Why Some Docs Won’t Prescribe Narcotics no Matter How Bad the Pain


Having Trouble Getting Pain Killers?  Here’s why.

Some Florida physicians are mighty gun shy  about prescribing narcotic painkillers for their patients and many of us who need them are being made to suffer unnecessarily.lots ofdrugs

I have osteoarthritis in my neck, back and a few other places.  Osteoarthritis is very painful.  I also get severe muscle spasms in my neck and shoulders.  The pain from the arthritis and the spasms is so intense it is beyond description.  It is get on the floor, pound your fists and scream pain…the kind that makes you cry and beg for relief, but for a lot of us here in Florida there is no relief.  Some physicians will go to almost any extreme to avoid prescribing drugs like Oxycontin, Oxycodone, Dilaudid  or almost any other controlled substance.

The drugs I mentioned are very powerful and addictive narcotics. Oxycontin is a time release drug, Oxycodone (the same drug) acts immediately and Dilaudid acts immediately and is said to be more powerful than morphine.  They are heavily controlled substances and should be.  They are dangerous drugs.

Florida used to be the place that prescribed those drugs for the rest of the nation.  In 2010, 90 of the top 100 oxycodone-purchasing doctors in the United States resided in Florida but then the Drug Enforcement Administration (DEA) cracked down — hard and many of the major clinics overreacted.  (read the full story on Florida’s narcotics prescription problem here http://articles.orlandosentinel.com/2013-04-06/news/os-prescription-drug-epidemic-2013-20130406_1_prescription-drugs-central-florida-certain-drugs )

Deaths attributed to opioid analgesics now exceed those involving heroin. By 2010, enough opioid analgesics were sold to medicate every American adult with a typical dose of 5 mg of hydrocodone every 4 hours for 1 month – See more at: http://www.pharmacytimes.com/news/Is-Floridas-Oxycodone-Problem-Under-Control#sthash.1sMZdorU.dpuf

It wasn’t only physician who were a problem, the monster drugstore chain Walgreens was involved, too.  http://tinyurl.com/l2t7ohc   The U.S. DEA said, corporate officials at Walgreens implemented bonus programs that incentivized pharmacists to sell oxycodone and ignore “red flags” that customers were abusing the popular painkiller, which leads us to our current dilemma.walgreens

Chances are if you are post-surgical, need a root canal, have cancer or a broken leg your physician will prescribe whatever you need.  But if you have chronic back pain, arthritis, muscle spasms or any other kind of pain that is not easily verifiable you are likely going to have trouble getting narcotics in some clinics.

I should point out here that I despise narcotics.  I am, since 1982, a recovering alcoholic.  I have to be extremely careful about addictive substances but I have tried virtually everything that modern medicine has to offer and narcotics seem to be the only way to get some relief from the absolutely debilitating pain I suffer on a daily basis.  My doctors, specialists in my particular ills have so far refused to provide me with any pain relief other than various forms of aspirin or Tylenol.  They are always careful to add that I can get pain relief from my “Primary.”

In fairness I must agree with their assessment that narcotics only hide the pain, they do not cure it.  I agree that physicians should look for the root cause and attempt to treat the pain by other means including physical therapy but in the time between the diagnosis and the ultimate treatment narcotics can provide relief.  No one should have to live with almost unbearable pain.  It is in that period between diagnosis and cure or treatment that narcotics have a legitimate place.  And…sometimes, however rare that may be, sometimes narcotics are the only answer to chronic pain.  Physicians have the training and the diagnostic tools to determine who has real pain and who is seeking to feed a habit or to sell prescription drugs illegally.

When a person has surgery or breaks a leg it is quite obvious that pain killers are needed and they are most often given…that is not the problem.  The problem lies with those who suffer from chronic pain…pain that cannot always be seen on an x-ray, CT scan or MRI.  Their pain is just as real as that suffered by someone with broken bones but getting relief from the discomfort is far more difficult because of the irresponsible behavior of a very small number of physicians and companies like Walgreens.

So what do you do if you are in pain and need a painkiller?  Well, you can get relief but it will take some legwork and it won’t be easy.

In order to get a prescription for a pain killer now in Florida you first have to convince a physician you need it and that is not easy.  Pain is one of those symptoms that is hard to measure.  Most physicians won’t prescribe narcotics for new patients…they’d like to get to know you first.  The real tragedy, though is that if you go to a major medical center like Mayo and need a powerful painkiller they will likely tell you to get it from your primary care physician.pain  Mayo is mostly a specialty clinic and while they have a few primary care physicians the number is small.

