What's the problem with doctor's not wanting to prescribe narcotics to people who really need them?

Doctors prescribe narcotics with extreme caution because it’s so easy to get addicted to them, and also because many people who try to get prescribed narcotics don’t actually have a real medical problem that warrants those types of drugs.

Prescribing a controlled substance can be a minefield for any doctor, factoring in the possibility of addiction, abuse, etc. Many people are well treated with non narcotic pain relievers but don’t want to believe it. I have noticed that oncologists are not shy about prescribing narcotics, cancer pain can be really intense.

@silky1 good people can turn into pain med junkies after the cause of their pain is treated. They are worried about ruining people’s lives. Also, every time they prescribe certain meds they get flagged in a database for the FDA to monitor. MD’s with a pattern of over prescribing certain substances can loose their license and go to jail if it looks too suspicious.

Generally you want to “graduate”, the idea is to treat with the minimal amount of the least intrusive medication to achieve the desired effect by starting small and moving up only as needed. Particularly as pain medication can be addictive, become tolerated, and can have other side effects.

I agree with all of the above. Plenty of people have no problem attempting to exploit their conditions, or inventing non-existent “pain” to get a narcotics high.

Short of cancer or other extreme conditions the use of narcotics is meant to be a short term aide for acute conditions.

A friends son became addicted to Oxycontin after a motorcycle wreck that shattered his face and sinuses. 2 years later he was stealing from them and forging checks to buy it illegally. It took about 18 months to get him straightend out again.

I have a friend who has potts, Lyme disease, Bartonella, Hashimoto’s and one other. Anyone of these diseases is painful. When you put them together it’s more than hideous. And there is no doctor around who will or can prescribe enough pain medication to keep her remotely comfortable. In addition, there is only one doctor around qualified to treat her potts, and then you must travel 11/2 hours one way, and be willing to pay $400 for a visit (he doesn’t take insurance). It’s a living night mare.

Also, it sounds crass, but it’s true: You can’t see pain! You can’t feel what someone else is going through! Unfortunately between the legal crap and insensitivity on the part of some doctors, it’s business as usual. I saw one doctor actually laugh at my friend when she asked for help. Oh, and even though they know before you walk in the door they won’t be able to help you, they’ll still cheerfully demand full payment. It’s the American way!

(I’ve been there done all that)

I think the attitudes toward pain management are leftover from our Puritan culture.

One of the primary problems is the DEA. Doctors who prescribe ‘adequate’ dosages of narcotic drugs – which for long term pain management means ‘increasingly large doses’ – pop up on radar screens and invite investigation from drug warriors. Reasonable people prefer to avoid those kinds of investigation, so the number of doctors who are willing to make those prescriptions quite naturally dwindles, and the ones who courageously will write appropriate prescriptions find their caseload increasing more and more as their colleagues fail to withstand the scrutiny and ‘comply’ with the wishes of the DEA to avoid adequate, appropriate and necessary treatments. Eventually they either retire or incur an intolerable level of “investigation” and interference that even they have to withdraw their services.

There was an excellent and well-documented story on this in Reason magazine several years ago. I’ll try to find a link later and include that.

Followup: I’m not 100% certain that this is the link that I meant, but it’s apropos, and from the same source. I expect it’s the one that I had in mind – even though it’s now 14 years old. (Reason did another short article in April of this year, which is easily found. I hadn’t read that one before now, though.)

@CWOTUS so it’s the DEA and not the FDA as I stated above. Thanks for the correction.

We were just discussing this issue in my pharmacy law class last night.

Yes it is the DEA (Dept. of Justice) that monitors dispensing of Scheduled narcotics and the paper trail is astounding: Forms for ordering drugs, forms for prescribing drugs, forms for inventory and losses… etc. The DEA is exempt from the HIPPA privacy requirements when it comes to narcotics and more and more practitioners are backing away from dealing with the agency and their own liability for potential abuse. It’s becoming more common for GPs to not even apply for a DEA number/license so they recommend (possibly) less effective but non-narcotic medications for pain management.

