When Your Doctor Won't Prescribe Narcotics: Tips for Getting the Pain Relief You Need

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 calls—and 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."