Can’t find a doctor to prescribe pain meds?

Don’t feel alone.  This doctor is worn down and just saying no.  Opioid poisoning as a cause of death more than tripled in the US between 1999 and 2006.   Death from prescription opiates is now more common than death from heroin and cocaine combined.  (USA Today)

Today a new patient came to the office looking for a physician to prescribe the opiates she wanted to take for her fibromyalgia, interstitial cystitis, and chronic low back pain.  She proceeded to say she just wished the good doctors who had previously been prescribing her massive doses of opiates were still around.  She thinks one of them must have done something wrong, because his office was just closed down suddenly and all his medical records were taken away.  I’m sure this is the Lakewood, WA  physician who lost his license for inappropriately prescribing opiates.  She was a caricature of the opiate-seeking  patient.  She had not just one of the ill defined painful conditions that are impossible to exclude, but at least three.  She had been prescribed both Oxycontin, as well as large doses of “breakthrough” oxycodone.   I am not accepting new pain management patients into my practice.  This made it easy to explain that I would not be able to treat her for these problems with opiate medications.  Actually the abuse of opiates have become such a rampant problem that I don’t know of a physician in the county who is accepting new pain management patients.  This is sad for patients new to the community with legitimate need for pain medication, but just an impossible position for physicians.  Any physician who becomes known as accepting chronic non-malignant pain patients would be quickly overwhelmed by the droves of new patients needing pain medications who would show up to receive care.  Years ago a wise older physician (he was probably as old as I am now, and likely far wiser) told me we all have our albatrosses.  These he described as very needy and difficult patients that you’d just like to find a way to get out of your practice.  He explained that if we all just keep a few then no one will be overburdened with too many.  Otherwise they will just keep circulating in the medical community, and all of us will still need to take care of them.  It’s best to just buck up and keep doing our best for them.  These days I feel like these patients are not like rare albatrosses, but rather like common crows, just everywhere, and dashing in to pick me apart like road kill.

There seem to be so opiate seeking patients now that an open door to see them would just overwhelm anyone.  Cynically yet realistically I know that this is in part because no one physician will knowingly prescribe the quantity of drugs that they want, so they need to have multiple physicians prescribing their meds who are unaware of each other.   (this problem to be the subject of another post soon)  Anyway this episode made me smile because this patient was either incredibly naïve, or a very good actress.  I suspected the latter.  Most opiate seeking patients are very smooth and make me at least feel like maybe I should try to help them by seeing if I can help them manage their pain with less opiates and good care.  In my experience this very rarely works, because the customer really just wants the drugs.  I know that although there are some patients for whom opiates for non-cancer pain is the best available treatment, there are so many professional patients who resell the drugs on the street and others who are addicted to the meds and overuse them in vast amounts, that as primary physicians we are in an impossible position.  We either become suppliers of the prescription drug culture, or we turn away some appropriate patients.  Which is worse?  This depends on your viewpoint, but at this point I generally just say no.

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212 Responses to Can’t find a doctor to prescribe pain meds?

  1. What a disgusting article. People in pain with chronic conditions and you refuse to treat them? Go to hell!!!! I have a busted tailbone and can’t get any relief because of doctors like this thinking that opiates are evil… THEY WORK! I’m so sick of living like this. Screw every doctor who feels this way and lets people suffer needlessly. What a bunch of self-righteous assholes.

  2. My name is Ryan. I was injured in a work accident at the age of 24. I went through the whole scenario of the first ER visit to the first referral to the pain clinic from Tylenol 3 to duragesic patches. Once your Rx history becomes as mine has your a red flag for life. I have been to the ER for serious issues only to be left in the exam room for up to five hours just so the staff could get me to walk out from frustration. I realized that I was in a bad situation. My quality of life and littery my life it’s self was left in the hands of someone other than me. After many pain clinics surgeries MRI’s and injections all recorded and observable. I was unable to obtain relief. A desperate person seeking relief from pain and a desperate addict seeking relief from withdrawal must seem very similar so I do understand where the MD is in a bind. On the other hand in the US it seems that we as patients feel that if we have an encounter with a MD that if no prescription is written then it is somehow an invalid exchange. If you have observable anitomical abnormalities it should be obviously acceptable to prescribe relief in appropriate amounts. Anyone in real pain seeking pain relief is drug seeking because that is what they offer as their only solution. I finally got so desperate that I started to expirment with heroin. I could self regulate my dosage it was available 24/7 it was cheaper than pills off the street and sometimes cheaper than insurance and cash visits. The downside is legality and ostracism from anyone that knows. The Mexican cartels suddenly out of nowhere flood the US with heroin right after the prevalent abundance of OxyContin becomes mainstream. It seems like there is an addenda involved there bigger than any doctor or clinic. If you look at the statistics more people died from Rx drugs than heroin so what’s worse. You get the freedom of choice and self regulation. Either way your treated the same Druggie. All I need is reliable medication availability. I am unable to obtain medical care. What choice does one have when the Dr starts you down the path of opiate dependency only to ostracize you and cut you off from access to the solution that they chose as the appropriate measure to begin with? I am a chronic pain patient for over ten years. I have documented exam and surgical procedures available to the MD for evaluation. At what point is there an appropriate amount of evidence to allow for the writing of a prescription. The use of opiates is a double eadge sword there is no totally safe answer but as it is the only answer provided by the best our society has to offer let the consenting responsible adult deside. Self harm should be a right weather it’s euthanasia or sex change if I can buy a gun I should be allowed to buy a pill..

