Can a doctor refuse to prescribe you pain medication? This blog will answer that question and provide insight into how the Coleman Institute can help you detox from pain medication with the Coleman Method and live a life free of addiction.
John's Story of Pain Medication Dependency
John is a 60-year-old man who was the victim of a motor vehicle accident in 1996 that left him with multiple injuries, including skull, vertebral and other bone fractures. He was hospitalized for several weeks. He had his entire face rebuilt and rods placed in his back while the doctor screwed other bones back together.
John experienced severe pain, and— needless to say— because it was 1996, he was treated with a vast spectrum of pharmaceutical aids, including hydrocodone, oxycodone, and hydromorphone.
Treating Pain with Opioids in the ‘90s
In the 1990’s doctors began to prescribe more opioid pain relievers, as they believed pain conditions were inadequately treated. As a registered nurse on a medical-surgical unit in the hospital, I was tasked with asking and documenting every patient's pain level. This measure was considered the "5th vital sign." As a result, great efforts were taken to help physicians overcome the fear of using opioids.
It worked.
As opioids became more widely used and accepted, the unintended consequences of the increased non-medical use of opioids have taken their toll.
According to Psychiatry.org, "an estimated 3 to 19 percent of people who take prescription pain medications develop an addiction to them”.
More like this: When Pain Medication Becomes a Dependency
John Grew Dependent on Pain Medication
John, who had never had substance abuse or addiction problems, became physically dependent on opioids to manage his pain.
He never lost his medication. He never shared his medication. Instead, he faithfully went to his doctor—his family internist—who gladly filled John's prescriptions. They had enjoyed years of knowing each other, and his doctor also was his wife's physician. His doctor's office would occasionally request a Urine Drug Screen to stay in compliance. But there were never any 'surprises' or illegal substances found.
John’s Doctor Stops Prescribing Pain Medication
Last year John's doctor told him that he would probably not be prescribing his pain medications soon. But they told him not to worry; the office would help him find a pain management specialist in the area. This news was more of an inconvenience and just a little problematic. Plus, he knew and liked the office staff, and John had well-established his monthly routine.
It was a little frightening to anticipate turning all this over to a new practice: one glitch, one late prescription was terrifying. John knew the horrors of pain medication withdrawal. He had experienced it only once since beginning pain management when he forgot to pack his medications and left for vacation. It never happened again.
What John didn't know was that this trend was happening all over the United States. As a result, the government took urgent steps to dent the unanticipated consequences of years of overprescribing addictive pain medications.
More like this: What to Do if Your Doctor is Refusing to Prescribe (Opioids) Pain Medications
Can a Doctor Refuse to Prescribe Medication?
Medical providers find themselves in an increasingly difficult position when treating pain. Doctors are responsible for prescribing pain medication. However, they can also face serious legal issues for inappropriate prescribing, including malpractice liability, medical board discipline, and criminal convictions. A fascinating article in the American Journal of Law and Medicine describes why physicians are turning away from prescribing pain medications, even for "legitimate" patients. According to a report by The American Medical Association (AMA), there has been a nationwide decrease in opioid prescriptions of over 44%.
Most physicians who prescribe controlled substances for pain management have patients sign an agreement that includes behaviors expected on the part of the patient to receive prescriptions. If these behaviors are breached, dismissing a patient from the practice is simpler.
But many offices are simply moving away from treating pain conditions due to complexities and extra scrutiny and are referring their patients to the care of pain management specialists. In this case, most offices will advise their patients of this decision, hopefully giving them some options and enough medication to get them to a new prescriber.
More like this: Suboxone Alternatives to Detox Off Pain Medication
The Dangers of Quitting Opioids Cold Turkey
Unfortunately, over the years, I have heard people express that withdrawing from opioids “won’t kill you; it just feels like you’re going to die.”
It is far more medically dangerous to abruptly stop drinking alcohol when consumption of it has been heavy and regular. In addition, people who have been on pain medication for a short period may have some minor flu-like symptoms when they stop.
The U.S Food and Drug Administration (FDA) has even received reports of serious harm in patients that suddenly quit taking pain medications after growing a dependency.
Opioid Withdrawal Symptoms
Those who have become physically dependent on the same medication because of extended use may experience the following symptoms for a prolonged period:
- Extreme muscle cramping
- Sweats
- Nausea
- Vomiting
- Diarrhea
Anybody who has experienced this phenomenon is highly motivated to avoid it.
More like this: Detoxing off Opioids: 5 Things That Could Stop You
New Rules for Doctors Prescribing Opioids
The CDC developed and published the CDC Guideline for Prescribing Opioids for Chronic Pain, providing recommendations targeted to primary care providers. The recommendations focused on treating chronic pain (which is defined as pain lasting longer than 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.
The new guidelines included lower dosage recommendations since the evidence showed that even relatively low doses of morphine milligram equivalents could increase a patient's risk of overdose. This document also shifted focus to not only “high risk” patients but also to all patients on opioid medications. In addition, they placed more emphasis on checking state prescription drug monitoring programs and having impeccable and thorough notes on all patients receiving treatment. Finally, they recommend discontinuing opioids when the risks and harms outweigh the benefits.
Many doctors were non-compliant with the new regulations, and many lost their privileges to prescribe opioids. As a result, primary care offices around the country decided to leave the pain management business to specialists who were well set up to deal with the more stringent regulations.
Attempting to Contact a Pain Management Practice
John's doctor's office made several attempts to connect him with a pain management practice. Still, to their surprise, even if he could make it to the 5-month waiting period, this office did not accept patients who were on the doses of medication that John was taking. He was on 180mg of oxycodone daily; some were extended-release, and some were short-acting for break-through pain.
John's doctor made several other inquiries on his behalf. Still, he finally had to face the reality that what he had believed and counted on for years, his right to pain management, was apparently no longer valid.
This is when John reluctantly contacted the Coleman Institute.
More like this: My Pain Doctor Cut Me Off, What Do I Do?
UNDERSTANDING ACCELERATED OPIOID DETOX
Eight months ago, he signed on for a 4-day Accelerated Outpatient Detox with fear and resentment.
Recently, Dr. Coleman poked his head into my office and said, "It was amazing seeing John today! He said he was amazed at his life compared to how his life was when he was the prisoner of his pain meds."
He described that his post-accident life had revolved around when the next dose of medication was due. He was trying desperately to cut back or go just a little longer. He was in a perpetual state of taking the meds and then experiencing the physical need. He dreaded severe weather conditions that might prevent him from being able to get his medication. John hated going into the pharmacy to get his prescription, feeling judged and labeled as an 'addict.'
"How is his pain?" I asked, but I was sure I knew the answer, based on my ten years of working with patients like John.
The Doc smiled. "What pain?"
A Life Free From Pain Medication Dependency
If you are physically dependent on your pain medications and question, "can my doctor refuse to prescribe you your pain medication" please call us. There are a lot of people out there who are taking this leap. You, too, might be amazed at the taste of freedom that John enjoys.
Joan Shepherd, FNP
