Why Your Physician is Withholding Pain Medication

More than 1 in 3 people in the US have chronic or severe pain and have been prescribed prescription pain medication.

For many people with chronic pain, taking prescribed pain medication is a necessity for daily living. So what happens when this pain medicine becomes limited or taken away all together? Can a doctor even withhold a prescription? Is it legal for a doctor to withhold a prescription from a patient? For millions of people plagued with chronic pain, the cracking down of pain medication is a new reality. Across the US, physicians, care providers and pharmacists are limiting, even refusing, to distribute opioid pain medication.

This crackdown is gravely affecting millions who rely on these medications, begging the question: Don't people in chronic or severe pain deserve to have their pain alleviated? The answer to this question may seem simple but for physicians and policy-makers, it's not.

Not even close. In theory, if someone requires medication to help their disease or illness, they should have open access to this medication. To illustrate, can you imagine if a diabetic's insulin was withheld or closely monitored? However, what if this medication was playing a role in an "epidemic" that is killing thousands of people and destroying the lives of countless more?

Regardless of your stance on the opioid crisis in America, the reason your physician may be altering your pain management plan is deeply complex, driven by layers of social, economical and political factors.

Read on as we share how patients are being affected by the crackdown on prescription pain medication, why the rules around pain medication are changing, and what you can do about it.

How This "Opioid" Crackdown is Affecting Patients

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Millions of people are being affected (or will be affected) by the opioid epidemic which is targeting both illicit street drugs and prescription medication. Pain patients are being caught in the crossfire between health providers, policy-makers, and drug abusers. As a result, the pain medication that many patients have come to rely on is being re-evaluated, restricted, and in some cases, taken off the table.

Here's how patients living with chronic pain are being affected:

  • Their Pain Medication is Being Withheld- As the government and healthcare providers tighten up on how prescription pain medication is being distributed, patient dosages are being re-evaluated. In some cases, hospitals and clinics are restructuring and replacing pain management doctors who they deem to be higher risk for "over-prescribing". As a result, prescription doses, refills, and medication types are being dramatically tapered down or refused outright.  

  • They Must Submit to Random Drug Tests- In order for some patients to be prescribed pain medication, they must agree to the rules of their hospital or clinic's pain management program. This can mean random drug testing, random pill counting, or having to participate in other, sometimes costly, medical and psychological testing in order to continue getting pain medication.

  • They Feel Stigmatized- A common theme among patients is the feeling that they are being stigmatized. Many pain patients report in online communities, forums, and through the media that they are being treated like "drug addicts". In other words, patients report that they are being treated like drug-seekers who are desperate for their prescription.

  • They May Face Withdrawal- Stopping prescription pain medication or drastically cutting down doses of opioids can be very dangerous. Medical teams must responsibly assist and monitor any weaning off of medication. For patients taking high doses of prescription medication for prolonged periods, eliminating medication altogether can come with withdrawal symptoms including: feeling flu-like, muscle aches, insomnia, nausea etc.

  • They Have a Higher Risk of Taking Illegal Drugs- When chronic pain patients are denied pain medication, pain and withdrawal can lead to patients seeking medication/ relief elsewhere. This may mean buying prescription pain medication illegally or using cheaper, opioid street drugs to alleviate symptoms and pain.

  • They Have a Higher Risk of Pain-Related Suicide? Cases of pain-related suicide are emerging in the media. Although there isn't sufficient data to back the idea that suicide amongst chronic pain groups is on the rise, there are numerous cases reported and physicians speaking out about this issue. In some cases, chronic pain patients were denied medication to treat pain, while others had doses cutback and found their pain unbearable. Some patients described suicide as "their only way out", reportedly telling others about a plan to end their life if more cutbacks to medication were made.

4 Reasons Why Your Physician is Withholding Pain Medication

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Millions of people are being affected (or will be affected) by the opioid epidemic which is targeting both illicit street drugs and prescription medication. For many chronic pain patients with underlying conditions (like fibromyalgia, pancreatitis, lower back pain, RSD etc.) the words "opioid crisis" take on new meaning. For this group, it can feel like their living in a silent crisis, where the pain medicine they need to get through the day and maintain their quality of life is being threatened. However, there are real reasons why your physician, care team, and pharmacists may be denying your prescription.

Here's why your care team and pharmacists are changing their approach to pain medication:

1. CDC Guidelines For Prescribing Pain Medication Have Changed

The Center for Disease Control and Prevention (CDC) is the federal health protection agency that works with other government agencies to create rules and regulations, and pass laws that enforce greater public health. The CDC describes its role as "detecting and responding to new and emerging health threats".

