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Adrienne Dellwo

Walking a Fine Line - How Doctors Can Prescribe Narcotics without Feeding Addiction

By May 20, 2008

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We pain patients and our doctors face some real problems when it comes to narcotics, such as Vicodin and Oxycontin. As patients, we don't want to be treated like criminals for simply managing our pain, yet we understand that there are some criminals out there trying to scam doctors out of those meds. Doctors, meanwhile, want to help legitimate patients feel better, but they don't want to give drugs to addicts.

So how do we show that we aren't addicts, and how can doctors be sure they're giving drugs to the right people?

A new study from the University of Michigan and Ohio State University offers a solution. And implementing it takes work from both doctors and patients.

The study consisted of putting measures in place in one busy, multi-doctor clinic. First, it created an opioid registry of all patients who got opioids from the clinic. Second, it required doctors and patients to sign agreements detailing conditions for receiving narcotics. One condition was random urine tests for illegal drugs. Another was allowing the clinic to check state prescription records to see if patients were getting drugs from more than one doctor at a time.

The study showed that 35% of the 167 patients on the opioid registry violated the policy in some way. Those taking a medication containing oxycodone were twice as likely to be violators.

While 35% seems pretty high, the researchers expected the rate to be higher than it would in private practice, because this was a clinic where patients were likely to see a different doctor each visit, which makes it easier for addicts to slip through the cracks.

Are you willing to periodically take a urine test and have the doctor check your prescription records in order to consistently get your refills? Do you think a system like this should be in place everywhere? Post your comments here or in About.com's Fibromyalgia & Chronic Fatigue Syndrome forum.

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Comments
May 23, 2008 at 4:56 pm
(1) greybeh says:

It may be a necessity for the medical system. I would be willing to do this if the testing could be done in a way that would not cause me to inconvenience my employer. I would want my doctor to be sensitive in explaining WHY I would have to submit to periodic tests. Perhaps a doctor could give a very simple pamphlet and say a few words in explanation that it’s a program-mandated requirement and in no way implies that the doctor does not have trust in me.

Patients should be made aware of things that could cause them to have false-positives (poppy seeds!)

Ultimately, it’s unfortunate that things are the way they are in the medical system. Can we honestly say that doctors CAUSE people to become drug-addicts? So, why are doctors held responsible for the personal choices that people make? Sure, if a doctor thinks someone is a drug addict, they can refuse to treat someone. Doctors shouldn’t have to be so fearful!

May 23, 2008 at 6:18 pm
(2) VaBreeze says:

Would I submit to urine testing? Yes…if it would mean I could get the meds. necessary to control my pain. However, I shouldn’t have to do this. If I was getting illegal drugs…do you think i’d need to see a doctor for more? It’s costly and an infringement on others rights. Maybe the next thing would be to enter our homes and see if we have been on the internet searching on how to make our own drugs. I do totally approve of checking state records for the amount and type of prescriptions that have been filled for the individual. I have nothing to hide, so it’s not a problem. But to have to submit to a urine test just to get what I need…I would do it…I just feel it’s unnecessary and gives others more power/control than i’d like to see.

March 3, 2009 at 4:10 pm
(3) clare says:

I have a unique perspective on this prescription drug problem. I take pain medication and hate the way I am treated like a drug addict when I have never abused my medication but I also know the games and tricks that drug addicts play to get what they want. My ex-husband is an addict. I saw how easy it was for him to get what ever he wanted even when the doctor knew he was an addict and even when the doctor was told he was abusing. I believe that extreme regulations on pain medication will only prevent or hinder people in pain from getting relief and having a better quality of life. The drug addicts will ALWAYS get what they want no matter what anyone does to stop them.

