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The New Prohibition Era-Opioid Pain Meds

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    The New Prohibition Era-Opioid Pain Meds

    This topic always gets me so upset because I've been battling chronic pain for over five years without any sustained relief. The new opioid medication regulations that began in October of this year are in my opinion, wrong-headed and counterproductive. They punish chronic pain sufferers like us, who have done nothing wrong, unless you're one of those people that think pain is a character-builder, or God's plan for you.

    Moreover, I predict that it will do little to reduce drug overdoses for people who abuse Rx drugs, and here's an example of why I saw that: my nephew, who has a long history of abusing drugs like OxyContin, overdosed on heroin this past Tuesday. Fortunately a first responder administered Narcan, which revived him and probably saved his life. For now.

    I think it's likely that he wouldn't have turned to heroin if controlled dose Rx drugs had been available to him. Here is an in-depth article that discusses this issue. (From the Atlantic under Features if my link doesn't make the cut):

    The money quote:
    The crackdown on doctors might have stanched the flow of prescription pills, but it did so with a deadly externality: West Virginians have turned to heroin—a cheaper and, frequently, more accessible high. Law enforcement officials here told me that heroin is now their “number-one problem.”

    My nephew has been through numerous drug rehab programs over the years, and yet here we are again. There's really no reason to believe at this point that another stint of "treatment" with a devastating price tag is going to change his behavior. But in lieu of any other options, we will again cough up the $$$ to the "recovery" industry that has a failure rate so abysmal that if it were a new drug, would never even be considered for Phase I. But one thing that will be different for this round is that the next time he relapses, there's a really good chance that he will choose a street drug that will kill him.

    Meanwhile, those of us who suffer not just day by day, but hour by hour, will go untreated. I see no good news for anyone here.
    Dx 07/13

    I stopped taking opioid pain meds about 2yrs ago when my hospital based medical plan instituted a new Pain Clinic model for administration of pain meds. My decision to stop opioids was the result of my first appointment with the Pain Specialist, but that experience is a bit OT to this thread.

    I've since then read several interesting articles regarding the new rx'ing rules implemented by DEA, the related cost and inconvenience to some of the most seriously ill patients.

    The additional cost of monthly office visits for rx refills is a primary concern, plus the demands of another OV more frequent than my MS, MRIs, etc. Add to the increased cost is the fact that a pain 'specialist' charges more per office visit. Also the cost of monthly urine testing.

    Consider the impact to the DEA as legalization of MJ becomes more wide spread. I think the DEA's new business model is based on keeping themselves 'relevent', and to minimize the impact of job losses and budget cuts.

    Then there's the GP who wants to increase earnings by becoming certified in Pain Management, many who own their own labs for monthly urinalysis.

    The new DEA regs are just so counterintuitive considering the burden on an already streatched health care delivery system and counter to reducing the cost on the 'system' and the cost burden on patients.

    There must be a better solution to the Pain Med abuse problem, but I just don't think the new regs are the correct answer to this problem.


      Regulators brought this upon themselves and us when they declared pain to be "the fifth vital sign." That implied no one should have any pain ever, and if a patient does have pain, then medication should be prescribed to eliminate it.

      Well guess what? More pain med prescriptions were written, and drugs being what they are, more people used, then abused them. At least with prescription drugs, the FDA sees to it that you get exactly what it says on the label.

      Now, as the OP and Atlantic point out, new stiffer regulations (for monthly office visits and drug tests) are brought onboard to fix the problems created by the old regulations to "fix" pain, and they are causing people to go back to heroin off the street. Predictably this causes more illegal drug trafficking and drug overdose deaths.

      Those who pay the price are those who have a legitimate need for medication to treat their chronic pain. They are assumed to be criminals and drug abusers until "proven" otherwise - after jumping through all the hoops and expense of Pain Management Clinics, more visits and drug testing.

      I don't think pain is character-building, and I realize pain cannot be eliminated completely from the planet. But how about making it possible for patients with legitimate chronic pain to get enough relief to carry on with their minimal daily activities - caring for themselves, their homes, their families, maybe even holding a job.

      MS itself is bad enough, with no cure at present; at least let us get treatment for some of the symptoms.


        Thanks MSW and onlyairfare for your thoughtful responses. It helps to know I'm not the only one who feels frustrated about these wrong-headed policies. Sometimes I blame puritanical American thinking and other times I want to wring the necks of people who ruin it for us by using painkillers for recreation. But what really frosts me is the irony that the last thing I want to do is get high. I don't even like to drink because too often, MS makes me feel "sloshy" enough, and it's not fun. I'd be willing to wager that most MSers feel the same.

