People with chronic pain often don’t have access to painkillers because their doctors won’t prescribe opioids. Doctors see plenty of patients who want drugs, not pain relief, and have to decide in a short time which category the patient fits into. The DEA is cracking down on docs who it believes over-prescribe opioids.
There are many, many sides to every story. When it comes to access to opiates, not a single side is happy. Except for numerous recreational drug users, who are still getting the drugs they want.
If you’re reading this, you’re probably familiar with a patient’s perspective, but doctors have their own struggles. Dr. Charles, a literary medical blogger, recently chronicled his frustrations with determining whether patients are drug-seekers or just need pain relief. Some doctors don’t even apply for a license to prescribe schedule II drugs* because the risk and hassle are too great.
How long will we as a society continue punishing people who face each day in agony?
*The brand names of some Schedule II drugs include: Actiq, Duragesic, Sublimaze (fentanyl); Alfenta (alfentanyl); Demerol (meperidine); DHC Plus (dihydrocodeine); Dolophine (methadone); Leritine (anileridine); Lomotil, Panlor, Synalgos (diphenoxylate); Orlaam (levomethadyl); Sufenta (Sufentanil)
It is a difficult problem. As a doctor who does prescribe opiates for headache, I can say that there are indeed people who use them to benefit and this allows them to function, work, drive, etc. It is also true that many patients use them to mask depression and anxiety and are unwilling to take other measures to help themselves. Lastly, there are people who become truly addicted and are a real danger for all. I am sympathetic to the patients and doctors as well. I was falsely reported to the state board by a former disguntled employee. This produced an investigation from which I was exonerated, but only after months of hassle and expense. I am much more cautious about prescribing narcotics now, and only do so as a last resort in very compliant patients.
I was interested in your discussion last year of Lyrica and Sleep, and because of the approval for fibromyalgia last week, have written about this in my own blog at:
http://www.revolutionhealth.com/blogs/stevepocetamd/new-drug-approval-for-5264
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Thanks for your input. I wish there were an easy fix, but know that’s just wishful thinking.
And thanks for the link. I get a lot of people looking for information on Lyrica and can’t give much help.
Kerrie
Hi. I’m a longtime sufferer of chronic daily migraine. I do have a headache specialist who understands the reality of pain, and does prescribe pain medication for me, helping me to monitor its use and effectiveness. This is, however, the first time I have found a website like this. I am wondering if others who do use opiodes for pain management could tell me WHAT you think constitutes “appropriate and effective” use.
There’s no easy answer. Every time I take a painkiller, I worry that maybe I’m taking too many too often or that I’m just trying to escape from the pain. I try to take no more than three abortives a week (painkillers or triptans), so that’s what I fall back on.
Plenty of people take them all the time (literally round-the-clock). There’s a risk of building up a tolerance or having withdrawal symptoms, but if that’s what you need to beat your pain, then the trade off may be worth it.
I don’t think my pain is bad enough for me to take narcotics regularly, but there’s absolutely nothing wrong with it as long as you and your doctor both know what’s going on.
K
About the only reason I’m thinking of staying with my current primary doc is that (so far) she’s not afraid to dish out the meds. But yeah I had one doc where I was FIRMLY told that he WOULD NOT prescribe any pain meds. Fired him LOL.
I just came across these “got morphine?” T-shirts and had to share the link:
http://www.cafepress.com/medtees/711070
Be sure to wear one to your next doctor’s visit!
I thought I was going to barf, reading a doctor whine about patients who come to his office for medication to soothe their pain. Don’t they know that THAT’S THE REASON WE GO TO THE DOCTOR?! Hello! I know there are drug-seekers, but I have to wonder if this guy doesn’t go into the room with that in mind, BEFORE he even hears a word from the patient. I mean, gimme a break. Of all the things to whine about! Oy. Sorry, K. I really tried to read with sympathy, I honestly did, but by the time I got to the end, I just wanted to shake him and every other doctor that’s left me writhing in pain for hours in the waiting room! Guess it’s going to be awhile until my sense of humor returns when it comes to this kind of thing. The PTMD (Post Traumatic Migraine Disorder) is still too fresh a wound. I just wouldn’t take kindly to my doctor laughing at me behind my back when my pain level is what it is, but I’m sure some of them did. (And, to be honest, those examples he used were pretty lame, laughable and very obvious, so I don’t mean to totally knock him, it’s just the general premise, not the specifics, in his ode, if that makes sense.)
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I’m sympathetic to his argument because there are a lot of people just looking for drugs. Drug-seekers to have certain behaviors, but people with chronic pain also have these behaviors unless they have adequate pain relief. When a doc doesn’t know the patient and his or her history, it’s extremely difficult to tell which category that person falls in.
It’s hard on us, but it’s also hard on people who want to take care of their patients, but have to make tough decisions that could be harmful to their careers.
I can’t find the quote right now, but I read that a doctor has a one in forty chance of losing his or her license for prescribing narcotics. That’s a HUGE risk.
K