March 29, 2009 at 1:41 am
(4) Debra V. R.N. says:

This subject really hits a nerve for me. I know for a fact that narcotics do work for FM pain. But of course the word “narcotic” is a dirty word. I have talked to hundreds of people with FM who say that narcotics DO work and I know they are the only thing that touch my FM pain. They are trying to minimize this illness and say that narcs don’t work because if they admit it, then they have to admit how horrible this pain really can be. And addiction? Come on. Pain pills were MADE for pain. And that is what they should be used for. If I have a choice of “addiction” than I would take that over having this horrible pain that is likely very similar to cancer pain. Traditionally narcs were preserved for short term pain or those with cancer that are dying. Ok, we might not be dying but it sure feels that way to alot of us. And where is this research that says narcs don’t work for fibro? Who did they study? I do know it was not the hundreds of people I have talked to in the last 5 years with FM. I am fed up with the false information going to doctors about this disease. Every patient should be given the option with the risks vs. benefits. We should be allowed to relieve this horrible pain in some way. I am lucky, I have a doctor with some sense. And I am not a druggie. I never asked for or needed a narcotic until my 40′s when FM hit me so bad.
Debra R.N.

January 24, 2011 at 1:24 pm
(5) Loretta says:

thank you Debra V.
Where is you doctor.
I have a degenerate bulging disk the lower back, and I have bursitis in both hips. I’m 48, and I started to use narcotics for this. I do feel like I’m addict because dr. look at me weird, but I can’t walk. I have no idea what else to do?
I mean If I can seat here and nothing all day. I’m ok., but I have a 3 and 5 year old, so I need to move, exercise and run around all day.
Thanks for making me feel better about myself Debra V.

September 2, 2009 at 12:59 pm
(6) charles chris says:

I’m a native american living on a reservation I’m suffing from head injury do to an assult. I was hit with tire iron across the face and kicked about the head. I have no say in my treatment. I take pain meds. get treated very poorly by health care dr.s I have no say. It suck being native american. THRID WORLD TREATMEAT. Looking for outside help.

October 21, 2009 at 4:29 pm
(7) j davis says:

Welcome to the new police state of medicine. Because of the rogue agency known as the dea thousands suffer unnecessarily. Put bluntly the dea is practicing medicine without a license and dea agents have no medical training or medical degrees. What transpires between a doctor and patient is not the business of the government of anyone else for that matter. Keep these right wing sociopaths out of my doctor’s office!!

November 5, 2009 at 3:48 pm
(8) Aaron says:

My pain management doctor is currently under state investigation and the DEA has asked all surrounding pharmacies to stop filling his prescriptions. I have a T7 compression which causes terribly debilitating effects and have been on Norco 10/325 for about a year. Since all the pharmacies stopped filling his prescriptions, I decided to try to stop taking the medication. When I did so, I had terrible withdrawl effects for about 4 days. Then I spent nearly 6 months out of work because my back pain was so intense I couldn’t do anything but lay around all day. In these six months, I went to several doctors who have all said the same things: physical therapy, TENS, massages, Celebrex, Voltaren, etc. I have tried them all – including spending over $500 per week at regular physical therapy – 4 days a week in traction. Two hours after therapy, I hurt again. Now my doc is prescribing Tramadol. Kind of takes the edge off but I still have problems getting up during the day because of the pain. At first, when I got off the Norco, I was really proud of myself, but the longer I have gone without it, the more and more hopeless I get over the pain. I am in my late 20′s and can’t imagine a life with this much pain.

All that being said, I can’t find a doc that will prescribe me the meds I know work (Norcos). I actually saw one doc that said “I don’t have anything against prescribing narcotics, but I don’t want the police busting down my door, so I don’t prescribe anymore.” Is this a joke? Tramadol side effects are worse than Norco and they are similar in their pain relief method (Opiod-like) but since Tramadol is not a narcotic, any doc will prescribe it. Problem is, no one will prescribe what works best for me with minimal adverse affects.

I’d love to know how many DEA agents are in chronic pain. I’d love to know how many of them are board certified physicians. The fact is, the war on drugs has been lost on all levels. Those who can’t get opiods will turn to opium or heroin. There’s always a fix for the drug addicts. Let’s stop making our drug problem a legal issue and start making it an educational issue. Teach abusers the dangers and consequences. But ultimately, STOP TORTURING PAIN PATIENTS by throwing our doctors in jail or scaring them out of prescribing narcotics. It’s not your place to tell my doctor what they can and can’t give me to give me some semblance of a normal life.