        At the moment, I'm trying LDN as there are some claims that it can help with pain. I'm only about a week into it, and am just at a starting dose so it's too soon to tell. It would be so nice to never have to be treated like a criminal or a child ever again by these pain management people. Keeping my fingers crossed.
        Dx 07/13


          I was recently at a conference where it was discussed that American's expectations are ZERO pain and I believe that is part of the problem. We have become a society where everything has to be perfect, everyone has the right to live as if they are an heiress, the fingerpainting your kid made in kindergarten is a masterpiece etc. I really hope our expectations become more realistic on so many levels.

          It is very sad that many of the people with opiate dependence were actually prescribed these medications inappropriately to begin with and these likely well meaning providers created the addiction. That said however someone came about it the literature does NOT support that opiates are effective for long term pain control and they have been shown to be problematic in many other areas.

          I'm not a fan of withholding pain medication from patients in pain but also do not think obtunding our patients with opiates on a long term basis is the answer either.

          I hope benzodiazepines are next on the list and overall believe it is time to start investigating other methods of pain control.
          He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true to the last beat of his heart. You owe it to him to be worthy of such devotion.


            Frankly, people are going to get addicted to whatever they want to. Be it food, drugs, passions/hobbies, gambling, Alcohol..etc.

            Thursday, I had to give my Soc. Sec. # for the Vet to dispense pain meds for my little 9 pound dog! Guess I should be feeling great, they didn't request a pee test.

            Something is more than just wrong for making the legitimate patients suffer more expense and for me personally, just getting in to the doc when I need to has been a major effort..trying to feel well enough on the day of the appointment, to go in.

            I live 2 doors down and across the street from a dope dealer. The police could care less, I've called in so many buys they referred me to the Drug Task Phone # and no one calls back. The real problem is: 'THE POLICE DON'T WANT TO DO THEIR JOBS.' Or, they'd stop the damn traffic'ing and Leave REAL patients alone.

            Something is very wrong, if the Gov't wants pee tests, it needs to pay for them. Its' $40. per test for me. Sadly, I dropped out of pain clinic and was immune to the pee tests, at one point, not sure now.

            When I took it upon myself to get off all those opiates, I tossed them in a jar. That has made me a 'target' for family members stealing and selling drugs. Even with that information, not one arrest! I've spent $10's of thousands of dollars for security, etc. They just over-ride electronics...

            why make a police officer do his job? Really, there is no public over site of their behavior, at all. Doesn't matter who you are, when the theft is regular and frequent..they try to make the patients lunatics and take them in. Fortunately I have a psych eval, but, it is a real pain.

            Having the largest insurance carrier of America (The Gov't) regulate healthcare, something is wrong, very wrong. fed


              Yes, Jules A said it well:

              Frankly, people are going to get addicted to whatever they want to. Be it food, drugs, passions/hobbies, gambling, Alcohol..etc.
              And moreover, I really wish people would learn the difference between addiction and dependence. The first means that you will use just about anything because you crave the high or the feeling that the substance or behavior gives you. Dependence is needing to maintain a certain level to avoid withdrawal. It is accurate to say that Gabapentin, Lyrica, Cymbalta, and the whole host of other antidepressants and anti-seizures also cause dependence because you cannot stop taking them suddenly without adverse effects. Yet they hand those out like candy.

              And if we want to talk about overdoses, let's start talking about Tylenol, shall we?

              As for expecting all the pain to be gone, I don't even know where to start. I would pay serious money to just have a level six day every now and then. Most people I know would have thrown in the towel ages ago if they had to cope with the kind of pain I do every day. And if some people expect perfection, that is not my fault. I just want to have hope that I'm not going to spend the rest of my life rocking and crying. Sorry if that expectation is too high.
              Dx 07/13


                Fed Up, I had a client I consulted with on a regular basis for years, located on the outer edges of the Central Business District.

                Parking was always a problem in that area, I'd find myself parking a couple of blocks away, walking in front of a Pill Mill Clinic, with patients openly selling their scrips and blocking my access to the side walk as they conducted their drug transactions.

                The worst part is that Police Headquarters, an historic building in this large city, was one block away from the Pill Mill.


