How can I find a nurse to deliver an injection around Santa Monica?
December 13, 2017 12:54 PM   Subscribe

Several months ago I started taking a delayed release psychiatric medication that's delivered via an injection every 4 weeks. The first several injections were arranged by the facilities I was in at the time; then I was in New Orleans for three months, where I had a fairly easy time arranging to receive them at a community clinic. Now I'm back in Santa Monica, CA, and not having such an easy time finding a means for this. Where should I turn?

The injection is due on the 21st. I still have refills from the guy who prescribed the med in New Orleans but I don''t have an appointment with a local psychiatrist until January 11th. In New Orleans, I picked up the meds at a normal pharmacy and brought them to the clinic for an appointment for the injection. But the MD I go to for family medicine at a local clinic here said he can't help me because the prescription is from 'outside'. Does anyone know of a place I can arrange to just show up at with the meds and have them do the injection? Does anyone have any other ideas? All suggestions welcome.
posted by bertran to Health & Fitness (25 answers total)
I'm not familiar with CA laws, but have you called any visiting nurse services versus offices? I know they can do injections for people who need to have them at home more regularly (like injectable blood thinners.)
posted by cobaltnine at 1:08 PM on December 13, 2017

Just to clarify, is the medication supposed to be self-administered and you don’t want to do it, or a professional needs to administer it? I think you will have a hard time finding someone to do this unless you know someone in healthcare. Maybe if you brought it to an independent non-chain pharmacy along with whatever paperwork you have from the doctor who prescribed it originally, they may help you. Another option could be hiring a home health aide although I’m not sure they are able to inject.
posted by tatiana wishbone at 1:11 PM on December 13, 2017

Response by poster: I think it's normally administered by a professional; no one I've talked to about it has ever suggested otherwise.
posted by bertran at 1:18 PM on December 13, 2017

You should be able to get your old doctor's office to call your new doctor's office and explain the situation. (Just like transferring an ongoing prescription from one doctor's office to the next, but with an extra step of making the injection appointment.)

It's still working, correct? You're able to comply with any tests your new doctor might require? You have prescription paperwork and access to your past medical records? If yes, can you push back on your current doctor? If it's from "outside" but you need to continue it because it's working and the condition doesn't go away, then it's your new doctor's problem to make sure you keep getting what you need.

It wouldn't be any different if you were taking Prozac or insulin and your new doctor wouldn't prescribe it because it came from "outside," because you would be facing withdrawal and resurgence of symptoms while they decided to write a new prescription from "inside." Your doctor needs to be making sure you are getting the care you need. I can't tell from your question if it's a controlled substance or something that would make a doctor hesitate, but if what they are telling you is "uhhhhhhh I guess you have to go off your medication suddenly because it wasn't my idea in the first place" then you need to fight them or get a new doctor.
posted by blnkfrnk at 1:21 PM on December 13, 2017 [1 favorite]

I agree that it's worth calling both your primary care physician's clinic as well as the psychiatric practice and explaining that you have a previously-written prescription for a long-acting injectable medication but you're struggling to find a provider to administer it, and that you're concerned about a potential relapse in your symptoms if your medication regimen is interrupted. I'd not be surprised if your primary care practice pretty much considers this to be your psychiatrist's problem but it's worth pushing in both places.

Another route might be to figure out who the manufacturer of the drug is and to see whether they have any patient-assistsance phone lines that would help you find a provider to administer an existing prescription. For example, this appears to the website that does that for Invega and risperdal (which I realize may not be what you've been prescribed, but the manufacturer of that drug may have their own similar helpline).

Good luck - this sounds like a really frustrating situation.
posted by iminurmefi at 1:36 PM on December 13, 2017 [1 favorite]

Response by poster: There is information on this medication along with an instructional video for professionals here.
posted by bertran at 1:36 PM on December 13, 2017

Another idea - have you contacted your county's community mental health program?

County Mental Health contact list for California
posted by iminurmefi at 1:39 PM on December 13, 2017

The instructional information you provided suggests that this medication is administered intramuscularly. It is very common to self-administer intramuscular injections. I do so every week for my hormone replacement therapy. Or at least I was before I started having my wife do it in my gluteal area (less residual pain for me). There's a lot of videos on Youtube for self-administering intramuscular injections, although I understand if that sounds really scary, especially if you've had a nurse do it in the past. If you do want a provider to administer it, I recommend following other suggestions here, particularly for having your previous psychiatrist contact your primary physician's clinic.
posted by lilies.lilies at 1:54 PM on December 13, 2017

Does it have to be administered by a medical professional? Lots of people, such as type I diabetics, are skilled at giving themselves injections. There is probably somebody in your social circle that can help if that is a legit option.
posted by COD at 2:01 PM on December 13, 2017

I would ring walk in and urgent care clinics and find out if they can inject a prescribed medication for you.
posted by DarlingBri at 2:02 PM on December 13, 2017 [1 favorite]