My 83 year old Grandmother is a cancer patient whose doctor wont prescribe narcotics. Isn’t it enough already.

July 8, 2010 at 2:59 pm
(9) KC says:

I here you,I had L-4 L-5 fusion with instrumetation a few months back and I am still in pain, surgeon wont deal with me, my primary wont prescribe any pain meds, and even my pain clinic has stopped giving me meds! my god man,back in the 80`s and earlier if you were in chronic pain usually no problem,but you are right, the f*&^#! goverment is scaring doctors on prescribing to to many patients,

April 18, 2011 at 5:12 am
(10) karla says:

Just the other day I was waiting to be seen by my doctor. An older woman next to me was visibly in pain and I felt very bad for her. The receptionist called her up to the desk and asked her what she needed to be seen about and she explained her pain. The receptionist very rudely said that she would have to go somewhere else because the doctor doesn’t prescribe pain medication to his patients. She got upset (I would be too) and the receptionist explained that too many people are abusing it and the doctor may have his license taken away if he prescribes it.
I thought this was terrible!! Pain medication is for people in pain, yet they treat us like we’re junkies!

May 4, 2011 at 11:28 am
(11) Sean Milus says:

OH YEAH. i have a comment for you. Lets say its pretty obvious from the persons condition how much pain they are and have been in. Lets say its obvious that that pain is going to continue indeffinately. the study you wrote about says it sounds like a good idea to sign a pain contract to protect the patient and doctor alike. consisting of things like illegal drug tests and i know from experience keeping appointments to get refills. now first of all there seems to be some overlaping directions. by the doctor taking illegal drug tests and then cutting off narcotic treatmnt when someone comes up hot, since when do physicians have the authority to punish and refuse necessary treatment tp patients that obviously are not drug seekers? Isnt that under the jurisdiction of the police to punish for those crimes? Otherwise the physcian would be able to call the police when a violator was found if they had the right to punish..correct? I would agree that a physcian has every right to to give stern instruction not to use or how to stop using etc. But refusal of treatment for that is a moral judgement the doctors are making when they really only have the signed “right to treat” not “right to judge and impose judgement”. Then where does that leave the patient when they do? Suffering from the original pain, suffering from withdrawl pain,(which EVERY article and prescription info ive ever found, or been given states NOT to cut off those drugs cold turkey it can cause a patients death by doing so) where do they turn then? Doesnt take a rocket scientist does it. So by doing this they put the patient in what 3, 4 times the danger then they were in originally before they decided to step up and be a hero and save them from “narcotic dependance”?

May 4, 2011 at 11:29 am
(12) Sean Milus says:

I dont think I really need to touch the FACT my wife was fired from her pain specialist and her hydromorphone because her dental appoint the day before made her miss the “PAIN SPECIALIST” . so he fired her and cut her off just like that…oh and lets not forget that it goes into your medical records that you are “uncomplient” and or “uncooperative” with no chance of removing the comment and no chance of getting the help you need from your next medical practice. So what does this say about the idea of a “PAIN CONTRACT”? Id tell you but I dont think you would post this after i did.

December 30, 2011 at 7:57 pm
(13) Concerned pain patient says:

I have been a pain patient of a pain management consultant group for over two years. I go every 3 months. Recently they started giving urine test. I was surprised, but submitted my test. I now owe a bill for that urinalysis that of course I had not anticipated. I am a cash only patient with no insurance. Because I have not paid my bill, I have not been able to get back in. Now I’m worred that when I finally can afford it, they may be suspicious. It has been over a month. Meanwhile, because I could not manage my pain without tearing my stomach up on 10 advil a day, I took a medication left over from a friend’s post-op pain. I feel guilty and afraid they will be able to detect it. I hear they have urine test that can detect anything as far back as 3 months! Does anyone have any suggestion?