                  This is the new prohibition. I never took drugs before my diagnosis. First, I got ON so I had a high dose of dilaudid ordered for me in the hospital. Then, my PCP was prescribing 10mg of Percocet per month +1 1/2mg of Xanax.

                  I asked my doctor if she was worried about addiction. She kept assuring me that it was ok. Then I got a jaw infection that required two months of IV antibiotics in the hospital. I was prescribed 2mg of dilaudid every 3 hours. As the jaw healed, I was still asking for dilaudid. They asked me what hurt. I said my eye., maybe at that point I was experiencing rebound pain I still don't know.

                  After I got out of the hospital, I was still taking the 10mg Percocet. First, once a day, then 2 times, then, every eight hours. I was dependent and I knew a tolerance was building but the terrible achy feeling of MS was something I just didn't want to feel.

                  My PCP didn't want to keep prescribing to me so she sent me to a pain management doctor.

                  His office was wonderful. It was in the a Cancer Center which was a beautiful building. I had a great experience with him and over the four years we seemed to building a good relationship based on trust.

                  Then, I went to my October appointment at the Cancer Center and his office was GONE. They gave me his new address so,I hobbled over there in the heat. Finally made it there and they rushed me into a tiny office with a man sitting at the desk. My beloved pain doctor was angry and said, "YOU ARE LATE!" I had just lost 15 minutes going to the wrong office. He was talking really fast about now they had a new system. I would have to come every month and all prescriptions would be sent electronically.

                  So I went to my November appointment on time, hoping he would be in a better mood. He said, well I'm going to have to test you now. That was the first time he had ever tested me without a month's advance notice. I wasn't worried because I take my medication the way I am supposed to.

                  Well, in December I go in for my appointment. I came a half hour early so I wouldn't be late and he kept me waiting an hour after the appointment time. He walks in with his laptop, doesn't say hello, looks at the results of my test and says, are you taking any barbiturates? I said, " I was taking Donatol but they don't make it anymore." He said, "well your barbiturate level,was 5000. The maximum it should be is 50. Would you like to take the test again to see if it's,out of your system? I said, no thank you.

                  When I left the office I was scared. I know for sure I did not have barbiturates in my system that day. What if he tests me again and it shows up something illegal and I get arrested? He obviously has a bogus lab. Anything could happen. I talked to the office manager who has been very approachable lately. She told me others patients have come to her upset about the lab results. She says she wants to change labs. But for. me the doctor patient relationship has been severely damaged.

                  I don't know what to do. If I go off the pain meds, I will have long term withdrawal effects and be in pain.

                  I get so annoyed when they say, " the new war on drugs ins being waged in the doctors office." They should let doctors practice medicine.

                  Does anyone have any suggestion on how to handle this? If I stomp out saying I'm getting a new pain doctor, that would be drug addict behavior. If I stay I could be getting into who,knows what. My pain doctor is a very good person. He wants to help people and, at the same time, he is not a pill mill. Why does the DEA make such a mess? I think they are destroying more lives than they are saving.


                    Wow, this is the dilemma that I am up against now. I've been using Norco for pain in my arm, at night, for the last 3-4 years. I always make the medication last longer than the Rx allows so they know I am not taking too many or selling them or ?

                    So now I have to see my GP, who as my lead Doc manages the pain meds, which I never understood as they tested everything and concluded I was having pain as a result of MS. He already sent an email saying I needed to be seen at least twice per year and take urine tests. He didn't say what all they are testing for but I assume most everything?

                    I really don't want to subject myself to regular trips to the hospital as I am trying to work a few more years while I'm still able. I guess I'll be trying to get by with just the mega-gabapentin routine and see if that helps?



                      Palmtree, I was trying to avoid getting into my personal experience with my pain med docs, but after reading a couple of things in your post that sound erriely similar to my own experiences, here goes.

                      I was on Vicodine for 10yrs, rx by my MS doc for the first 5yrs, then a PM doc when I relocated to the P.N.West. The PM doc and I had a cordial doc/patient relationship. His knowledge of MS pretty limited, but he always wrote my refills 3 refills, one rx on three seperate scrips to accomodate my MS.

                      The nursing staff on the other hand play the 'bad cop' while the PM doc played the role of 'good cop'. I found the good cop/bad cop totally alien to anything I'd ever experienced, it totally bewildered me. But, I'd never had a urinalysis during my 4yrs as a patient there, because I complied with the terms of the PM treatment contract.

