QFT and amen brother. They can have their damn drugs if they can find a way to fix me. I did about an hours worth of work today around the house and the last 5 hours have been pure hell. Here I am a 220lb full grown man and I have been lying on the couch with tears streaming down my face, even though I have 60mg of morphine in me and two 325/10 percocets and they aren’t working. Hard to fool the kids sometimes that Dad is okay when I am crying because of the pain. Please take care of your back people, you don’t want this problem. 
I haven’t heard of the DEA being involved before this post but my state has really cracked down on prescription narcotics, partially because there’s a huge methadone problem here and there have been more prescription related overdoses than than those from illegal drugs.
I’ve been very lucky considering I’ve been bounced around from PCP to PCP after the one I’d established a trust relationship with died of cancer. I’m especially lucky in that I’ve done and said things that have worked against me like showing up after two weeks of sleep deprivation begging for something, anything to knock me out while wearing a Grateful Dead shirt. If I’d been in my right [and well-rested] mind I’d have thought that one through a little better. I also went in saying Demerol wasn’t really doing it for me but that a friend had let me try one of his prescribed morphine pills and that seemed to work so… could I switch to that instead? That got a few raised eyebrows but my long-term prescription history really speaks for itself. I only take narcotic pain medication on rare occasions, and only refill a couple of times per year.
In April as a result of new state laws I had to meet with my doctor for what was basically a drug counseling session. I was given a stack of paperwork I had to fill out where they asked a number of questions about pain levels, narcotic usage, family history and mental health. I think the whole thing was designed to make sure the doctor has a clear understanding of the patient, their usage patterns, and their risk of addiction. I had to pledge with a long list of “will nots” and consent to things like reporting for drug testing at the whim of the doctor. At the end of the appointment my doctor told me that based on my exceptionally low addiction risk and my prescription history she thought it would be a waste of time and money to have me submit to a drug test. She then asked if I needed anything written for a refill since I was there. I did not. Incidentally, I found out later that my supervisor’s wife was given the drug test by the same doctor, so she obviously wasn’t opposed to ordering them.
From a personal perspective I hate these laws. I hate having a new/different doctor’s first thought being that I’m a ‘drug seeker’ when they first hear what I’m prescribed. I am opposed to drug testing. I hate being monitored, and I hate that if I ever move or need to switch doctors again that I could end up with one that’s not willing to deal with me as an individual rather than a potential addict. On the other hand, I’ve seen a number of people that I think were prescribed way too much and ended up abusing their medication. I also ended up getting a little insight into the underground prescription market [thanks to a neighbor that lived there less than a year], and found it disturbing. There is a huge problem with people selling / trading their prescription drugs, and I think it’s more prevalent than I was previously aware. Because I’ve seen the dark side I can appreciate the increased regulation; of course it helps that I’m not negatively affected. I see both sides which leaves me essentially neutral.
THIS! As mentioned above, I have been in chronic pain since 2003 following back surgery, actually three back surgeries within as many months. The reason I have chronic pain is I have been diagnosed with FBSS (Failed back surgery syndrome). Essentially the surgeon screwed up, not enough for me to sue him (although I probably could, but not really my style), but enough that his work only made things worse. So, I am the way I am today because of a doctor, but that’s okay I guess as surgery isn’t a perfected art. So, one time I had considered trying a pain management doctor thinking they might have a trick or two up their sleeve that might help. My PCP made the referral and I went to the appointment with high hopes. For the first time in my life I walked out on a doctor, pretty much in the middle of her taking, err giving me the third degree. I had never felt so disrespected in my whole life. From the moment I walked into the office I was treated with suspicion and what I preceived as an almost hostile attitude. I went to this doctor for a consult, never intending for her to ever write me a prescription. Yet, I was still treated like a drug seeker. Finally I had enough and when she started lecturing me like I was a12 year old instead of a 40 year old in pain I calmly stood up, told her she was fired and walked out the door. It is unbelievable how those of us with chronic pain are treated by medical “professionals”. I wasn’t going to stand for it, she might have people trying to scam her, but that doesn’t mean you have to automatically assume that everyone who walks in the door, looking for relief is a drug addict. Perhaps she should have studied to be a DEA agent or cop instead of a doctor.
I am sorry to hear about your situation. I don’t have the level of pain you describe, and in my case the intensity of my pain varies greatly, with the most intense occurring least frequently. The first time I got attitude from a doctor was after my PCP died I kept getting switched to new people they hired into the clinic. I liked the first one but she didn’t work out for some reason and didn’t stay past her trial period. I then got stuck with another one who was extremely hostile, but not in regard to medications. I live in a small town without a lot of options, but a new guy came into town and opened up his own practice. I was going to switch to him but on my consultation we got to talking about my medications. He told me point blank he wouldn’t give me my prescriptions - narcotic pain meds and sleeping aids, specifically. It didn’t matter to him if I only took 20-40/year - he wouldn’t budge. I got the hell out of there, and re-engaged the hostile lady because at least she didn’t fight me on that.
