In the state of Indiana, we have new regulations for prescribing scheduled drugs and the monitoring thereof. Some are that you should see them every 4 months, take a detailed H&P, have the patient complete an objective pain assessment tool, sign a treatment plan, receive education concerning the potential harmful effects of narcotics and perform a urine drug screen. And, if they are on the "Holy Trinity" of opiate + Soma + Benzodiazepine you may as well go ahead and tell them they will be SOL on getting refills. I have already lost several patients who became livid when I followed these recommendations. I told them to drive to Kentucky or Illinois then to get their narcotics...good riddance. So, if your patient is complaining about your 4 month rule, tell him to come to Indiana! Now if the ER and Pain Management docs around here would not undermine all the hard work I put into getting people off or doses down by giving them narcotics for a carbuncle life would be good!
