Texas: NP's only prescribe hydrocodone products to hospice pt./hospital facility practicie

Esme12, ASN, BSN, RN · Dec 17, 2014

That is terrible....there are many patient that don't qualify for hospice but have severe chronic pain. What are they supposed to do?

So now how do they answer the pain question...what level is your pain? A 10 because the government won't let the primary caregiver prescribe me relief.

SO what do they take? Tylenol with Codine? Dilaudid PO? I'm sorry...tramadol, regardless of it's supposed breakdown, is like taking Ibuprofen. For me...it is useless.

The government has taken away so much from primary caregivers and the patient in genuine need. Why punish the patient that really needs the meds and go after the MD/PCP that over prescribe. It makes me angry.

Riburn3, BSN, MSN, APRN, NP · Dec 17, 2014

I live and work in Texas and don't have much of a problem with this. Prescription narcotic abuse is getting out of hand to the point that the practice I'm at stopped prescribing it months before the mandate. Now patients that need it get converted to Tylenol #3 or #4, or get a referral to pain management.

That said, I don't like the limit to practice either, and wish a system existed in Texas, like in New Mexico, that allows your to track patients and their controlled substance prescriptions online. When doing some clinicals there, it's amazing how many people stroll into urgent care asking for hydrocodone hours after getting a prescription in an ER.

Trauma Columnist · Dec 17, 2014

I practice in IL and we can prescribe hydrocodone, dilaudid, fentanyl, ADD stimulants, etc. Its very important for the TX APRN organization rally behind this cause and change the policy.

MikeFNPC, MSN · Dec 17, 2014

I live and work in Texas and don't have much of a problem with this. Prescription narcotic abuse is getting out of hand to the point that the practice I'm at stopped prescribing it months before the mandate. Now patients that need it get converted to Tylenol #3 or #4, or get a referral to pain management.
That said, I don't like the limit to practice either, and wish a system existed in Texas, like in New Mexico, that allows your to track patients and their controlled substance prescriptions online. When doing some clinicals there, it's amazing how many people stroll into urgent care asking for hydrocodone hours after getting a prescription in an ER.

Check out this link:

https://www.texmed.org/uploadedFiles/Current/Practice_Help/Technology/e-Prescribing/EPCStexas.pdf

Mike

edmia, BSN, RN · Dec 17, 2014

This policy has nothing to do with reducing abuse and all about diminishing the practice of NPs. If it was truly meant to tackle abusers then the same policy would apply to MDs unless they are pain specialists.

Sent from my iPhone -- blame all errors on spellcheck

Riburn3, BSN, MSN, APRN, NP · Dec 17, 2014

Mike, thats going to be great when it gets universal adoption. It was one of my favorite aspects about doing some clinical work in New Mexico. Just pop in a name and you get a list of their prescriptive history in seconds. Some of the patient reactions when you called them out on their drug seeking patterns was great.

Riburn3, BSN, MSN, APRN, NP · Dec 17, 2014

Edmia, it still inconveniences MDs by having the schedule change to II, requiring scripts be filled out on triplicate pads. Like I said earlier, the MD I worked with stopped prescribing it months before the change and has never prescribed schedule 2 on an outpatient basis just because he doesn't want to deal with the liability and extra red tape.

Jules A, MSN · Dec 17, 2014

Our colleagues, NPs and Physicians, have largely caused this by both prescribing narcotics willy-nilly and not placing limits on patients when it is clear they have exceeded the expected time for pain control treatment. Although I have issue with placing limits for NPs and not MDs I think the change to Schedule II is a long time coming. Opiates have not been shown to effectively treat chronic pain on a long term basis especially when risk vs benefit is considered. This is an epidemic and even for people with legitimate chronic pain we can do better than simply giving them a handful of pills for years and years with no glimmer of seeking an improvement in function.

Perhaps we should also consider the lack of substance abuse education in most NP programs and how that impacts the inappropriate prescribing of both opiates and benzodiazepines.

Riburn3, BSN, MSN, APRN, NP · Dec 17, 2014

Our colleagues, NPs and Physicians, have largely caused this by both prescribing narcotics willy-nilly and not placing limits on patients when it is clear they have exceeded the expected time for pain control treatment. Although I have issue with placing limits for NPs and not MDs I think the change to Schedule II is a long time coming. Opiates have not been shown to effectively treat chronic pain on a long term basis especially when risk vs benefit is considered. This is an epidemic and even for people with legitimate chronic pain we can do better than simply giving them a handful of pills for years and years with no glimmer of seeking an improvement in function.
Perhaps we should also consider the lack of substance abuse education in most NP programs and how that impacts the inappropriate prescribing of both opiates and benzodiazepines.

Couldn't have said it better.

MikeFNPC, MSN · Dec 17, 2014

That's a great point. I'm fresh out of school (one week :yes: ) and there was little emphasis on substance abuse education; other than what I saw while precepting.

Riburn3, BSN, MSN, APRN, NP · Dec 17, 2014

Great point as well Mike. Another interesting thing I find is that at least for me, I wasn't questioned at all about opioid or substance abuse on the certification board. You would think learning about substance abuse with prescriptive authority, and being tested on it would be relevant to practice since it has become such an epidemic.