Scroll to the *** at the end if you don't want to read the background..

Background:

My physical medicine & rehabilitation doctor said he will no longer prescribe me narcotics. He immediately cut me off. I have a number of injuries in my left arm causing chronic pain from a car accident on 12/25/2006. I have had 15-20 surgeries on it. I also have a tendon avulsion of the right pectoralis major from a weightlifting injury in Feb of 2008. I wanted an MRI right after the injury, but was refused. Well, it took me 1 year and a half to get the MRI but I have a serious injury there.

Regarding my PM&R doctor, he has a reputation for accusing people of being addicts. For instance, he accused a friend of mine of being an amphetamine abuser when a urine test came up dirty because of his Adderall (an amphetamine-based drug for ADHD). Anyways the Dr. is a real zealot when it comes to mistrusting his patients.

In my situation, I had surgery on my arm on 7/23. Before my surgery, I called his office several times to try to make arrangements for him to handle my pain medication. We had discussed it 2 months earlier and he had said he would be willing to handle the pain meds, but we had no concrete plans since May about how I was supposed to get the meds.

So, when I got to surgery on the 23rd I told my surgeon that there was a possibility my physical medicine doctor had dropped the ball and maybe she should handle the prescriptions.

Well, after the surgery I was handed a prescription for 30 percocets from a resident working for the surgeon. I filled those immediately. The next day, 7/24 I finally got ahold of my PM&R doctor and he wrote me 60 percocets @ 2/day and 60 15mg MS contin @ 2/day for the month.

I tried the regiment of 2 Percocet and 2 MS contion, but I was still in agonizing pain. I also live in a medical marijuana state, but the MMJ didn't help wither. I called the PM&R doctor explaining that I was still in terrible pain and asking if I could take 3 MScontin per day rather than two. I got a message back from a nurse that basically told me to get lost.

So, I decided to continue to get percocets from the surgeons office, to supplement the medication from the PM&R doctor. Of course, the surgeons office often had residents write the prescriptions.

Well, when a month passed and I went to see the PM&R doctor, the residents came in first and I also allowed two medical students permission to watch my appointment take place. They already knew I was going to get a lashing, but I didn't. Needless to say I was embarrassed in a minute. The doctor came in with a full record of every prescription I filled since my last visit, apparently from a state database. He asked me to name who wrote specific prescriptions that were filled on specific dates. I couldn't answer the names of the residents. He thought the surgeon's residents were other doctors and that I was using 4 doctors. He talked to me like a police officer "Why are you having so much trouble remembering," made his accusations without calling the surgeons office, told me I shouldn't have taken medication from the surgeons office in the first place and that he would no longer write medication for narcotics. He said I could try Ultram or ice. That was the end of the appointment. He didn't even ask me about my left arm injury, the surgery, or the pec major avulsion. I essentially paid him to purposefully accuse me in from of Med students and then kick me to the curb.


***Here is my actual question:
What should I do? I switched to Suboxone from a doctor I found locally and paid in cash. In the Suboxone literature, it says that suboxone is not indicated for patients with pain management problems. What should I be taking instead? Methadone?

Did the doctor violate any of my rights? There is only one PM&R clinic in the hospital, and the hospital is the only place I can go using my insurance. I am now probably flagged as a junkie and won't be given pain meds. What can I do about that?

Ahhh yes, "the doctor came in with a record of every prescription I had filled....apparently from a state database." And people say that it doesn't exist, that it doesn't happen.... Well, here is one example of what happens when East meets West, so to speak.

Andy - have you spoken frankly with this doctor? I don't know at all if it would have made a difference, but what did you have to lose?

15 -20 surgeries? Geez. That is ALOT. Makes me think that the arm will never be OK. After it is messed with too much, seems like a body part never returns to "normal". And then to cut you off? Just have to wonder.

Hope you find some resolutions, Andy. And I pray that your arm is functional. One needs the arms, eh? I know about pectoral injury. Hmmm, not easy.

Andy, I agree with Rain...first I would try to get an appt. with that pain doctor WITHOUT the medical students! Isn't it worth a try? I would go armed with your info. from the surgeons office, or better if you could get a call or letter from that office to your pain doctor saying that many residents refilled your prescriptions. I just hate to see you lose a good doctor over a bad mistake. This similar thing happened to me and I paniced an am on methadone now. Its ok, but I find it irregular in treating my pain. I'm not a heroin addict, just needed my vicodin and lost 3 docs in a row...