You might also try calling Walgreens or Target, as they often have flu vaccine clinics and walk-in NP visits--they may be able to help.
posted by stillmoving at 2:31 PM on December 13, 2017 [1 favorite]

Another idea: if your health insurance has a consulting nurse hotline, call them and ask for help. Sometimes they know where you should go and can help put you in touch with the right clinic/person in your health insurance system.
posted by purple_bird at 2:44 PM on December 13, 2017

Do you have a psychiatrist in California who is managing your care?
posted by pintapicasso at 2:59 PM on December 13, 2017 [1 favorite]

I think your best bet is to harass the psychiatrist with whom you have an appointment on the 11th. I do not know if the ED would do this for you. You might also try walking into a smaller/seedier primary care practice, perhaps in an immigrant neighborhood, where the rules are a little less strictly applied. Don't give up! You'll get it done.
posted by 8603 at 3:32 PM on December 13, 2017 [1 favorite]

I would call the number provided on the medication website you linked, 1-866-274-7823.
posted by TheGoodBlood at 3:55 PM on December 13, 2017

I would first ask your previous doctor to call your current pcp and ask him to do it. It's a one time thing until you establish with your psychiatrist , and the detrements of missing are high. It really should clear things up for him to say no this is really a legit thing and you have appropriate follow up just not yet.

Then I'd call the new place to see if they can make it urgent appointment for intake and move it up, but it is the holidays.
posted by AlexiaSky at 7:42 PM on December 13, 2017 [1 favorite]

Response by poster: I've contacted the patient support of the company that makes the drug and it sounds like stillmoving has it right and that I can have the injection done at Walgreens; I'll know more tomorrow.

Thank you all for your responses!
posted by bertran at 7:54 PM on December 13, 2017 [3 favorites]

That video was super specific and I might be tempted to self inject if I couldn’t find anyone to do it for me. I agree with the suggestions above- call the manufacturer’s number and also call walk-in clinics.
posted by PorcineWithMe at 7:56 PM on December 13, 2017 [1 favorite]

Safeway pharmacies have been doing psych IM injections for many of our patients in Northern California, so that might be another option if Walgreen's doesn't work. You could also contact the LA County Dept of Mental Health at 1-800-854-7771 and ask for guidance. I work for county mental health up here, and we have a lot of clients on these medications, so they should have some experience with it.
posted by lazuli at 9:02 PM on December 13, 2017 [1 favorite]

I would also counsel against self-injection, just because the RNs here often have issues with the injections and have said they're really fussy in terms of how fast they're injected, how much pressure is required, etc. Given the cost of the medication, you're probably unlikely to get insurance approval for an early refill if you mess up the injection.
posted by lazuli at 9:04 PM on December 13, 2017 [1 favorite]

Long Acting Injectables should be administered by a healthcare professional. They need to be stored correctly as well placed in the correct muscular area. Sometimes if the RN doesn't shake the syringe long enough or inject in the wrong area, the meds wear off more quickly and you will need to augment with additional oral meds to manage returning symptoms. Calling the patient support of the parent company is exactly what you needed to do. They often provide services such as calling you to remind you of your next appointment for your IM, finding the pharmacy to deliver to your provider or help with making appointments. Good luck with it and congratulations for being so proactive with your care.
posted by IndigoOnTheGo at 5:22 AM on December 14, 2017 [1 favorite]

And now that I see which medication you're talking about -- yes, that was the particular one our RNs were having issues with. The pharma company actually sent one of their RNs around to do additional training on these injections with our licensed RNs. (I've heard good things about the effects of the med, just some frustration with the act of injecting it!)

I have also heard that many local private-practice psychiatrists won't do injections, because they're not really trained in it, either, and they may not have RNs or other support staff on hand. PCPs are sometimes leery of administering long-acting injectable psychiatric medications, because they may not be super-familiar with them. The pharmaceutical company has been working locally with Safeway pharmacies to make them the go-to place for picking up the medication and having it administered. My sense is that's going to become more of the standard model (whether Safeway or Walgreens or other in-store pharmacies) for people in private-practice settings.
posted by lazuli at 6:42 AM on December 14, 2017

And to add on to lazuli's comments, it's very difficult to find providers to perform the service because they are unsure of how to bill the appointment. They will not be paid unless they provide the correct code for the insurance company to be reimbursed.
posted by IndigoOnTheGo at 8:44 AM on December 14, 2017

Response by poster: The solution turns out to be that the clinic I have an appointment to see someone at can do the injection even though I haven't seen them yet. A Vons in my area also does injections.

Thanks again everybody for your input and information.
posted by bertran at 7:13 PM on December 14, 2017 [1 favorite]

Response by poster: I want to add as a follow up, for the sake of anyone looking at this with a similar question, that the Santa Monica Urgent Care Clinic on Colorado Blvd will give injections, and also the pharmacy at the Von's on Broadway will give injections for some medications that have been ordered through them.
posted by bertran at 12:15 AM on February 3, 2018 [1 favorite]

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