The real problem is that doctors are too cautious because law enforcement is looking over their shoulder. That means that people that really need the drug suffer needlessly because of an overabundance of doctor caution. After all why would you limit pain relief to a terminally ill cancer patient. Who cares if the patient becomes addicted. This is what happens when you mix religion and law, nobody prospers except law-enforcers.

Normal people can easily overcome addiction. Addictive people will just find another drug, without a doctor’s supervision. I vote that the law butts out and let the doctors and patients figure things out for themselves.

The argument is then what if the doctor too easily prescribes pain killers, my answer, who cares, it’s none of my business.

My friend has so often mentioned how she WISHES SHE HAD CANCER! because if she did, her pain would be managed. Hers is a terminal illness, but it’s sort of a “sucks to be you” attitude on the part of the medical establishment.

I know that I have been denied two kinds of prescription drugs that I legitimately needed (Xanax and some sort of pain killer) due to ‘potential for abuse’. Now, I was living in WV at the time, where there is an extremely high rate of prescription drug abuse, but I thought it was tremendously messed up that I couldn’t get the medical care and treatment that I needed for two conditions that multiple doctors have acknowledged.

The psychiatrist, to whom I’d explained that I was using alcohol to treat my severe anxiety and panic attacks, even said to me that he’d prefer I take a prescription to manage the anxiety, due to the impurities and whatnot (plus, I imagine, the fact that alcoholism runs in my family), but he still refused to give me anything. This left me drinking alcohol to calm my system down to be able to breathe, eat, and function, in addition to networking and trying to find Xanax on the street or through friends. Something not right about that to me.

The doctors for my chronic and sometimes-debilitating back pain have said that they ‘didn’t want to start me down that road at such a young age’. They continually tell me to take massive doses of Tylenol and Advil in combination, in addition to ritually prescribing me Flexeril, which does absolutely nothing. So, basically, I get to be miserable and stuck on my back in pain, unable to move.

In KY, you can not even order this drugs through the internet, legally.
I have arthritis, diabetic and fibromyalgia. It took me years to find a doc to help ease the daily pain. I was not dr. shopping, just trying to get someone to understand how bad I hurt. I do not abuse pills, I usually only take a half at a time.
I think we all deserve to choose, how much pain to tolerate.

Buying the drugs on the street, is no fun.

Yes @MissAnthrope. The DEA sets the basic enforcement guidelines for legal distribution but each state’s Board of Pharmacy pushes legislation for further restrictions and liabilities and these change and become more strict with each legislative session. The dept of Justice does have too much power over our individual choices but the practitioners do have to operate within all these boundaries. It’s an incredible headache to keep up with new laws.

The legal issues with narcotics effect manufacturers and distributors too so there’s a lot of emphasis on developing new drugs that are non-narcotic. Tramadol, for example, acts on the same pain receptors as morphine without causing dependency and it’s been a godsend for many people with chronic pain but it doesn’t work for everybody and unfortunately (or fortunately, depending on your point of view) it takes years for new drugs to get FDA approval and even longer for them to go off-patent and become affordable.

This leaves a therapeutic treatment gap for a lot of people. A large part of the increase in medical care costs is liability insurance. In some states, doctors can be sued and lose their practices if their prescription pads are stolen and misused or they fail to secure pharmaceutical samples. It’s small wonder that this is turning into a clusterfuck and leaving many people without effective resources for treatments.

@MissAnthrope

Wow! Xanax is usually, while controlled, dispensed fairly often for anxiety related issues.
I have had Xanax prescribed for anxiety years ago during a divorce and when I travel on long flights.

I asked my doc for some when traveling overseas last year and he whipped off a prescription for 10 for my travels.

Of course he knows I am not an addict so, he trusts me for my very infrequent requests.

I’ve yet to meet a GP who doesn’t easily suggest or prescribe. I wish they were tougher and maybe there wouldn’t be so many junkies on Oxy, Percoset, Xanax, Darvoset, etc. A lot of people have no idea how badly your body will make you feel is you’ve gotten used to that stuff and then decide to quit.

My doctor said they have to fill in forms every time a narcotic is prescribed defending their reason for prescribing it. I don’t know if I think this is right or not.