  3. I got ostracized today,by an d.o.–I wont kill myself, but I think about it, no quality of life, I do not need, radiofrequency, I am the 1 before they busted my great dr, who said no opanas 40, with fentynal patches , & 6 percs to 4-6 oxycodone 15, they work, I do not develop a tolerance.i cant believe the drug companies.-I went to 1 dr, he was a piece of shit, he looked at nothing, & said well I do not prescribe do you want to see me or not , its a simple yes or know,i told him , he is the most arrogant punk dr.-I have ever seen, I am still a world class black belt, but the deprivation has taken me upto blood preesure 288/ 179–he says go to a blood pressure dr, I said are you even a dr.-if he felt my pain, he would cry like the rich baby he is.-his waiting room was filled with extras from the movie deliverance.-we are in a country that is communist, we have no rights-I need a compassionate dr. in akron, ohio area-help

  4. I would like to thank tammy for that comment on pain meds.she is right tammy what needs to happen is the dea needs to stay out of our buissness and worry about other things if its ok to use pot or liquor then why in the hell cant we buy pain killers over the counter one pissed of patient with suvier back problems

  5. you imbeciles think you are nobel, you deprive responsible adults of medicine they need, I went to 3 dr’s, pain pump 30, 000, radio frequency 1100.00—4-5 pills I have gone from 0-9 quality OF LIFE 50.00-WHY ARE YOU DRS?

  6. you are 10000% correct Darrell, we spend billions on the war on drugs, cAN WE STOP IT NO, LIVING IN CHRONIC PAIN IS HORRIFYING, the drs want to put 30, 0000 pain pumps-I have taken 4-5 pills a day for 14 years I don’t want shit put in my spine, I don’t want fusion, I want pain medication so I can exercise & take what I need, I have 129 pAGES ON MY BONE DISEses, but I must fight with hagi manigi, I don’t want cut up, its my body these people are killing good people for high money, I want no devices in my body give me my 4-5 a day, same as the opast 15 years & leave me go, I am not getting high at 61 years old on 5 pills thru a 24 hr period this country is fucked up,

  7. You should be ashamed of yourself. You may be praised by this society & your peers, twisted as they are by the century of immoral drug war & its abundant, unscientific propaganda about The Opiate in all its forms, but you are in utter violation of not only your Hippocratic Oath by but humanitarian ethics & empathy. Your assessment of this patient, in severe pain, suffering & come to you {most unfortantly for her sake} for help, is based in nothing but bigotry, & is no better than if you determined that she must be an idiot if she were African American, or a hedonistic mental case if she were a lesbian. You are correct about one factor : she is a typical seeker of opiates. Yet what you, along with every mind corrupted since the inception of the Harrison Act, fail to comprehend, is that those who seek opiates seek them because they need them, not because they are depraved abusers. The true abusers in the world of drugs are people like you. As a chemist & indepedant scientist who has been on Morphine half of my life, I can attest to its lifesaving qualities, safety, & pleasurable side effects. But of course in this depraved, anti-pleasure, pro-suffering, anti-intellectual society, we want medications that dull the senses of mind rather than uplift & enhance them.
    Live in half the pain that we do every day for one day, one week, one month, & you then come before us with this disrespect, you sorry little man. In fact, live with it until & unless you aid us — let us see how long this would go on if it were so.
    I wish you insight, enlightenment, & the compassionate understanding you so sorely lack for us.
    -Philoreian Purcell

  8. QUR WONDERFUL LEGISLATORS CAME UP WITH THIS BRILLIANT IDEA ALONG WITH THE DEA TO REMOVE PAIN MEDS FROM THE MARKET ONLY TO PUSH DESPERATE PEOPLE TO USE HEROIN NOW WE HAVE THIS HEROIN EPADEMIC AND PEOPLE ARE DYING….I DO NOT BELEIVE HEARING ABOUT PEOPLE OVERDOSING ON PAIN MEDS BEFORE THIS LAW PASSED (KASPER LAW) NOW THE SAME HEROIN ADDICTS GO GET THE PAIN MEDS AND SELL THEM TO PEOPLE LIKE ME SO THEY CAN SUPPORT THE ADDICTIONS THEY HAVE. I WOULD MOVE OUT OF THE STATE OF KENTUCKY IF I COULD AFFORD IT BUT NEEDLESS TO SAY IM ALWAYS BROKE FROM TRYING TO CONTROL MY PAIN….
    THANK YOU
    SO MUCH KY

  9. I have two rods and six screw ( 2 screws broken). My current pain management dr recently passed away. Trouble finding a dr that will now right my needed meds. No where to turn. Plz help me. I have several meds I need. However, there are tow that take precedent over all others. The largest town surrounding me is Lufkin and Nacogdoches tx. I cannot continue to dr hop, in search of getting my meds! I can barely perform simple daily activities and often can’t attend the needs of my 7 yr old soon.

  10. Oh But its ok doctors are living life without pain.Where they are the biggest users. What happened to the Hippocratic Oath?? Money over patients lives. Some of my family and friends did overdose suicides to end the pain because Doctors dont care anymore. So we are forced to buy off the streets risk jail become a criminal! The pain is too much anymore im next.Thank You my caring drs.

  11. No where else to go. Idiot CDC. My wife is writhing in pain and we can’t get her relief even in the ER because “migraine” patents are categorically refused any pain meds because they have been stereotyped into a group that say “narcotics” do not help migraines. Tell that to my wife who is sleeping because I gave her one of my lortab. They’re idiots.

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