I later went to an orthopedist to see if I could get some information that would help get to the root of the problem. When he heard I am prescribed morphine he immediately got attitude with me. “People that have had back surgery get morphine!” Yeah, well I get 20 at a time, only take them at night when going to bed, usually cut them in half when I do take them and maybe get two scripts per year. Fuck off. I hate even telling doctors that’s one of the medications I get because my use is so infrequent, but I suspect it would be worse if I didn’t mention it and they found out later. The orthopedist made me feel self-conscious enough that when I got home I counted my morphine script out. Out of a #20 script I had 12 remaining. I’d had the prescription for NINE MONTHS. Fuck off, indeed.
My pain management medications consist of ibuprofen, Tylenol 3 and morphine, and I have them available at all times. That doesn’t mean I’m always taking them though. Unfortunately I think medical professionals hear that I have them and they get mentally stuck there. Doesn’t matter that I may not have touched anything for months before the appointment 
For clarification here - I wasn’t asking him for drugs in my consultation, we were talking about him being my primary care physician for the long term, and he said he would never prescribe me those medications in the future.
Obbn, I’m not familiar with your personal history, or with the doctor who did your surgery. A statistic that I have heard (not from a formal study) is that back surgery only helps about half the time, and usually makes things worse the other half. This comes from a friend of mine who is a pain management physician based on his personal experience with his patients.
I don’t post this to cast blame on you for agreeing to have back surgery, but more with the idea that I think ortho spine doctors should do a better job explaining to their patients the success rate of surgery at reducing back pain.
It’s not a DEA requirement. It may or may not be a requirement of his state medical board.
My state (Kentucky) recently passed a set of laws that put some requirements on our controlled substance prescribing and required our state medical board to create a full set of guidelines. It was all implemented very badly, in that many of the board’s guidelines conflict with the state law and there have been tons of unintended consequences that weren’t exactly unforeseeable. But they are what they are and we have to live with them.
One requirement from the board is that when I start any controlled substance I have to do a drug test first. I actually really hate that requirement, because it doesn’t tell me what I’m supposed to do with it. Will I get in trouble if the test shows marijuana and I ignore it? What about my old folks who get some narcotics but only take them every now and then when their backs really act up? Am I supposed to stop writing for them if their pee test turns up negative?
Overall it’s a good law and the regulations are fine. 90% of it is stuff that responsible prescribers were already doing–the problem is that so many were prescribing irresponsibly. But this is one part of it I don’t care for.
You are spot on with you post. Unfortunately I have done much more research on the subject post surgery, rather than pre surgery. I guess I put too much faith in the surgeon who did my surgery and took everything he said at face value. I do remembering asking him what the success rate for fusion surgery was and he confidently told me 85%. Well, post surgery research has led me to discover he was telling me the truth, but the truth he was telling me was not reality. What I have found is that 85% of all fission surgeries ARE successful, however the definition of success is that the hardware was placed correctly and the patient came thru the surgery without any major complications. (mine was a fail, he nicked my dura and put me in considerable jeopardy.) The true success rate of fusion surgery, ie: full recovery, is about 15%. In my case I ended up having three surgeries, the original fusion, one to repair the dura and a third to fuse another level when no improvement was made. For patients that have had multiple surgeries, the success rate is in the single digits. In one study, those who have had three or more back surgeries have a zero percent chance of ever returning to any meaningful type of work. This information was not disclosed to me and would have certainly made me less inclined to proceed with a surgical option.
I remember the asking the doctor what I would be able to do after the surgery and he told me anything I could do before it. Well, he was partially right as I CAN do anything I could do before. I just can’t do it for any length of time or on a repetitive basis. I truly believer I was misled by this surgeon and he did not fully disclose the risk. After he nicked my dura I couldn’t even get him to return a phone call, even while I lay in the ER, with the medical personnel there telling me that if the pool of spinal fluid in my back bursts, I’m a dead man. I hate to sound bitter, but this doctor’s lack of disclosure and total disregard of after care for his patient literally destroyed my life. I have been left in massive pain for the rest of my life, lost my career and watched my marriage fall apart.
Thankfully, I remarried and have a wonderful and very understanding and supportive wife. While I am in pain and very limited in what I can do, I an not paralyzed. I am very thankful for what I have and realize there are many out there much worse off than I am. I would like to take the time to apologize if my posts seem as if I am drowning in self pity. I have my moments where I get very down, but as I have said, it could be much worse and I have a wife who loves me very much. What else could a man ask for?
With regard to some people who do this, it’s for the same reason they started (or ramped up) their cannabis use. It’s helpful for the pain, although perhaps not as much and not in the same way as opioids, and lacks much of the toxicity and most of the side effects of those opioids (and the NSAIDS they usually come riding in on).
At the Institute at which I’m treated for my migraines, a person must agree to regular drug tests as part of the agreement to be a part of their program. This includes marijuana and just about all other illicit drugs. The reasoning for this testing is that use of these substances can contribute to the exacerbaction of migraine symptoms and if/as long as a person is using, the program will not be effective.
Please share, I hear the exact opposite.
Might sound insane obbn, but I know that some people who just couldn’t get enough drugs to stop their pain decided to pretend to be heroin addicts and got onto a methadone clinic, where they could get considerably stronger doses of opioids than are usually accepted for pain.
