Woman came in at the end of a shift to drop off a Methadone Rx for her mother. Her mother has been a patient of ours for decades, so we knew her quite well. She had been in a nursing home the past three months and had only recently been released. What I recieved the Rx I noticed right away that something was wrong. It was written as:
Methadone 10mg, 1tQID
With our Methadone patients I take a special note as to what they usually get and I immediately recognized that this was an increase. Previously she had been on:
Methadone 5mg, 1tTID
So I ask the patient's daughter if there had been a dose increase. She stated that there wasn't, the doc refilled it with the same directions as before. I decided to give the doc a call to see what was up. And do you know what she told me?
She couldn't remember what she was on so she just guessed.
Fucking guessed. On Methadone.
Never mind the fact it would take literally two minutes to check past records, this doc simply decided to take a shot at what it was previously.
How Methadone is legal in this country I have no idea. It is probably the most dangerous prescription medication on the market. The last few years, docs are handing this shit out like candy. We have several patients that are on 600+ tablets a month (our current record holder gets #900 a month) and have been on those doses for what seems like ever. Half the time they show up shit faced to pick it up. Brilliant idea, no?
I just do not understand the lax standards when it comes to Methadone lately. The pharmacist and I both told the patient that she may want to consider a new doc after what occured.
At least we'll prevent one dumbass Methadone prescription.
5 comments:
Being tagged as a chronic pain patient is bad enough. I prefer a med not well known- even the residents in the er don't know it by name! Funny when they 'confront' me about my positive tox screen, when I've shown the bottle to the triage nurse, my nurse, the residency director and the resident...
I would think that the issue with being a potential drug abuser (which you already get as a chronic pain patient) coupled with the half life of the drug would be enough to insist upon another drug.
What a lousy excuse on the Dr's part. 'I accidentally killed her because I guessed... oops.'
Methadone is useful in avoiding physical withdrawal in dependent patients since the dose required to do so is much lower than the dose where the euphoric effects are seen. Furthermore, it sticks around a while so the patient usually only needs one maintenance dose per day, ideally given at a clinic, which is slowly tapered as the patient recovers. This allows many patients who have become dependent to lead normal lives.
However this same long-acting effect can make it a poor choice for pain management. The drug can sneak up on you when using it for pain. What sometimes happens is drug will accumulate under the radar until suddenly the patient is experiencing respiratory depression.
So I share your unease in dispensing it but I wouldn't if I worked at a methadone clinic. Or at least my concerns would be different ones.
It is all about dollar bills and Methadone is cheap cheap stuff. It will scary to hear a doc being so lax with it. Up the dose like that and get a few beers in the patient and she probably will go to sleep and not wake up.
900 a month????? O...M...G
im a methdone patient at a local clinic here.i started at 50mg a year ago.my first months were the hardest since i wanted to decreas each and everyday i wanted to stop being dependent on a drug,especially after i got off one to another.today im at 2mg.when people at the clinic ask me what im on they dont belive me and ask me how i feel.i tell them that its all mental,especially after the doctor doesnt have faith in you that youll never get out of this.when you first enter the clinic he even tells you that he doesnt expect for you to get out of this medicince.and i wanted to prove him wrong and now i am.but my question here is does anybody know if it affects you if you want to be a pharmacist after being in a methadone clinic for 2 years.do they check all your backround as to where you been and what you been doing?can somebody please answer me this im majoring in pharmacist and really like this career.if somebody has an answer please email me at EmoNumber@hotmail.com i would TRULY appreciated if somebody can respond to this.it will be another weight off my shoulder.thank you and have a nice day
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