January 11, 2012 at 12:40 am
(14) Sky771 says:

I suffer from Reflex Sympathetic Dystrophy ( for those that have never heard of itís a serious nerve disorder that causes severe agonizing-wish I could die kind of pain that has no cure)…I am so fed up with drs. treating pain patients like they are drug addicts..no, you donít have a right to demand a urine test and make me live under a pain contract-those are the worse damn things anyone has ever heard of..do one thing wrong such as miss an appointment and you are labeled for life..as ďnon compliantĒ which will make trying to get more narcotics from another dr. a living hell..
I and other chronic pain patients have a right to live free from pain. There needs to be a law that protects doctors from the DEA bullshit that they have to deal with..what the hell does the DEA have to do with my care? Is the DEA there when I am in tears because the pain is uncontrollable in the middle of the night? Is the DEA going to pay my bills because I canít work-since they wonít give me the proper amounts of narcotics that would let me live a semblance of normal life? Is the DEA going to comfort me when I have to endure hours of pain just because my dr. wonít increase the dose because heís afraid of having his license pulled..Its time for patients to stand up and be heard..enough with this torture..I know Iím never going to get better and my dr. says my condition is worsening and spreading..so why the hell does the DEA have any right to add to my suffering? THEY DONĒT! and if we donít make our voices heard, guess what? The next thing you know, they will ban Vicodin, Norco, Oxy, Dilaudid..

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February 20, 2013 at 10:03 pm
(20) Lisa says:

It’s not all the fault of the DEA. it’s the pharmaceutical companies lobbying to get their “new and improved” more expensive drugs on the market.. yes they do give outrageously expensive “gifts” and vacations to agents of the FDA and DEA to overlook the not so great results from clinical trials. And the whole addiction thing has turned into a scam. All of the new drugs are more addictive and cause more lasting damage than the old tired and true…and dirt cheap medicines that actually work.
The doctors are being trained in med school all about drug seeking behavior to the point that if the nifty sample they got from the pharmaceutical company sent them doesn’t work, youmust be faking and just want to get high. There seems to be no way around it, because the doctors aren’t even given all the info about the clinical trial of the drug they are being compensated to push.
In the past, in clinical trials, the new drug was tested against the old drug and placebo. Now, they are tested only against placebo and if a few subjects get the desired effect, is deemed good enough. Nevrmynd that the same number of subjects on the placebo Got the same effect or the majority that had bad side effects. But they want it on the market, because they spent all that money making it and they need to sell it for lots of money. If you look at THE FDA website, you will find a link to another site that publishes the actual results of the trials and ALL THE REPORTED INCIDENTS SINCE THE PUBLIC RELEASE OF THE DRUGS. it’s shocking.
Also, if you research who in government owns stock in these companies, it explains a lot.
The alleged war on drugs had become a war on doctors and their patients.
Here in Texas, a few years ago some child psychiatrists were caught prescribing serious antipsychotics to infants. My grandson has been on everything from ritilin to methyline to, now, Zoloft. They took him when his parents said ENOUGH and refused to drug him anymore.

May 11, 2013 at 4:41 am
(21) pat says:

