You know, even if I
know that these pts. are not just limited to my practice, it's still somehow comforting to hear that i am not the only one dealing with this!!
And the Ambien pts. - ugh!!! Happens all the time out here in Silicon Valley (did you think California was full of healthy-lifestyle, thin, bike-riding/hiker type of folks?
) And those stupid Lunesta commercials - "safe up to 6 months of use" In fact I just told a pt. yesterday "Sure, and just TRY and get a pt. off of it after they've been on it for six months!!" No thanks...
Leslie, we give our pts. a fixed amount (I'm talking Ambien here) to last over say, 3 to 6 months (which amounts to about one a week). If I were you, with that pt. who then runs to the Neuro with her sob story, I'd invoke the "trust" thing that I mentioned in my Vicodin rant above. I have told pts. that if I find that they are getting these drugs elsewhere, then I will not prescribe it for them again - once they breach my trust, which is so vital for a working doctor-pt. relationship, then I will not rx. that med again. Period.
Having said all of this, lest you think that I am a cruel and inhumane doc who lets her pts. suffer, I will add that I DO use Vicodin regularly for a very select group of pts. One that comes to mind is a wonderful, very mentally intact 90 year old woman with crippling OA, who has a GFR of like, 18. I wouldn't let an NSAID past her lips. She has gotten an rx of one Vicodin (reg. strength) BID from me for about 3 years now. She never asks for more, and the rx request comes in like clockwork. I rx it every three months, and she is forever grateful, because that allows her to go about her ADLs with SO much less pain...
It's just a shame that it's been so abused. I heard that it was the second most common cause of liver transplants (behind chronic liver disease from hepatitis and cirrhosis) - don't know if that's true, but I wouldn't be surprised...