One of these threats to public health are the over-prescription and danger of opioids. As a result, the CDC has created new, stricter guidelines for how physicians should prescribe pain medication. A recent update to the official Guideline for Prescribing Opioids for Chronic Pain has lowered recommended doses of opioid prescriptions. The Guideline also encourages physicians to treat all patients as "high risk patients" when prescribing opioids while providing specific recommendations on how opioids should be monitored and discontinued.

The new CDC guidelines aim to educate primary care providers about patient addiction and offer greater training around prescription opioids.

2. Your Physician Can't Overprescribe

More than ever before, physicians are being told to monitor, track, and prescribe fewer opioids than ever before. It's no surprise that this change in approach is affecting whether or not you are being prescribed any pain medication, they type of medication you are being prescribed, and the quantity. Physicians who "over-prescribe" face real consequences and risk losing their right to prescribe prescription pain medication, risk losing their jobs, risk losing their medical licenses, and can even can face criminal charges. It's not like it was in 2008, folks!

3. Medicare & Insurance Companies to Cover Less

A 2018 article in the NY Times, "Medicare Is Cracking Down on Opioids. Doctors Fear Pain Patients Will Suffer", looks into Medicare's role while shedding light on how physicians are stuck between a rock in a hard place. Recommended doses of prescription medication are being limited and Medicare has set in motion plans to no longer cover "long-term, high dose prescriptions".

In addition, Medicare is moving forward with a plan that can deny coverage of opioid pain medication that exceeds 7 days and more than 90 milligrams of morphine (or equivalent) daily. Other insurers could abide by the same policy. Physicians who "over-prescribe" are being closely watched.

"One in three Medicare Part D beneficiaries received a prescription opioid in 2016. One third of these beneficiaries received painkillers for 6 months or more."

4. CMS is Monitoring & Flagging Patients

According to CMS, "since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, as did deaths from prescription opioids. From 2000 to 2014 nearly half a million people died from drug overdoses and at least half of all opioid overdose deaths involved a prescription opioid."

Since 2013, CMS has worked diligently to devise a methodology for identifying and flagging beneficiaries/ patients who are "over-utilizing opioids". The "Overutilization Monitoring System (OMS)" tracks a beneficiary's opioid dose, the number of places prescriptions are being filled, how many consecutive days prescriptions are set for etc. This aims at stopping patients who are "doctor shopping" and taking high-risk levels of opioids for a prolonged period.

CMS also looks into how well providers are complying with guidelines surrounding opioid prescriptions, with consequences aimed at those who do not comply and have patients identified as "over-utilizing opioids".

What to Do About Pain Medication Being WithHeld

So, what can you do if you're physician is withholding medication you need to control your pain? First off, it's important to know that many physicians are on your side. A lot of physicians understand the danger and repercussions in cutting back opioid prescription medication but their hands are tied. Simply, physicians cannot prescribe pain medication like they used to.

Here's what you can do about your physician withdrawing pain medication:

  • Find a Pain Management Specialist. We know, this is much easier said than done. But many primary care physicians are referring patients to outside pain management specialists. Pain management specialists understand the new, stricter CDC guidelines and may be more comfortable taking you on as a patient. In saying this, wait times for these clinics can be lengthy and depending on your dose and medication type, a pain specialist may not be willing to work with you.

  • Join an Online Chronic Pain Community. Having the support of others who are going through the exact same thing as you is priceless. Being a part of a chronic pain support group will not only let you vent, but can help you navigate this tricky situation.

  • Try CBC Oil/ Marijuana. Marijuana can treat pain, nausea and inflammation. Marijuana is an all-natural way to manage pain with fewer addictive properties and can be taken without "getting high". Marijuana can be used to wean yourself off prescription pain medication, reduce narcotic dosage, or to fully substitute for narcotics.

  • Try Proven Drug-Free Pain Management Techniques. Beyond prescription pain medication, there are many things you can do to control and manage your pain. Exercise, practicing mindfulness and other forms of meditation, yoga, massage therapy, and nutrition can all be helpful alternatives to treat pain.

  • Know your rights! As someone with a diagnosed, painful condition, your care team has a moral and ethical obligation to help you. In saying this, your physician can refuse you pain medication or deny you as a patient. This tough, but educating yourself and knowing your patient rights can help you navigate.

For many chronic pain patients with underlying conditions (like fibromyalgia, pancreatitis, lower back pain, RSD etc.) the words "opioid crisis" takes on a new meaning. For this group, it can feel like their living in a silent crisis, where the pain medicine they need to get through the day and maintain their quality of life is being threatened. This is a scary place to be, but it's important to know that you're not alone, there are things you can do, and many care professionals are on your side and continue to prescribe what they feel is right for their patients.

Do you suffer from back pain? Have joint pain? Join the PeerWell blog and learn how to manage your pain.

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Hi, I'm Grace. I write all things surgery for the PeerWell blog. You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement".

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