DEAR DR. GOTT: Why would two doctors write a “no refill” prescription that was the same except for the number of days the prescription was to last?
The first prescription (written in hospital by a resident) was for 30 tablets with a dosage of one to two tablets every four to six hours, as needed for pain. It was written for four days. The prescription could not be refilled before the four days were up even though the two highest dosages would use up the tablets in fewer than four days.
The second prescription (written after discharge by a private practice physician) had the same number of tablets and the same dosage but was written for two days and, therefore, could be refilled before the prescription ran out no matter which dosage to be used.
DEAR READER: I believe you are somewhat mistaken. A “no refill” prescription CANNOT be refilled. This type of prescription is most commonly used for narcotic pain relievers and antibiotics.
In the case of antibiotics, it is used to prevent individuals from “self-medicating”. Many people think that common illnesses such as a cold or the flu will get better if they take antibiotics, when in reality, they are totally ineffective. Antibiotics are for bacterial infections, whereas the common cold and the flu are both viral.
In the case of narcotics, “no refill” prescriptions are used to deter abusers and help physicians better monitor the use and detect potential abuse. By making the user contact the prescribing physician each time a refill is wanted/needed, the physician is able to keep a record of which drug is given, the number of pills, the recommended dosage, and how often the user calls for another prescription. If the user is calling or appearing in the office repeatedly before the prescription should run out, especially if they appear/sound agitated or have repeated excuses (such as they dropped the pills down the sink), the physician can cut the patient off and/or help them stop the addiction. The selling of narcotics often accompanies addiction (another reason to limit prescriptions), because the user “graduates” to stronger drugs the longer the abuse goes on, and by selling the lower dosages, they can pay for their drug of choice.
I can’t tell you why the physicians chose to write the prescriptions as they did. It’s my opinion that the lowest possible dosage should be used whenever possible to reduce the risk of dependence. Narcotic pain relievers aren’t the only way to deal with pain, and (again, in my opinion) should only be used when other methods fail. Over-the-counter pain relievers, ice, heat, relaxation techniques and more can be used instead of or with narcotics. There are a few exceptions to this, of course such as major surgery or trauma which typically causes intense pain; and immobility should be treated with narcotics, primarily while in hospital and for a short time after discharge. Following discharge, the patient is typically well enough to move around and pain levels should have decreased, lessening the need for prescription pain relievers and allowing other options to adequately cover needs.