Health

Opioids and the Slippery Slope of Addiction

Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change. This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D., the chief resident in the psychiatry residency at the University of Washington, a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program and member of the Women’s Voices’ Medical Advisory Board, to address the concerns of a woman suffering from chronic pain. She is confused and angry about the difficulty she had in obtaining prescription opioid medication that relieves her pain and that may have also caused her to become addicted to her pain medication.

 

Dear Dr. Pat:

I can’t get my doctors to understand that I have serious pain issues. I am fifty-five years old and live in a suburban area in upstate New York. My pain started three months ago, when I was on a family hiking trip and I put my back out. I have had chronic back pain for some time, but this was extreme. After spending three days essentially bedridden, with very little improvement, I went to a GP in Colorado near the resort where we were staying. He did an exam and said that my lower back muscles had gone into serious spasm to protect my spine, something he called “discogenic back pain.” He prescribed Percocet and a muscle relaxer. I was already taking Klonopin for long standing anxiety disorder.

The medications made a real difference. The pain improved quickly, I was able to return to New York on the scheduled flight, go back to work and be a mom for my busy teenagers. The Colorado doctor had given me 90 pills of Percocet, warning me that after the initial severe pain resolved, I should save the medication in case the pain returned since New York State, unlike Colorado, had passed laws requiring doctors to limit prescriptions for drugs like Percocet. Unfortunately, I found out that the Percocet and the muscle relaxer drug did more than take away the back pain–I just felt better, more relaxed and happier. At first I was really good about taking the meds as prescribed. Then I found that that didn’t cut it—I would feel uncomfortable and take an extra for relief. After a month, I saw a back specialist upstate in New York but I never told her that I had been given Percocet in Colorado. She did an exam, ordered imaging tests and agreed to give me a month of Percocet along with a course of physical therapy for the same diagnosis the GP in Colorado had made. She checked the electronic records of controlled drugs to see if I had been given any medication in New York State and found no record since my original Percocet prescription was filled in Colorado. The physical therapy didn’t help. I tried to take fewer Percocet pills to make them last but felt that I was not performing well at work, had fuzzy thinking, was easily agitated at home and worried about how I would get another prescription.

When I returned to see this doctor, she refused to order more narcotics for me since she was concerned that she would be “investigated” by New York State. She referred me to a pain management specialist who did a complete re-evaluation of the back pain. He felt that my pain issues were back to the chronic level of low back pain that I had for years. However, he was concerned that I was in danger of becoming “addicted” to the Percocet. He almost insisted that I see an addiction specialist and made the appointment for me that same day. I was astonished that he could think I could be an addict after only two months of Percocet use for real back pain. After all, I have a serious job, a husband and two teenage children, a home to manage. I take care of all of this, in spite of the pain and the Percocet. I cancelled that appointment with the addiction specialist. Clearly real addicts have made it impossible for patients with real pain to obtain the necessary pain relief we need in New York State. I am functioning with this back pain and I suppose it will gradually get better, but my mood and energy are certainly not good.

What can I do to find a doctor who will understand my problem? Is it true that my doctor could have been “investigated” for prescribing a second month of Percocet for me for real pain? How did this happen? What should I do?

Cindy

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