                      My PM doc also moved to a new location. I have visual spatial deficites, I get lost easy even in familiar places, stores, etc. The first couple of appointments after the docs moved, I would get horribly lost, paniced, but I was determined to at least show up for my appointment even if only out of courtesy.

                      I explained to the receptionist that I realized I was late, was extremely sorry, and understood if they had to reschedule my appointment. Explained that the relocation combined with the spatial skills problems, were cognitively incompatiable for me. (To say the nursing staff must have received their training in the state prison is putting it mildly.)

                      Eventually there was a mix up in the number of refills, and I left the office with 2 refills versus the usual 3 refills. When I called the office to request the 3rd refill, explaining the error made on the earlier rx, the refil was refused. I was given an appointment for later in the week.

                      My decades of insomnia was now complicated by the increased pain over the next few days. I always seemed to wait until early AM to take sleep meds, which naturally only make me hung over and sleep deprived the following day for my appointment.

                      I was sleep deprived and hung over, just a mess when I showed up for the appointment to clear up the error made on my previous rx, 2 refills versus the usual 3 refills. I brought a copy of the original rx I request from the pharmacy to document the error.

                      When I showed up for the appointment, there was a derigatory comment about my balance problems, lack of focus/blood shot eyes, and despite being properly dressed and groomed, I was obviously distressed from the sleep med hang over combined with being sleep deprived and the stress I anticipated during this office visit that was clearly developing into a showdown with a doc I previously had a very good relationship with.

                      I was immediately escorted to the office building bathroom by a nurse, standing guard out side of the bathroom stall, for a urnine test. I wasn't allowed to have my purse with me!It was a humilating experience.

                      I knew I wouldn't be returning to this doc, but I agreed to the urine test because I waned documentation in my file that my urine was clean per the terms of PM treatment contract.

                      I went for my next neuro appointment about 2 months later, explained the 2 versus 3 refills misunderstanding at the PM clinic, and my neuro refilled the pain med rx.

                      It didn't take very long for my neuro's hospital plan to establish a PM clinic, which I was referred to. As usual, I was sleep deprived and experiencing mild balance problems.

                      The receptionist commented about my obvious state of poor balance, bloodshot eyes and impaired coordination. Explaining that I have MS with chronic insomnia, ineffective sleep med complications and balance problems made no impression what so ever. I was a marked woman already.

                      Things deterioted quickly once I saw the PM doc during the initial visit. There were obvious cultural and english second language differences that contributed to a very awakard first and last appointment with the PM doc.

                      There was some PM doc grunting sounds, deep disapproving breaths and other non verbal negative judgments when she looked at my bottle of pain meds.

                      Again I agreed to the urine test in order for my records to reflect that I had nothing in my system other than 2 non narcotic meds rx'ed by my MS doc, knowing I wouldn't be returning to the PM clinic.

                      I was not only offended by the PM Contract as 'medical care', I couldn't afford additional cost of monthly visits for another specialist and the cost of monthly labs.

                      I couldn't rely on being able to comply with the terms of the PM Contract demands for monthly OVs. It's necessary for me to break up grooming and personal hygine preperations for my Neuro visists over 2 days because of fatigue, insomnia, etc., and I only see my neuro every 3 months, MRIs 3x a year.

                      The constant pain is very difficult to contend with day to day, in addition to the negative consequences on my physical and mental well being. I'm near the threshold for tolerating it much longer.


                        I forgot to mention that doc offices make their share of mistakes, errors, etc. I've experienced 2 very serious oversights by my MS doc's office.

                        One involved postponing my monthly TY infusion while I was evaluated for PML based on a new, serious mobility issue. I got a call from my Neuro that I had changes on MRIs, first in 8-10yrs, but no PML. No discussion about when I would resume infusions. I assumed it would be handled by the MS doc staff. After all I can't call the infusion center asking where's my TY when infusions were suspended by my doc.

                        That call never came, so I called my neuro's office, left a voice message about resuming my Ty infusion. I got a voice mail from a nurse asking what rx refill did I need.

                        A few more days of voice mail/phone tag, and almost 60 days since my last Ty infusion with the danger of a Rebound exacerbation looming. I finally got the Ty appointment. That was not the only potentially huge 'office admin' problem I experienced over the years. But I'm not nit-picky, I realize office staff changes, short staffed due to illness, things happen even in my usually very well run MS docs office.

                        All that to say that doc offices make errors all the time, including MS docs and PM docs.