. HAVE HAD OVER 30 SURG ON PAIN MEDS 4 YRS PERSCRIBED TO ME IS .PARANOIA MORE WORRIED ABOUT INS DA THAN PATIENT. WONT C ANY IF ON OPIATE NOW BED RIDDEN TORMENT ANXIETY OF PAIN. ON FORCED TAPER ME OFF MEDS I SUFFERED, INCREASED PAIN, HEART PROBLEMS, MY BP HEART RATE UP HAD A BLEED IN THE BRAIN NOW IM 3 HEART MEDS FROM STRESS, TOLD DOC AN PC IM HAVING SUDICIDAL THOUGHTS THEY DID 0 I SEE PAIN MANG SPEC. THEY DONT PERSCRIBE WORK W PC. W CONTRACT URINE TESTS DONE NOTHING WRONG SEE A PAIN COUNCLT WHICH IS RECOMEND IM ON DISIBILITY. HEARD OTHERS R IN MY SHOES PAIN SUCKS THE LIFE VERY SOUL FROM TO MANY USE TO BE THOSE CHARTS W THE SCALE OF 1 – 10 NOW IT DOES NO GOOD TO USE THEM FOR ALMOST ALL MY HOSPITAL STAYS HAVE BEEN TRAMATIC BECAUSE ITS SO HARD TO GET MEDS CRONIC PAIN PATIENTS GET TREATED LIKE CRIMINALS.HAVING PVCS, NOT EATING GETTING DEPRESSED WHY SHOULD ANYONE HAVE TO SUFFER SO MUCH. NOW TRY FINDING DOC FOR PAIN WHAT IS USE OF A PAIN CONTRACT IF DOC DONT UP HOLD THERE LEGAL PART DEATH RATE IN OR WAS THE HIGHEST OPIATE 2 DOCS LOST THERE LICENCES NOW ALL R IN FEAR. THE SUCIDCE RATE IS UP WE CAN ONLY SEE MORE ALCHOLISM, ILLEGAL DRUG USE PEOPLE TAKING THERE LIFES. IF A DR CANT TELL A PATIENTS ILLEGAL GOES DR SHOPPING I SAY SHAME ON THE DOCS THIS DAY N AGE ALL RECORDS R AVA. THEY CAN TELL IF U GET SCRIPTS CANT GET MEDS FILLS EARLY DONT BUY IT . I WOULD NOT CONSIDER TAKING MY LIFE IF THEY EVEN TRIED TO PROVIDE ME ANY SUBSTITUE

August 18, 2013 at 10:05 pm
(22) keith cassell says:

Wow I am not alone. What is a person to do I hate drs I cant find a pain Dr to help me and when I do I get treated as if I am a street junky I have had 37 operations for chrons disease and I also suffer from severe bone and joint pain due to steroids for the illness I also have kidney failure gout brocitis I cant spell it but its so very painful my Dr just discharged me from his office because I asked for my medication early and the reason was because the medication runs right through me into my bag I can take a pill and within seconds it is in my bag so one time due to fear of withdraw I took it out rinsed it off and retook it then I found myself in the hospital with septic poisoning I went to my Dr told him this and he said sorrry I have to discharge you so now I find myself scared I been on this med for 25 years I am going to suffer for something I have no control over please God help me all I have is prayer if a Dr is reading. This please help me I have never done street drugs I don’t drink I have real pain and need my life back until then there is no hope for me and I am afraid of dying. I think I deserve the right to live pain free and happy my God please help me

October 28, 2013 at 2:55 pm
(23) dolly says:

What is wrong…especially in Michigan…I have a daughter suffering and even got to the point where they schedualed surgery and then they cancelled 2 weeks before the surgery…she is 40…bulging disk, pinched nerves and degenerative joint disease, yep she has been going to docs to get pain medicine once or twice, then only to say…”we don’t tyreat cronic pain”! But this latest Dr, and I was with her was absolutely convinced” a neuro surgeon” that surgery would help and so went the pro ops etc! 2 weeks before surg, they called and told her that they cancelled her surgery because her record of pain med use was too much…ah hello folks she has MRI’s exrays and all…yep she is justified to have surgery just like the dr ordered and suggested…now cancelled! I do not understand Michigans way of doing things here!
Couild some one answer this for me, as mom”me” is in a dilemma too! I don’t come here very often so please email me a possible fix or suggestion of anything to do…she has two kids and is really depressed about this! cal2bama@gmail.com Thank you so very much!

December 7, 2013 at 3:12 pm
(24) christmas wishes says:

Additionally you could make a craft, baked goods or sew something.

It can be difficult to come up with gifts when you have no money to spend on them.

Bondi Beach is about 1 km in length with white sandy beach, offering plenty of room for everyone.

January 15, 2014 at 12:17 am
(25) tina says:

so sad to hear all the pain we have to deal with. for so long they made us feel that its all in our heads. finally except fibromyalgia as a real thing now they tells us we are on are own……send lots of love and good vibes to all Ive been blessed for now my dr well NPR has been very understanding but I m afraid to ask her to up me from 5mg ive been on for 3yrs some times need more so end up short and no way u will get them filled up 1day to soon Ive got many thing that’s cause me pain & live in fear that she will stop writing RXs too…Peace

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