Boogie

If he's that bad about meds, I don't know if he'd ever forgive you for taking the surgeon's drugs even if you proved that it was his residents that write the rx's. And if you didn't let his office know you were taking meds from both docs, that was wrong. If you didn't let the surgeon know when your PM&R doc gave you his rx, that was wrong too. But no matter what, not even asking you about your injuries and just yelling at you, that was extremely, horribly, blatantly wrong. I'm not a lawyer but I'd be tempted to ask one what could be done. Would you be willing to take it to the licensing board?

I assume with the buprenorphine, you're in a lot more pain than with the morphine? If any new doc you try thinks you're a junkie, you can explain what happened and show proof that the other docs were the surgeon's residents. They can't hold the idiot's mistake against you.

Oh, and I wanted to add, I would absolutely not pay for another session of slander and verbal abuse from Mr. False Accusations & Paranoia Needs Psych Meds For Himself M.D. If you want to try to reason with him, don't pay for it. Use phone, fax, or the like instead.

I can understand though the Doctor being upset. It does make one look as though they are double and triple dipping. this is why there are so many issues with getting prescriptions, beleive me, I know what it is like to be in pain, but we also have to be responsbile as well. It is getting harder and harder and some of us can barely get a prescription for 15 or 20 when we go for each visit. I admit, it makes me mad, as I need pain medicatin on a PRN basis. and it is difficult. You can show all the proof you want if the word is out there your doctor shopping you better off going to a methadone clinic, I am not really sure if there is a case. Cutting off a patient totally, yes is not the way to go, and forcing them cold turkey however, their license is on the line. I doubt it constitutes ruining a Doctors reputation by trying to file against hi, but just my opinion. we are only hearing one side. we really do not know the Doctors point of view. I try to look at both sides. If in fact the Doctor handles it this way, he may have for fact he felt foolish. we have to be honest with our Doctors, we really do, i do hope it all works out for you though

Insurance companies also keep track. They send (at least in my state) periodic records of Rx's filled by the patient. They highlight scripts that weren't written by the primary Dr. I found that out back in the good ol' direct script days. Learned my lesson and paid cash after that.

i am betting most insurance companies do this if they think there is excess being written. i mean i know i was looking at my scripts on line today with my evil insurance company who fights me on everything, and i can check every script filled, so i am sure they monitor.

Andy------that doctor is INSANE for snatching you off strong narcotic medication like that and leaving you to sink or swim! He's CRAZY! You could die during withdrawals! I just cant believe it! If he's that stupid, thank God he's done with you. Drop him and go to someone who is knowledgeable about pain killer addiction and willing to help you withdraw. Where did he get his medical license from?

Sam, I completely agree that we MUST be honest with our docs. Use just one doc for pain meds, etc. One pharmacy. It is the patient's responsibility in the relationship.

Having said that - cutting a person off immediately with no recourse is not ethical. They have no doubt never done withdrawals. IMHO, tapering a person (when you no longer want to treat them) is best. Or referring them to another doctor. But, to just cut them off? "Shaking my head".

I just get SO tired of this crapola. Where people are forced to suffer. It should NOT be so. Truly, I have little hope in my lifetime of things changing. In the meantime, people suffer. If I was a doc, I could not look at myself in the mirror.

To all CPers - take care of your good selves as best you can.

I honestly have never come across a Doctor who has cut anyone off and refused to taper, now I have seen a doctor or two or three place a patient in detox but he or she cannot control if the patient refuses to stay. I agree to cut off totally is unethical but again, we do not know all sides just one. But again I do not agree with cutting off at the knees one bit, I believe in tapering, however, in a case like this, I would agree more with refering to detox, and medical induced detox would be the safest, but just my opinion.

Also wanted to say, I am not saying it does not happen, but usually the Doctor will refer to another Doctor, or refer to detox and admit, or taper, but I can see both sides. Doctors get very skitzy these days. I can certainly understand a Doctor being upset in a case where he feels someone is using him for his scripts, but on the other hand, he also needs to get with the other Doctor and come up with a treatment plan. if he has all the scripts he knows now who esle wrote them. so obviously there is a problem and the patient needs help

I think it's ridiculous to even talk about addiction, tapering, and detox. Better than making someone go cold turkey without support, but it's like saying it's worse to make a cancer patient quit (mid-treatment) chemo and pred cold turkey than to quit the chemo and taper slowly off the pred.

Unless the OP is lying, this is simply needing higher doses of a med, a doctor being prejudiced against using more than some arbitrary number of mg per day, and the doctor being stupid enough to not look up which surgeon the residents were with. How could any decent doctor would want to do anything other than raise the dose to provide acceptable pain relief?