                        So when I look at the PM Clinic Patient Compliance Contract necessary to continued pain treatment, it's strikes me as more than a bit ironic. Even hipacratic/sp?, to put the patient to such high compliance standards, with the patient always under threat, even when an office error is responsible, or the standards in the contract are inconpitable, unrealistic for some patients.

                        The patient is the offender under suspition, regardless of the circumstances. That relization led me to the decision that despite daily pain, deteriotating physical and mental health as a result, it was not in my best interest to continue treatment at this time.


                          My GP has always been the one who prescribed my pain med. I don't take much and it doesn't eliminate pain, but it does make it tolerable. My pain is due to facial and tongue spasm.

                          Well I've complied with the once a month appt. and found the appts. okay because I then use it to "catch up" with other issues I need to discuss with him (since it's my GP it really has come in quite handy.)

                          For instance, I had pneumonia and after I finished my antibiotics (I was diagnosed at the ER) I was supposed to have an appt with the GP. Of course he didn't have any appts for weeks, but I had my "standing" drug Rx appt. so I was in good shape because that also became my pneumonia follow up appt.

                          However, I was struck with the ridiculousness (is that a word?) last appt at GP. It was late on a Friday, and for some reason he wasn't there so I saw the NP. Of course the NP couldn't give me the RX for the pain med, it had to be signed by the I had to go back the next week to pick up the RX. Fortunately, I wasn't completely out of the med, but if I had been, I would have had to go three days without it (I was there on a Friday afternoon and the office doesn't open till 9 on that would have been a painful weekend.

                          Another new thing...when my husband drops my RX off at the pharmacy, he has to have my ID...just to drop it off. I can understand them requiring my driver's license when he picks it up for me, but to need an ID just to drop off a RX is a little over the top in my book.

                          I've never been asked to do a urine test though...I find that hard to believe that a person with a chronic illness gets treated like a drug's not bad enough we have pain, we have to jump through hoops to get a Rx.

                          Of course I should have seen this coming...when it became harder to get a $5 box of Sudafed than it was to pick up my $3000 box of Betaseron, I should have surmised things were going downhill


                            Wow, looks like a lot of us have common experiences with pain management! It kind of makes you wonder why these doctors would even want to go into this specialty when they seem to have so much contempt for their patients. I know that sounds harsh, but really, these stories are chilling. I have some of my own, and not dissimilar to many of yours.

                            There’s just so much to comment upon and respond to here, and I really appreciate everyone’s sharing on this topic.

                            Here’s something palmtree said that struck a nerve with me:

                            If I stomp out saying I'm getting a new pain doctor, that would be drug addict behavior.
                            Yes, we put so much effort into avoiding the “drug-seeking” label. Sadly, we can maintain an irreproachable record for years, and then have one little, innocent slipup (I had one of these recently), and you are literally in a world of hurt. The rules are arbitrary and contradictory:
                            Exhaust your supply, and you’re depending on them too much. Don’t take them all, and you’re hoarding so you can take more all at once to get high.

                            Tell them your pain is an 8, and you’re not hurting enough to need meds. Tell them it’s a 10, and you’re exaggerating.

                            Comport yourself in a normal, rational manner, and you must not be in that much pain. Come off as agitated or depressed, and you need group therapy—no pain meds for you.

                            And as someone up-thread said, things can be written into your record easily and without your knowledge. All it takes is one self-righteous, vindictive, or sadistic doctor, nurse, or PA who is having a bad day and you’re done. No chance for appeal or redemption. God help you if they cut you off when you’ve built up a dependency—it’s off to a detox unit with you.

                            I don’t know about you, but I am so sick of living under this medical terrorism. I am so tired of being under constant suspicion and assumed to be incapable of making my own decisions. I have had it with being treated like I’m weak and self-indulgent because I just want the Pain. To. Stop.

                            I am so very sorry for all of us, and am out of ideas and out of hope.
                            Dx 07/13


                              I asked my general doctor about this and he told me that at one point doctors were encouraged to treat pain agressively - hence the pain scale etc. It went pretty overboard and now they are stepping back from that mentality. I agree that it does punish people like us, but I do think that there was abuse in the areas they are looking at (how much particular doctors prescribe narcotics). It sucks, but it is what it is.

                              My neuro group only allows one doctor in the practice to prescribe narcotics. My neuro says it makes it easier for them to deal with the newest regulations.
                              Sasha - dx January 2011; tysarbi, zanaflex, gabapentin, and baclofen
                              ~Life is not about waiting for the storm to pass, it is about learning to dance in the rain.~