Obviously that is the last possible resort, but just an idea for you.
It’s also suggested that Kurt Cobain was on heroin for back problems by the way.
I see you’re in Florida. In that case, yes, a law was passed last year requiring periodic UDS for patients being treated for pain with narcotics. There are many more rules that came down that we had to follow. Specific prescriptions that can’t be forged, mandatory counseling prior to treatment with signature, mandatory visits at least every 90 days, mandatory reporting of patients caught forging prescriptions, etc etc. You can google for all the specifics. Our patients were initially a little annoyed but they got used to it. However, we did weed out almost 25% of our chronic pain patients due to failure of the drug screen. Most weren’t for another drug but for not having ANY of the drug in them. Apparently it is a very lucrative business to sell pain pills. If you’re seeing a primary care doctor who is still prescribing pain medications, consider yourself lucky. Most will not at this point due to the heavy regulations and huge fines.
Just some advice, that I hope you won’t need, but if anyone who has had to deal with addicts (and I assume lots of doctors, especially pain specialists, have had to), asks you for any kind of verification, you need to learn to never take it as a personal insult. Some addicts are very, very good at lying and convincing others that they’re trustworthy, ruthlessly exploiting personal friendships if necessary (of course some are bad at it too; it’s not like addiction gives you super powers; it just gives your a reason to find out if you’re good at lying to someone and exploit it if you are).
So anyone who deals with even potential addicts is going to quickly learn to ‘trust but verify’ and make everyone, even their friends, go through these kinds of things, no matter how good the relationship is. It’s nothing personal, so don’t take it that way. If you must get upset, remember it’s not a reflection on you, but on the liars who made the system necessary.
Even if some test is not a strict requirement by a licensing body, a professional might well have some kind of practice they want to put in place, and once they’ve been burned once, they’ll want to extent it to everyone, no matter how good the relationship.
Great point. I understand that my doctor has everything to lose if he doesn’t follow the rules. I certainly don’t want to be an exception to the rules and I have no problem submitting to a test as I am following the prescription directions to the letter. I just wanted to know if this was a requirement for I really couldn’t think of anything I had done to violate the trust my doctor put in me. The last thing I would want to do is lose the confidence of the man who has helped me so much.
Also, thanks to everyone for your input, it has been helpful. I do apologize if it seems many of my posts revolve around my injury. It dominates my life and I am trying to deal with it the best I can. Talking about it helps and learning all I can about every aspect of the injury and treatment has been invaluable.
Thanks for the response, it sounds like being a doctor has become a real pain in the rear. I am very lucky to have the doctor I do, for not only has he agreed to manage my pain problem, but he has spent countless hours researching treatment options for me and has taken more time than he probably should have listening to my complaints and suggestions. A rare find if you ask me. I have been to a lot of doctors over the last few years and I have never known one to have a more loyal patient base, I feel quite blessed.
I just saw this article in the LA Times (a day late).
It seemed relevant to the discussion so I thought I’d provide a link to it.
—G!
I want a new drug.
One that won’t make me ill.
One that don’t
Cost too much
Or come in a pill
. —Huey Lewis (and the News)
. I want a new Drug
Here’s a good review commentary on the use of opioids for chronic pain: Opioids for Chronic Pain: First Do No Harm
Key points:
Primum non nocere! (Kill as few patients as possible)
Obviously you shouldn’t kill patients unnecessarily, but imo minimising killing ought to be pretty low down a doctor’s priorities. After all, objectively speaking killing someone doesn’t really harm them, they just cease to be. The major harm done is to the relatives.
Far better to ease ACTUAL suffering and er (slightly) on the side of over prescribing, at least to people who are actually in significant pain. It’s very arrogant to deny opiates to folk fully cognizant of the risk/likelihood of dependence who want them anyway; it says something about the pain they’re in. I am not accusing you of this by the way, I appreciate that in your practice you are going to be dealing with pill fiends*, just setting out general guidelines.
*Although I have a seperate argument that everyone should be given all the opiates they want, it’s not relevant to this.
Thanks for the response. From all I have read on the boards here your medical opinions are well respected and informative. However, I wish the above statement was a reality for me. If there are other non-drug therapies that could ease the pain enough so I could function I haven’t been able to find them. The only relief that I get from a non-drug source is via the use of a TENS unit, although the relief is very temporary and only effective under half the times I use it. Massage therapy does seem to help as well, but is also very short lived, not to mention very expensive and not covered by insurance.
The only option the doctors have given me besides the meds is surgery. The problem there is they don’t seem to be real sure of what they are attempting to accomplish. Rather it seems that the surgeons want to open me up, poke around and see if that makes it any better. After three surgeries I am just not willing to go through another without a clear objective and a reasonable chance of success. However, I haven’t given up and I continue to ask questions and search the Web everyday, looking for some sort if new technology or some surgical breakthrough. Haven’t found one yet, but there is always tomorrow. In the meantime I will have to continue with the status quo and hope that the continued use of these opiods isn’t causing irreparable harm to my organs and trust that I won’t stop breathing in my sleep, for that would really ruin my day.