Discomfort and hurtful sensations should be 100% enough justification for medical treatment, but pain goes beyond subjective feeling. Anyone cutting a patient in pain off pain meds (or even giving too low a dose) might as well be giving constant massive injections of cortisone.

well quite frankly since we only got one side, and if the patient is being cut off by all the doctors he was going to then yep i would say medical detox right now is about the best bet or a methadone clinic, and by the way, we do not know if they are lying or not, once you have shown an abuse within what the doctors take it as double and triple dipping your pretty much out of luck. so since the person is syaing out of luck there are options that could have been given and we do not know if they were or not. so quite frankly i think saying they need higher doses is ridiculouse. when a patient is hitting up that many doctors there is a problem that yes needs to be addressed, and if they are being cut off those issues need to be addresed

Boy, I can sure see all sides of this situation (thank you Sam). There are always more sides to the story. Needs to be remembered.

Having said that - IF the patient was just cut off - bad. IF the patient was over using docs - Worse.

I hope that whatever happened it was appropriate. Even if the patient was over-using - seems like there are better ways. Don't really know.

Hey, y'all - wishing you the best.

I don't like accusing people of lying. And if he was lying, he'd be a bit wary of reporting it to the licensing board etc, so my advice would be moot.

As I said in my first post here, it would be wrong to not report to both doctors as soon as he got his rx from his PM&R. But he tried using his PM&R doctor's dose and not using the surgeon's meds, and it was insufficient, and his doctor would not raise the dose.


The problem that needs addressing is that a patient is in so much pain they feel the need to self-medicate with higher doses after their doctor wouldn't listen.

Of course there might be a valid medical reason (not the drug war abuse paranoia) the doctor did not want to increase the dose, such as being afraid of respiratory depression, in which case the doctor should have stated this, listened to the patient's response, answered any questions about it, and given suggestions for alternatives.

Look at it this way: If someone had a severe infection requiring antibiotics, and two doctors each gave doses that were too low and would not listen that the doses were insufficient, what is any reasonable, desperate ill person going to do? Either see a rational doc asap or, if that's impossible, raise the dose hirself. You MUST have antibiotics that the pathogen is sensitive to, use a high enough dose to be effective, and take it long enough for the problem to resolve and not resurface. Pain medication is no different and should not be treated any differently.

Here would be my order of preference:

-Find a doctor who is reasonable and will give a sufficiently high dose to control the pain
-Find a doctor who will at least continue the old dose
-Use the highest dose of methadone possible
-Continue with the doctor using buprenorphine
-Taper down to pure agony
-Agony squared from cold turkey withdrawals

Quite frankly, if I was in a car accident like that, AND the injuries were so messed up I needed multiple surgeries on them, AND had a recent surgery for a separate severe injury, and was in as much pain as the OP seems to be in even with the highest dose my doctor would allow, and then I was cut off, I might be tempted to kill myself. I don't envy the OP.

my husband is a client of the pain clinic up here. The pain clinic however does NOT dispense pain medicine only epidurals by injection. THe epidurals help with the leg pain but how strange is it that a pain clinic as soon as you walk in the door asks you to sign a form to confirm that you must never ask for pain medication, or any type of medication or narcotic, while you are a patient in the clinic. Just ludicrous but it is the way things are, and it will get only worse with time.

Yes it's ridiculous what we have to go through. Dealing with The Pharmacists is usually the worst and most degrading part for me.

I can understand the Doctors point to a degree because there are people out there who do make it bad for people who are taking it seriously and trying to what is right and work with their doctor but the pharmacy ticks me off. if you have something to say to me pull me aside, no need to blast it all over the store. that is what bugs me

I wonder if that sort of verbal abuse/harassment is illegal. If the patient filling the prescription is legally disabled, might it be discrimination in a way that violates the ADA?

The Obnoxious lady at Walgreens always insists on talking as loud as possible when it comes to your personal information and is always rude. I thought about cussing her out. If it happens again i just might.

I don't know if OR is a different kind of state or what. But I never have any trouble. Pat has a very private area to discuss prescriptions. She never gives me any crapola. I hand it over and she fills it. She makes sure she always has my count in stock. It is not a chain. It is a local pharm.

After reading the stories on here, I consider myself very fortunate. BUT, Pat is very well aware of all I have been through and continue to go through. Maybe that is the difference. I don't know. But, yelling out personal info is ridiculous.

You know what I'd do? I'd call them on it. "This is PRIVATE info and I'd appreciate it if you'd keep it PRIVATE". Listen guys and gals - you will get treated by what you will accept. I'm not talking about being nuts or anything - calm, centered, sure of yourself - that kind of thing.

When I give this kind of advice, I am well aware that your experience my vary. Just be "strong". I AM WOMAN LOL!!!!