My primary care physician is not a Mayo Doc so when I tell him “Mayo says you should prescribe the narcotic,” the primary care doc says, “Why me?  They have all the fancy diagnostic tools, they came up with the diagnosis and they have all of your medical records, they should also prescribe the drugs.”

And to me that makes perfectly good sense.  Why should the Primary care doc put his license on the line?  Fortunately my primary, a first class professional who I have known for a long time has agreed to take care of me but the way the law is written, monitored and enforced makes him very nervous.

First the physician has to see and examine you to determine if the claim is legitimate.  Then he/she has to write the prescription.  They cannot call or fax the prescription in to a pharmacy as they can with most other drugs. When narcotics are involved the patient must hand deliver the script to the pharmacist and there are no automatic refills.  When you run out and need more you have to call your physician again for an appointment, have him or her write another prescription and again take it to the pharmacy.prescription

I understand completely why the law has to be so tough.  People were making millions of dollars on prescription drugs and thousands, maybe millions of people were becoming addicts as a result.  But for those of us who only want pain relief it’s a different story.  Somehow there should be an accommodation for patients who really are in pain…and especially those of us who are not quite as agile as others and sometimes have to depend on others to get us to the doctor and to the pharmacy.

This is a very important issue and should be dealt with in a reasonable way but when the DEA is breathing down your neck and lawsuits are possible the medical profession retreats and patient care becomes a secondary issue.  That’s not right.

I want to pause here for a moment to point out that Mayo has saved my life more than once.  It was at Mayo in Jacksonville that I got a heart transplant in 2007 and my care there is beyond reproach.  I have nothing but respect for the Mayo team and the manner in which they practice medicine but being as it is the place where I get 99.9% of my care they become part of this story.  When I have had surgery there or was seen for an injury there was no hesitation in providing me with the narcotics I needed to aid in the healing process.   It is when you have pain like mine that you hear the words, “See your primary (meaning see your primary care physician).”

Recently in a clinic visit I asked a physician who was intimately familiar with my condition if he could write me a prescription for a narcotic painkiller being as nothing else was working and it would be some time before I could get into physical therapy.  His terse response as he walked out of the room was, “I can’t do that, see your primary.”  The fact is he can do that…he didn’t want to.

Sometimes the arrogance of physicians is beyond belief.   They deny you pain relief and schedule physical therapy three weeks later.  What do they expect will happen in those three weeks?  Don’t they understand or even care that it will be three weeks of sanity challenging pain?  My sense is they don’t care about your pain — they are far more worried about protecting their licenses.

If the Hippocratic oath really says, “First do no harm,” the physician who denies relief to someone in real provable pain is violating his/her oath because by denying medication, they are doing great bodily and psychological harm.  Shame on them.  As far as I know there is no law, rule or restriction that requires narcotics prescriptions be written by primary care physicians only.  “See your primary” is code for, “The best way to stay out of trouble is to avoid writing any prescriptions for narcotics by passing the buck to primary care physicians in private practice.”

Physicians should have the guts to say, “My patient is in pain and I’m going to prescribe something to help him.” My experience, though, is that many of them would rather pass the buck to another physician who is also afraid of losing his or her license.

Have you had an experience like this?  If so I’d like to hear from you. I fully intend to write more on this issue and will do so not only from my experience but will also draw on what I’m hearing from other patients like myself who have provable, medically verifiable pain and are candidates for narcotic pain relief but are being denied treatment.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 3,000 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our new music video “Dawn Anita The Gift of Life” on YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs.  This video is free to anyone who wants to use it and no permission is needed. 

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and usually you will get a copy the same day.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.

En Espanol

Puede comentar en el espacio proporcionado o por correo electrónico sus pensamientos a mí en bob@baronson.org. Y – por favor, difundir la palabra acerca de la necesidad inmediata de más donantes de órganos. No hay nada que puedas hacer lo que es de mayor importancia. Si usted convence a una persona de ser donante de órganos y tejidos puede salvar o afectar positivamente a más de 60 vidas. Algunas de esas vidas pueden ser personas que conoces y amas.

Por favor, consulte nuestro nuevo video musical “Dawn Anita The Gift of Life” en https://www.youtube.com/watch?v=eYFFJoHJwHs YouTube. Este video es libre para cualquier persona que quiera usarlo y no se necesita permiso.

