do you really have to see a doctor to be prescribed muscle relaxers?
January 11, 2019 12:43 PM   Subscribe

I threw out my back and can't move very well. This has happened before in the past (twice in 15 years) and each time I called my GP and they called in a prescription for me. My current GP says I need to come to the office (impossible). I explained that in the past I was able to handle things over the phone, and they said that it was probably a long time ago when rules were different. It's true that the last time this happened was 9 years ago. But I just find it unbelievable that a patient who can't physically move would be expected to physically move in order to get the drugs that could help her physically move. I'm wondering if the rules really are this strict or if just this GP is.
posted by january to Health & Fitness (16 answers total) 1 user marked this as a favorite
Some prescriptions cannot be called in without an office visit. My wife is a dentist. What she can prescribe when you're sitting in her chair in pain is very different than what she can prescribe if you call the emergency line after hours with pain. I'm not sure if muscle relaxers fall in the same category as pain meds, but at least it's conceivable that your GP needs to see you first.
posted by donnagirl at 12:53 PM on January 11

yeah, muscle relaxers are one of those drugs they're more fussy about. i have always had to go in for a script, and get a physical paper copy i then brought to the drug store. unsurprising they want you to come in. especially if that particular person has never prescribed them for you before.
posted by misanthropicsarah at 12:56 PM on January 11 [1 favorite]

Having just been in a situation where my best friend was having trouble getting painkillers while literally dying of cancer, I can attest to the fact that there's been a big crackdown on all sorts of pain meds, including things that fall under the category of muscle relaxers.

Additionally, I actually got a mini-lecture about muscle relaxers -- which I use for my back -- from my doctor two days ago. This, despite the fact that I have used only a handful of the pills he prescribed for me exactly a year ago, and thus wasn't even asking for a refill.
posted by BlahLaLa at 12:56 PM on January 11 [2 favorites]

This is not out of the norm. Prescribers are becoming more strict as regulatory bodies start to monitor prescriptions more. Muscle relaxers can be abused, and ppl can become addicted. (Not saying at all you would do this, but just trying to give you POV from physician.)
posted by namemeansgazelle at 1:06 PM on January 11 [4 favorites]

Depends on if this is the same GP or not (eg someone who has given you muscle relaxants for this problem before).

I somehow manage to throw out my back about once every 18 months, and I was always getting an appt to come in because I assumed they would want to see me before giving me the prescription. My 2nd time in with my current doctor they said in the future I can just drop them a note through the secure messaging portal and they'll send in a script for me if it's the same thing. In the amounts required to get through an incident (like 5-10 pills tops) I think they determined it wasn't a huge risk...
posted by CharlieSue at 1:39 PM on January 11

It's partly because it's a new GP that hasn't prescribed muscle relaxers for you before and partly because in the last 9 years regulations about scheduled drug prescriptions have drastically tightened. It's really hard to go in and see the dr when you can barely move to hold the phone, but I think the dr has their hands tied in this situation.

In my practice, I have to see my dr every 3 months for my scheduled prescriptions, no refills without a visit and I had to sign a form that says I will only fill my prescriptions at one pharmacy. These rules all came into practice about 18 months ago and if my dr could circumvent them, he absolutely would.
posted by hollygoheavy at 2:20 PM on January 11

In my state, the law is that you have to have seen someone at least once a year for a problem, in order to prescribe a medication. For scheduled medications, it's 3-6 months, depending on the med.

If you really cannot move, do you have access to telehealth urgent care? It's not ideal as the exam is limited, but it would be enough to count for regulations.
posted by basalganglia at 2:35 PM on January 11

They've gotten a lot more strict with painkillers. I don't know about muscle relaxers, but it's gotten much harder to get narcotics even in the past few years. I try to keep them on hand proactively in case I need them immediately.

Funny timing, I woke up with muscle spasms today and took a Percocet, realized I was getting low, and called my doc to get a new rx so I can have them on hand. For Percocet, at least, they can't call it in. I have to take a paper rx to the pharmacy (which I'm having them mail to me).
posted by radioamy at 3:47 PM on January 11

I'm an emergency physician.