To the original poster: gosh, if Dr Dave cut me off immediately - medical malpractice comes to mind. I've been on pretty strong meds for 9 years. I can't believe he would just cut me off without tapering. In fact, I asked him once about it and he said he would bring me down little by little and then off. Comforting. So, I am completely confused that a doc would just do something like that abruptly - knowing that a patient would suffer. You have my sympathies - atho it's not worth much.

Yes its bad that the Dr. pulled you off the meds immediately. I was in the same situation. And no, you will not die for suddenly being pulled off of narcotic pain meds, you may feel like you are going to die, but you wont'. Now if you were immediately pulled of a benzo, like xanax or klonopin, yes you could actually have a seizure and die. But as for pain medicine, you will not die. So don't worry about dying from that. As far as the doctor getting in trouble, you can forget that. Sounds like hes got all his ducks in a row. You not only have the insurance company that contacts your doctor, even pharmacies will contact your doctor. Its horrible in todays time with pain meds. Everyone is out to get the chronic pain sufferer it seems and then you got the DEA thats all over the doctors. Terrible time to be in chronic pain for sure.

I will tell you though, Suboxone is not good for pain, but does take away withdrawals, but Suboxone is stronger and harder to get off of then oxycontin or any opiate you can think of and stays in your body for about 37 hours. Methadone is a big hassal, you have to show up in the morning everyday and drink your daily methadone drink in front of them. Methadone is also a bad med. Methadone goes to the bone, dont think I would even consider that but just my opinion. Good luck on everything.

Thanks for the advice. I will try this next time i have to go to Walgreens. I can usually go to the Mom and Pop shops unless i need to get something filled on a Sunday.

what i hate more than the nitwit at the counter yelling my information but the fool who insists on standing right up behind me. there is a line that says stand behind this spot for patiant confidentiality. usually when someone stands that close, i turn around and say can i help you. i hate when people do that

Andy, tiades and others have posted some good advice. If I may add my own 2 cents.... Try to be on the least amount of addicting stuff as you possibly can. That way if for some reason your supply is gone it will not be as bad physically as it COULD have been. I feel for those who suffered this way during Katrina. 2nd have a back up supply. I do this by not taking quite as much as is prescribed. Once again doing with a little bit of pain now and then is better than doing with a LOT of pain when totally cut off. Try a F2F company if one is available to you. One of the national ones. I don't think they communicate much with local pm clinics and docs. I can see why it happened. I don't think very long ago this kind of situation would have been handled this way. But things in pain world march to a very different drummer these days. It is almost impossible to have the relief you need from legitimate sources these days. Too much red tape and hoop jumping, missed appts, calls to doc gone astray especially when working with several docs. It sometimes comes down to a big [censored] ing contest on who gets to do the least amt of work for a patient.

Omg! My friend has had similar situations happen to her at her walgreens...she has a knee cap problem and is in constant pain do to her planter faciatious....<sorry for the sp>...anyhow...the lady always is rude and loud over the phone with her....if she didn't have a legit reason the doc would deny her right? then why treat a customer this way...I have told her numerous times to talk to her manager or report them there...but she feels like they won't fill her scripts anymore if she does...and it is the closest one to her house...I just don't understand pharmacists that pass judgement like that....I would like them to be in a car accident or have some dibilitating disease and then see how it feels to be humliated because you need your meds...sheesh what is this world coming too...

Did you read the post?

The patient was not "hitting up that many doctors".
The surgeon who did the operation, and the pain management doctor.
The fact that multiple residents wrote the scripts is where the problem started, and that was the surgeon's mistake.

Yes, the patient should have made both offices aware of the situation. Since he did make them aware ahead of time, the PM doctor should not have dropped the ball, the meds should have been available at the time of the surgery.

Other specialists such as surgeons should realize that when a patient is in PM that multiple residents should not be writing scripts, this seems to be a frequent act that causes problems.

Also - Maybe it's just in California, but I could've sworn I've heard or read that what the OP's doctor did is called "physician abandonment", and is illegal. Now, they have ways around it, but I'd assume that would include referring the patient to a new doctor, and it doesn't sound like that was done.

I don't know much about Walgreens but in my neck of the woods we have CVS which is just as bad. There is a Pharm Tech there that yells out everything from his "raised pedastal" (literally a section that is "above" the rest). Once there was a gentleman in front of me waiting for his prescription and there were about 8 other people in line (most women). The tech literally yelled from his pedastal "We're out of brand name Viagra, Do you want to come back tomorrow or accept generic. It looked like the poor old man was looking for a crack to crawl into. I felt so bad for him. I've also heard that tech yell to others and couldn't believe my ears. I've LONG since left that pharmacy.