Si quieres correr la voz acerca de la donación de órganos personalmente, tenemos otra presentación de PowerPoint para su uso libre y sin permiso. Sólo tienes que ir a http://www.organti.org y haga clic en “Life Pass It On” en el lado izquierdo de la pantalla y luego sólo tienes que seguir las instrucciones. Esto no es un espectáculo independiente, sino que necesita un presentador pero es profesionalmente producida y sonido hechos. Si usted decide usar el programa le enviaré una copia gratuita de mi libro electrónico, “Cómo obtener un pie” O “que le ayudará con habilidades de presentación. Sólo tiene que escribir a bob@baronson.org y por lo general usted recibirá una copia del mismo día.

Además … hay más información sobre este sitio de blogs sobre otros donación / trasplante temas. Además nos encantaría que te unas a nuestro grupo de Facebook, la Iniciativa de Trasplante de Órganos Cuantos más miembros que obtenemos mayor será nuestra influencia con los tomadores de decisiones.

Posted on July 17, 2013, in Prescription narcotics and tagged , , , , , , , , , . Bookmark the permalink. 7 Comments.

  1. I loved this blog post.
    I am an addict in recovery- 14 years now, but only one bad decision away from going back into all of the hell I was living in.
    My husband is in recovery also- same clean time- we did it together- against ALL odds.
    I want affirm that these ARE dangerous drugs, and I am GLAD they are finally being “controlled”-
    However, when a patient is in agony and all balled up in a circle, one should not WAIT 10 hours before bringing them 1 mg of morphine. I actually LAUGHED when the nurse brought the morphine in, and I asked what the dose was.
    I agree that there has to be some kind of protocol for utilizing these dangerous medications, but I am not smart enough to offer a fair, therapeutic solution to this problem.
    I have a couple ideas though.
    1. have some type of review when a patient in an ER is asking for pain medication, (when was the last time they came to the ER, and did they receive narcotics? DO they have a history of drug abuse? HOW many times have they come to the ER without following up with a Primary Care doctor just for pain relief? Do they exhibit medication seeking behaviors?
    2. A risk assessment such as this could be done when a patient is admitted also- but WITH the patient, explaining the dangers of narcotics use, and giving them a chance to comment on their own recovery- and give detailed info on what they are doing to SUSTAIN it.
    (a good doctor WILL come right out and ask questions such as “are you receiving drug counseling?)
    3. Many doctors need to realize that they need to pick their battles. Giving a patient 5 oxycodone with specific instructions to follow up with primary care (or perhaps stating there will be no more ER pain meds dispensed until such time is NOT the end of the world! careful documentation, and perhaps better patient accountability is what is needed.
    4. WE NEED OUR DOCTORS TO BE EDUCATED IN ADDICTIONS!!!! SO many of them are brilliant in all that they do, but they become bumbling fools when the subject of narcotics addiction comes up!!! REQUIRED clinical rotations in , say, a methadone clinic or acute detox should be MANDATORY for all docs /residents, etc,
    (ONE DAY AT A DETOX OR METHADONE/SUBOXONE CLINIC OFFERS A LIFETIME OF EXPERIENCE IN ADDICTION MEDICINE!)

    I don’t buy this whole “pain cannot be covered up with narcotics or we won’t know where the pain is, or how bad it is” theory. SMALL AMOUNTS of pain medication over a period of time will not “take away” pain, but rather make it tolerable.

    As for the primary care setting- I REFER back to the “MANDATORY ADDICTION MEDICINE clinical rotations” that are badly needed in this day and age for aLL DOCTORS

    Young people , in closing, are the most precious of patients in the primary care setting, and it is APALLING to know how many pediatricians and adolescent medicine docs have NO IDEA what addiction is, or how to effectively speak to a patient they suspect is medication seeking or taking illegal, illicit substances of any kind.
    GET ON IT DOC!!!

    “do no harm”.