Although they work pretty well and have a decades-long track record, muscle relaxants (MRs) have a major problem: they work by causing general nervous system sedation--essentially calming down the conductive pathways for the transmission of pain signals from the peripheral NS to the central NS--rather than by targeting the musculoskeletal tissue from which the pain itself originates

Muscle relaxants, by way of causing general NS suppression, come with loads of negative side effects, ranging from respiratory impairment to bradycardia, to name only the two most dangerous.

The scope and severity and these side effects were largely unstudied and therefore not well understood until about 10 years ago, when the onset of the opiate epidemic translated into copious research funding for the re-evaluation of all controlled substances and drugs of potential abuse and accidental misuse, among them muscle relaxants.

I would never prescribe MRs without seeing a patient, nor should/would any other doctor aware of the latest research and prescribing guidance from both the federal government and medical specialty specific governing societies.

Yes, dragging yourself to a doctor when incapacitated by lower back pain is a huge pain in the ass, but it's nevertheless mandatory these days. You'll just have to bite the bullet. I'm sorry. I know it sucks.
posted by BadgerDoctor at 5:27 PM on January 11 [12 favorites]

You might consider a concierge doctor. I understand that house calls are in the area of $200-$300. Ymmv as whether that's worth it or not.
posted by vignettist at 6:47 PM on January 11 [1 favorite]

Came in to echo the concierge dr idea. This is not how things ought to be, but based on my experience observing a relative's exchanges w/ their concierge dr, if you are by default paying your dr a flat monthly rate, they will dial down the knee jerk admonition that you must come in (so they can bill for another appointment.)

Maybe with controlled substances it would be a bit different, you mught need to be seen and/or they might need to fax or snail mail an rx to you, but for other, uncontrolled rxes , it will probably get much easier to take care of some things, if you pay monthly for the convenience. Sad but true: much of the run around patients get over simple shit (eg an office visit to discuss thryroid level bloodwork for a long ago dx'd condition being treated routinely for almost two decades) , is just economically motivated.
posted by elgee at 12:34 AM on January 12

I'd be surprised if a concierge doc would be willing to break the law and/or lose their license by prescribing a medication for a new problem without examining a patient. The CDC has a nice summary of state law on this; all but 9 states expressly prohibit prescribing without examination, and those 9 have more general provisions about a bona fide doctor patient relationship. But concierges are considerably more likely to make a house call, so there's that.

Not to derail, but the scenario elgee describes, coming in to discuss routine labs, is very different and pretty unethical. Which is not to say it doesn't happen -- something similar happened to me in high school when my doctor's RN wanted a $25 copay to read the PPD she'd placed three days before. But especially in the era of patient portals and auto-release of test results, it's sleazy and borderline insurance fraud depending on how it gets coded.
posted by basalganglia at 4:06 AM on January 12

Basalganglia, respectfully, I think you're possibly misunderstanding the point of working with a concierge doctor in this case. OP feels physically unable to get themselves to a doctor's office. A concierge doctor would come to OP to do the examination in person, and then would write a prescription.

Again, respectfully, for the sake of OP who is in real pain, I don't think we should allow this discussion to derail into the general crappiness of the US healthcare system.
posted by vignettist at 7:45 AM on January 12

I am not your medical student, but i just wanted to echo what everyone else says about a visit being necessary. I have been there and it really sucks-- I'm sorry.

Can a friend bring you some magnesium from the drugstore? Take 3 or 4 of them and be ready for a loose stool. That might work well enough to get you in to see the doctor. Hang in there!
posted by 8603 at 7:47 AM on January 12 [1 favorite]

Which country do you live in? The rules differ between countries. (In Canada, you can get methocarbamol (muscle relaxant) + ibuprofen over the counter, brand is Robax Platinum. If you’re in the US and close to the border, you could probably pop over and get a reasonable amount.
posted by cotton dress sock at 10:24 AM on January 12

vignettist, as I said in my comment, the value of a concierge doctor in this situation would be to come do a house call so that january wouldn't have to drag themselves to their PCP in person; telehealth urgent care is another option that is covered by some insurers (concierge usually is not). I was responding mostly to elgee's contention that an examination prior to a new script is a "knee jerk admonition" and a money-making scheme, rather than a point required by law and licensure.

In any case, I agree that a derail is unlikely to be helpful to january, whom I hope gets the care they need.
posted by basalganglia at 1:49 PM on January 12

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