A Pained Life: Medication Jeopardy

A Pained Life: Medication Jeopardy

When someone writes that they are out of medication and their doctor refuses to write a prescription for more — despite their abiding by the directions of how often and how many — it seems a dereliction of duty, especially when the medications are opioids.

bigstock-Doctor-writing-patient-notes-o-16554509Many years ago, I was prescribed methadone.

I was in a Philadelphia hospital, where my neuro-ophthalmologist was employed, at a point where the pain had overwhelmed me and I could no longer deal with it.

I was given increasingly potent opioids, but nothing helped.

Dr. Freidman, the pain specialist, suggested methadone.

“Methadone? No way. It’s addicting,” I told him.

But he assured me, “We often use it for chronic pain treatment. It is worth trying since nothing else has helped.”

I was concerned about being able to get methadone when I returned home to New York City.

“My mentor is there. He’ll give you the prescriptions. Don’t worry,” Friedman said.

Unfortunately, he was wrong.

When I told the doctor, “Dr. Friedman told me you would write the methadone prescriptions for me,” he stood up, said he would not, ended the appointment, and sent me on my way – with no prescription or instructions about stopping the drug.

I am very lucky. I had never had a problem stopping any drug, even codeine (after taking up to 14 grains a day for 8 years), but this methadone was another thing altogether.

I had been on it for only a few weeks. I had a few doses left, but decided to stop taking it. Within a very short time after missing the next dose I started feeling terrible — chills, sweating, headache, and full body ache.

I decided I must be in withdrawal. The only thing that made sense was to take half a pill, and if that helped, to wean myself off methadone by continually reducing the amount I took, halving the dose, then halving it again and again. It worked. Within about a week I was fine.

But there was no reason for it to have happened. The doctor should have at least told me how to get off the drug or given me enough pills to get through withdrawal.

Too often I hear people in chronic pain say their doctor went out of town and they were out of their meds or needed a prescription for refills, but no one at the office could, or would, do it.

Others write of physicians refusing to write any more prescriptions for narcotics, with no explanation or discussion of what they can expect if they stop taking the drugs.

It seems to me that a doctor who does not give their patient enough medication or has no one to cover their patients when they are away is doing harm.

Narcotic medications need to be given sparingly and thoughtfully. When a doctor does give them, it is incumbent upon that physician to make sure their patients do not suffer because they were away or changed their position on the use of narcotics in pain care.

It is another example of how pain patients are not always given the same care or due diligence those with other disorders, such as diabetes, can expect from their physicians.

All doctors explain what insulin does, how it needs to be taken, and what can happen if the patient stops taking it.

Why is it we should expect, and receive, any less?

Carol Levy

Carol Levy

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol was accredited to the United Nations Convention on the Rights of Persons with Disabilities, where she helped get chronic pain recognized as a disease.

Carol is the founder of the Facebook support group “Women in Pain Awareness”. Her blog “The Pained Life” can be found here.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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Authored by: Carol Levy, Columnist

There are 10 comments for this article
  1. Steve at 12:44 pm

    Robert is correct, this is medical malpractice.

    Untreated and undertreated intractable pain can and do kill, usually through cardiac over-stimulation and various changes in the cardiac, pituitary, and adrenal systems. Dr. Forest Tennant explains it best in ‘The Intractable Pain Patients’ Handbook for Survival’, which is (legally) available for free.

    http://bit.ly/PainGuidePDF

    Dennis is correct, pain patients need to be given a voice among those who regulate pain treatment. To those who lost kids, I’m sorry, but you kids was an addict who broke the law and took powerful medications without any regard for the directions. These kids toss random points in a “candy dish” and swallow handfuls, you can’t regulate that kind of stupidity. We pain patients are completely different from the drug abusers who make our lives hell.

  2. Steve at 12:31 pm

    I was cold turkeyed from methadone (although I had oxycodone, which helped with the mu-opioid activity, but not kappa-opioid or NMDA).

    Methadone it’s cheap and effective, but it is also misunderstood because of a few overdoses caused by uneducated physicians. Methadone should NEVER be increased more than once every 5-7 days. Other opioids can be increased every few days or even every few hours. If a doctor increases methadone as often as they increase oxycodone, oxymorphone, morphine, or fentanyl, the patient could overdose.

    There is a irrational fear surrounding methadone and because it is about $10/month, there’s no incentive for drug companies to spend money dispelling those myths. Some brand name drug companies will scare doctors away from methadone to boost sales of OxyContin (oxycodone ER – major culprit), Kadian (12 hr morphine ER), Avinza (24 hour morphine ER), Exalgo (24 hr hydromorphone ER), Opana ER (oxymorphone ER), and, now, Zohydro (12 hr hydrocodone ER).
    Sorry, I don’t mean to sound like a conspiracy theorist.

    Duragesic/fentanyl patches 400mcg/hr have no effect on my neuropathic leg pain, but low dose methadone (even 5mg/day) can have huge effects.

    Methadone is uniquely effective because it it’s not a pure mu-opioid (like morphine, oxycodone, fentanyl, sufentanil, alfentanil/Alfenta, oxymorphone, hydrocodone, hydromorphone, codeine, and remifentanil). Methadone is a mu-opioid, but it’s also a kappa-opioid, an NMDA receptor antagonist. Methadone is ideal for nerve pain, but it is also effective for back pain and cancer pain.

