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

  1. a comment to the GOOD doc . while on opiates, i di not want them, and asked to be reduced as soon as epiderals statred to work until my surgeries. but, i slipped and told someone what i was on and you talk about a magnet …… what a big mistake.. i bought a safe.. and hid it .. i never took more than rx . i respected what i was on, when i was offered oxy contin i refused ,after my husband and i looked it up on line {a drug of choice on the streets , so ,very addictive} and the way they pulled me off , i would have been in big trouble on that drug , I can feel for the doctors who are legit and really care about people and not just the mighty dollar bill.and what they must go through, I learned fast, I took several no’s to my neighbor and schemes to try to get pills from me, before she gave up.But who do they tell? I had no idea? How many people does a doctor see in a day?Then if one is on opiate for an extended period of time then the body stops making its own natural pain producing mechanisms {hypalgesia}not sure of the word ,but anyway i have had to do my own research while they allowed me to be in a severe hypothyroid state for 3 yrs ,i finally requested my labs after my cancer bout ,very lethargic ,still kickin, but never took opiates until it was as bad as labor pains ,every day ,for 6 weeks, so I expect, the people who really suffer will have to suffer because of the ones who do abuse these addictive narcotics, and the mothers who let their kids take rx and do not become educated , or the dr or his aid who does not INFORM THE PARENT about the drug that was rx. this is my 2nd comment after my former one

  2. scoliosis ,ruptured disc, severe spinal arthritis and a few other spine ,nerve damage broken foot 3 yrs ,,arch sticks out of the bottom of my foot ,due to drs mistake , other foot ,students made mistakes and bone is growing downward after 8 surgeries not needed . now they, because of new laws have taken me off pain meds , i lay in pain , barely feed myself my sugars 480 plus , can barely take care of myself any more , no weaning off , no heart check up at 60 yrs old . doing more damage than good .. drs here to kill. not sustain life i will not try to get illegal any thing , maybe my time is just up, due to the medical profession , who put me on opiates when i could not walk ,gave me epiderals mrsa and pic lines and surgeries , now the pain is full blown almost .i pray it doesnt.. i am ready ,if i have to go ,i dont want to but look at what they did to me

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