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  2. My husband died in June of 2013 and left me enough money to buy a house, but not in California where we lived. So I made the sensible decision to move to where my only family, my son and grand daughter, live. Houston Texas. I spent everything I had to get down here with all my worldly possessions and buy a house. I spent a year going back to Cali to get the morphine that I have been on for 16 years because I was unable to get it in Houston. My track record on this medication is immaculate. During this last year my son was diagnosed with Colon Cancer, I fought for and got my Widows Benefits from social security, I had a tough but also good year. I met and fell in love with a wonderful man (I fell in love partly due to his not ever even saying a word about it, he was simply there for me during a really hard year). Now, a year later, still unable to get my medication, I am left with only one choice. I am walking away from every thing I own and every one I love to go back to Cali. I left there because I can not afford to live there on my income so I am heading into homelessness. Not that it matters because I am leaving every thing behind anyway. What really chaps my hide is that every single doctor I have talked to (which is in the hundreds) is willing to let me come off of 16 years of morphine use cold turkey. They would treat a junkie better than that. My plan now is to try to get off of it up there despite being told by my doctor there that I am not a candidate for it. My quality of life before the morphine was non existent so I dont know what my future holds but my doctor has agreed to at least try to get me off of it so that I can at least be with the people I love in my final years of life. The whole thing is a train wreck and I think that the doctors in Houston (Ive heard that it is in fact the entire state of Texas) should have their licenses revoked for NOT prescribing narcotics to legitimate pain patients with documented and verifiable histories.Thank you, Mary

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  3. I Went to the ER for anxiety and panic Attack,I Do have chronic anxiety but never this bad I thought I was having a heart attack.i felt stupid going to the ER for this.anyway,The doc gave me valium,and it worked wonders.he gave me a script for 15 pills and said your regular doc will have to prescribe me more since it worked so well.

    regular doc said he wants to try antidepressants,I said ok,a
    month later im still having anxiety.i went back to him and he said he wants me to go to a psychiatrist.the psychiatrist asked me what helped me in the past,i said valium worked great,

    he said he wants to try some other meds,he gave me 4 different meds ,all to be taken at bedtime,45minutes later I was in the ER my brain was misfiring and I couldn’t control my body.It was so scary and painful,it took the doctor 6 hours to get it under control,i was having a panic attack while this was happening.the doctor was upset that I was prescribed 4 meds
    for anxiety.he said why are you not on valium like I told you before,i said the other doctors
    are prescribing me everything but what works because valium is a controlled substance.
    I went back to psyc doc and he said keep taking all four meds but space them out,i said I cant do this anymore I need valium,i was always very nice and respectful to him,he said no stay on the 4 meds.so I left.

    I went to my reg doc and told him I was in the ER again and psyc doc wont give me ,any valium and could he prescribe a few pills until I can see another psyc doc.

    Well you would have thought by his reaction that I asked him for heroin,with a shitty tone he said ABSOLUTELY NOT. he doesn’t prescribe ANY controlled substances EVER.

    ive been with this doc for 3 years and never knew this.

    This is what its been like here in ny,they turn you into a drug seeker and a doctor shopper,
    and I still cant find someone to prescribe.and I still feel the effects from the 4 meds that put me in the ER and I have not taken anymore of them.but I guess these doctors in their minds stopped a future addict and patting themselves on the back while I am still suffering
    the ony doctor that will give me valium is the ER doc,but I cant go to the hospital every week to get them.

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    • Thank you…your post may help many to understand how difficult it is to get help because of physicians who fear retribution by federal authorities. Their first responsibility is to patients…if they do that well and do it right they have nothing to worry about. shame on your doc!

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  4. Nicely written article, thank you. I have osteoarthritis as well in my back, neck and knee, and know where you are coming from. I currently don’t have a prescription for pain relief and haven’t for several years, so I suffer. But chronic pain can really wear on your nerves. I am a retired R.N. and agree with your observations about pain relief. I had a lap band several years ago so I am not supposed to take NSAIDS because they could damage the band over time. Aleve and Motrin don’t really help anyway. Additionally, my son died of an accidental overdose in 09 and was found to have alcohol, vicodin, and valium in his system, (but the weird thing was, they were all small levels of each). Anyway, I have mixed emotions about taking ANYTHING because of this loss. Pain is pain, NO one can tell you that you are not in pain. I especially know this from being a labor and delivery nurse! I guess I just wanted to say I appreciate your article. I originally was googling paranormal activity after a heart transplant. My close friend’s husband had a heart transplant a year ago (we live in Houston) and she has noticed a lot of personality changes and also things that go bump in the night. We were trying to find out if there is anyone out there that thinks the spirit of the donor could still be with them? We are all Christians and this scares us, but many creepy things have been going on since his recovery. Thank you for your insight.

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  5. Some of us have no option. I have liver issues and kidney problems as well. That locks out tylenol at any dose that will do any good and the nsaid’s such as motrin completely. The only thing left is narcotics. Fortunately I have a good primary doctor that I have seen for 22 years and he will prescribe what I need. I am very careful not to use more than the minimum. There have been court cases resolved in the patient’s favor involving pain relief. Being in pain does nothing to help the healing process.

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