    Steve

  3. Leyla at 10:55 pm

    I saw somewhere how much pain management physicians make after they finish their internships. Something in the neighborhood of over $650,000 per year. With that kind of money coming in, where is the incentive for a pain management doctor to read a little extra, look more closely at challenging patients, etc. Never mind that one person (the patient) depends on their lives for the physician to do what ever it takes to make life worth living. I understand the hard work these doctors must do in order to achieve their accomplishments (having done 7 years post graduate work myself). What I don’t understand is their carelessness in dealing with their patients. I All the hard work I did won’t do anybody any good when I’ve been house/couch bound for over 7 years. One thing I do KNOW without any doubt, with or without my illness, is that I would NEVER allow anybody to suffer they way I have. Pain patients are treated worse than animals. At least suffering animals are put out down to prevent further suffering….

  4. Dennis Kinch at 7:23 pm

    Remember, alternative medicines and most educational programs are not covered by insurance, and until this changes, drugs will be the only answer for people in pain, since most of us have hit bottom financially, thanks to our unwanted, unchosen diseases. As it is with organic foods and good nutrition, a whole bunch of us can’t afford it. Medicine, like food, is in the hands of greedy capitalists and “money talks, the rest of us walk.” The laws and rules behind these nonsense controls over who gets what and how much are decided by wealthy, powerful people who have great insurance and literally no idea why there’s a controversy at all. We (pain patients) must, NEED to get involved, to join groups and these groups need to unite and we need to bring our own power to the party. After all, there are 75 MILLION of us out there. This should scare some powerful people!

  5. Celeste Cooper at 11:38 am

    I had a reaction to Methadone, only I ended up in the ER. Not from withdrawal from the drug its self. The pain doctor told me that was unusual and I later found out that what I experienced was not unusual at all. I followed up the very next day after the ER visit and my blood pressure, which is normally very low, was off the scale. The nurses were very concerned, the doctor dismissed me.

    I totally agree that patients should be educated about their medications, especially pain medications. I also believe that chronic pain treatment needs a multi-faceted approach and that any medication should be to improve function so patients can do the things they need to support the system our body already has in place, such as getting up and moving, which improves mood and the release of natural endorphins. That said, pain medications do have their place in the life of the chronic pain patient. It should be the patients decision on what works best for them. No two of us are created equal. Don’t judge my pain and I won’t judge yours is my personal attitude.

    I have been told that some pain practices will not just treat patients with meds. Unless they are able to do some pricey interventional treatment, they don’t want to be bothered. This could be why we are in the predicament we are experiencing. Holistic care is what we should demand.

  6. Dennis Kinch at 5:18 pm

    This post should be shared everywhere. It states flatly what the problem is when people who mean well make laws and rules to protect us from ourselves. We need to start putting 50% pain patients on these committees. We also need to educate the public to the true statistics behind pain medications used properly and that small percentage of people abusing them. Everyone needs to be educated to what addiction actually is compared to what we are brainwashed into believing. Remember, we are responsible adults who are supposed to “free” to know what’s right for us as individuals. Well, 90% of at least!

  7. ginbug at 3:35 pm

    Unlike any other illness, chronic patients are looked at as a bunch of addicts by the general public and many in the medical profession. Most of us are forced to give up not only our dignity, freedom of choice, privacy, & every other right that every other american patient has. You cannot sue because of that pain contract you had to sign in order to get any type of help. I am so tired of being judged and abused by those that are supposed to be helping me for something I did not choose to have! People do not believe how we get treated until they experience it for themselves! I live in constant pain and now fear of what waits for me if I am unable to get my meds. Last time this happened, I ended up in the icu for over a week because my body went into shock from withdrawal of oxycontin which caused my heart to stop twice! All because my doc forgot to sign my script before he went on vacation and no other doc would at least give me enough to last until he got back! I wish that there was something that we could do; but no one cares about a bunch of “junkies”!!!!

  8. robert newman at 2:06 pm

    A lawsuit against the physician who refused to respond to his (yes, the doc was a guy) patient’s medical needs would be a potentially productive training tool for him and his colleagues. Withdrawal from dependence on opiates – painkillers of illicit drugs like heroin – can be severe, and refusal to treat them, or to recommend facilities where treatment is available, is plain out medical malpractice! Therapeutic abandonment in such cases can and often does lead to self-medication which can have catastrophic consequences.

    Old saying about donkeys: one can’t educate them, but one sure as hell can train them – e.g., with a strong 2×4. The same applies to many docs- and a widely publicized malpractice suit can be a powerful 2×4!

  9. Kaylee at 1:33 pm

    I’ve had happen to me that my doctor has been out of town and I’ve been unable to get my prescriptions refilled. I once went into withdrawals from fentanyl because of this. I don’t particularly like taking opioids but I’ve tried everything else and they have been one of the only things that have helped. If a doctor is going to be out of the office for more that a couple of days they should really have someone to cover their patients.

  10. Dave at 6:46 am

    Its unfortunate how much poisonous enthusiasm doctors have for medications and how unwilling they are to explore other treatments for pain. As a percentage 60 times more doctors in Germany practice acupuncture than doctors in the U.S. The refusal of doctors in the U.S. to obtain education in pain care and to make use of better treatments is a breach of the social contract. Out society cares more about the freedom of doctors to mistreat people in pain than it does the wellbeing of people in pain. The dried voices of people in pain will remain mute and meaningless and as distant as fading stars until we can get professionals to act in a humane fashion toward people in pain.