7th is still not here.The yo you effect is really starting to bug me.

Bad scene all the way. I have been getting my pain meds for yrs from private dr's. Fentanyl, hydro's and tyl#3. VA has never given me anything except a few tyl3's yrs ago...then stopped.
They would not order hydro's or fentanyl either so I continue to get them from private dr. I feel for you...pain is more than subjective!!

I called VA and they said Fed Ex had it since July 8th. Someone is lying

Meds by mail suck

SO much for them calling me on Monday or Tuesday to let me know about my medications, etc. Imagine that!

Still not a single word from them! I am suffering from a major flare up of sciatica that started yesterday, and I am having to take more darvocet instead of tapering off of them. I have a dental appointment at the VA this morning, and I'm going to see if they have possibly sent a letter out, which seems to be what she prefers. She must be scared to talk to vets on the phone. Either way, I will be calling this evening to make a appointment with her. I am also going to try to stop by records and get a copy of my pain agreement. I also want to get a copy of any flags that I may have in the system. I just have a funny feeling that I have been flagged for some reason.

I am thinking about moving back the Philippines myself, last time we sent money over there the exchange rate was 48.26 PP/1 USD; my wife is Filipina, so she likes the ideal too. I have to admit it's not as comfortable taking public transportation, but everything has a trade off

AS long as you are near Metro Manila or Cebu you shouldn't have a problem, but research first...I had trouble getting Xanax, but that was in 1995...The P.I. didn't have it yet ( or so I was told).

I saw a pain clinic in the metro Manila area online searching.

I use a private pain clinic, and get my meds from the VA. At first I went years complaining of severe pain and was given 6 to 8 800 mg of Tylonol a day. Now they know that that is way to much Tylonol for the liver to handle...maybe they knew that back then too!? It dodn't touch the pain, so I didn't take it.

Hope you get this worked out soon.

Boondoc

rental,
Is this a subliminal way of the VA getting vets to become illegal drug seekers ?
Just a thought.
carlie

Carly, if it's SUBLIMINAL how would anyone know?

Frank