It’s not a problem, unless you really need the pain relief and they can’t/won’t fill it because of governmental oversight and/or it’s such a pain that it’s not worth it to them. It is a mess.

They care more about liability issues than patients.

@Simone_De_Beauvoir I don’t think that’s really fair. The liability is an issue of course, but as I stated earlier in the thread, many of these medications are HIGHLY addicitve. Many are worried that once they start a patient down the path of narcotic pain meds, their lives could be completely ruined. It happens all of the time, and so if the decision is between their patient suffering with some chronic pain by using less-effective non-addicitve prescriptions vs. risking turning them into someone who will rob a bank, become a prostitute, murder someone just to get more meds, then that is a difficult decision. I would be weary of any MD who would make that call lightly. Do remember that by-and-large MD’s get into the profession because they want to help sick people get better (but it’s true that no MD likes to get sued or have their license to practice revoked either).

@Blueroses “Tramadol, for example, acts on the same pain receptors as morphine without causing dependency and it’s been a godsend for many people with chronic pain but it doesn’t work for everybody and unfortunately (or fortunately, depending on your point of view) it takes years for new drugs to get FDA approval and even longer for them to go off-patent and become affordable” That drug has been around for a very long time. I have consistent pain because of leg injury and am allergic to morphine derivatives. For a couple days Tramadol helped but then I started having hallucinations and insomnia. In fact, I had insomnia for about two weeks after I stopped taking the drug.

Many of the substitutes cause more problems than natural heroin.

@gorillapaws There has been a clear shift in the amounts prescribed and this shift’s cause isn’t because of concerns about addiction. You can’t tell me doctors 5 years ago cared less about addictions than they do now. What I specifically deal with on a daily basis is advocating for terminally ill patients (and who gives a shit about their addiction, doctors don’t) to get their pain meds and a patient often goes an entire weekend (due to administrative and otherwise failure of the system) without pain medication and it’s only because I am able to pull strings that they’re getting any through the weekend, at all. Sure MDs get into the field because they have a vague sense of helping people (I’ve been there, I was all set to be one) but when they’re actually doctors, they know how to conform to existing paradigms and the current paradigm is constrained by more than just doctor’s opinions on patients and addiction.

@Simone_De_Beauvoir “They care more about liability issues than patients” If a doctor is found liable for breaking some law, they can’t help anyone. What we need to do is go after the people that make the laws that delve, unnecessarily into doctor/patient relationships. Filling out form every time a narcotic is prescribed is a waste of everybody’s time but don’t blame the doctor.

@Ron_C When I said ‘they’, I didn’t just mean the doctors.

@Simone_De_Beauvoir that’s a fair point. I think they can be handcuffed by the system for sure, and I do think things need to change structurally. I know many MD’s though, and I do know they really do care a lot about their patients. Whenever my father lost a patient in a difficult surgery he would often cry with the rest of the family and sit with them for a long time. He’s told me about how incredibly hard it is emotionally, and I know he’s not the only MD who feels this way.

@gorillapaws How old is your father? He might be a dying breed. I read somewhere that patients feel better talking to a computer software-generated nurse than to a real live doctor because they feel less like an idiot and have time to process information. That’s sad.

@Simone_De_Beauvoir My father is in his early 60’s, and I’m sure he would agree with you. One of the major problems with our system is that as insurance companies have taken over the field, and the costs of running a practice have skyrocketed (malpractice insurance and healthcare IT for example), the amount of time doctors get to spend with each patient is much shorter than they would like. Insurance loves this, but it’s a real problem for the industry as a whole.

@gorillapaws you are absolutely correct about insurance companies taking over. My wife (registered nurse) told me that they inspect the hospital and tell them what staffing levels to use and they are not negotiable. Then they tell the hospitals what they are willing to pay and what procedures are authorized. They even go as far as dictating the computer software for doctor’s and nurses notes. Then they hit the doctors’ offices and do the same to them.

When it comes to paying bills, they purposely disallow some charges just to see if anyone complains (personal experience). The best improvement that could be made to the entire medical system is eliminate health insurance companies. They demand under staffing, underpayment, and excess profits. Not only is this bad for the health system is morally reprehensible.