Even though the risk of addiction to opioid medications is low for chronic pain patients, heightened awareness of abuse and stepped-up law enforcement against misuse has spooked many physicians, making it harder for some pain patients to get the drugs they need.
"One doctor we went to referred to narcotics as the N-word," says Ann Jacobs, a patient advocate for the American Pain Foundation who cares for her chronically ill husband in Laramie, Wyo. "[Doctor's] are so fearful of the DEA, scared of losing their license. So people go begging for pain relief."
Many doctors are concerned that there is a limit on how much they can prescribe in the course of their practice (legally there isn't), and if they fear their total number of prescriptions has gotten too high, they may cut back on refilling or writing new prescriptions.
"Time and time again we get calls from people where their physician has refused to prescribe any more opioids," says Penney Cowan, founder and executive director of the American Chronic Pain Association. "This is real. We've had [patients] call where the doctor has fired them and won't even take their callsand that's it, out in the cold."
Some doctors require a narcotics contract
It's a tricky balance. Doctors need to monitor their patients to ensure there's no wrongdoing, while patients with a legitimate need want to ensure a continuing supply of meds. Some physicians ask the patient to sign a contract, which may include things like having pills counted at each visit, keeping with the same doctor to avoid "doctor shopping," and regularly turning up in person. For an explanation of this practice, see Health.com's interview with leading pain expert, Russell K. Portenoy, MD.
"You have to be there every 30 days, or you have to actually go there to get it refilled," says Cowan. "And in some cases if you miss one appointment, you've broken your contract, and the doctor says that's it, good-bye, no more."
Doctors need to increase their awareness
Andrea Cooper, 52, of Phoenix, Md., who suffers from fibromyalgia and spinal degeneration, has felt the stigma of narcotic use. "The last pain specialist I had, I just hated it. There were signs up all over the office about rules and limitations. All about being suspicious of the patients. Not the way medicine ought to be practiced. I found it insulting." Adds Jan, 45, a chronic pain sufferer in Boulder, Colo.: "I think doctors have to be able to distinguish between the people who can handle it and those who can'tand help the people who can."
If you're having difficulties with your doctor
If a physician, for whatever reason, is uncomfortable writing prescriptions for opioidswhether it's a new prescription or a refillpatients can ask for a referral to a pain specialist. Pain specialists can also be located through online directories below.
- The American Board of Pain Medicine lists doctors who are board-certified pain specialists.
- The American Academy of Pain Medicine lists medical doctors who regularly work with pain, and may or may not be board-certified pain specialists.
- The American Academy of Pain Management lists health-care providers who regularly treat pain, though they may not be board-certified pain specialists or medical doctors.