This is part 1 in a series of 3 about opioids and the struggle for pain patients to keep their prescriptions.
“I am so angry right now!” exclaimed Lisa E., a registered nurse and fellow back pain warrior who resides in Batavia, Ohio. “I don't think there's anything I can do about it.”
Lisa gave a UDS (urine drug screen) to her doctor 30 days in advance. When she went in for her monthly appointment, she was stunned that the results showed that she had not been taking her Percocet.
“You could've knocked me over with a feather!” she said.
“As I was telling him that I'm compliant with my meds and there's obviously been a mistake, he looked at me and said, 'No you're not and there was no mistake. I can't prescribe them to you if you don't take them.' I kept telling him that I actually DO take them and then I realized that I sounded exactly like everyone else who goes and says the same thing (when they are actually selling them instead)... Except I was telling the truth! And I have absolutely no recourse to prove myself! I was so frustrated that I wanted to cry, but it's futile.”
As he walked out of the exam room, her doctor looked her square in the eyes and said, "That's strike one." Lisa, who has been managing back for 15 years, sat dumbfounded.
Lisa's frustration represents the negative stigma many pain patients receive when attempting to renew their opioid prescriptions. Unfortunately, this shame stems from actual addicts who abuse the prescription system for those who actually need it for pain relief because there is a difference between an addict and the chronic pain patient. As soon as she hit enter, other Backers joined in sharing some of their stories.
Caption: She posted this in an online degenerative back disease and chronic pain virtual support group. Others chimed in, expressing frustration from their personal stories and in full support of Lisa's concerns.
Let's take a look at some responses.
Steve T.: Those bastards!! Mine did something similar to me as well but tried saying I was taking things I was not! STAND YOUR GROUND. I would suggest you get testing done at two other labs independent from that doctor or his organization. Have the results explained to you and nothing sent to your doctor? Until you get the results and fully understand them. Different people have different metabolic rates, therefore, process meds at different speeds. If you have a relatively low dose and a high metabolic rate, you may have 'used up' and passed them before testing (easiest way to say it).
I'm betting though that the original lab made a total error, but my problem with this is the bully doctor coming down on their patient in a threatening and intimidating manner!! Who needs that added stress along with the pain and suffering they are already in?! Not to mention a compromised reputation! I can't stand that! Some doctors just love to show a percentage of patients 'abusing' as it lets him off the hook when he is checked on and things look dubious or suspicious (it's very involved to explain, but believe me it happens —sadly) Make absolutely certain you take the meds as ordered in case of 'pop tests'. All the best Lisa.
Deborah W.: My pain doctor [once] tried to tell me that I wasn't taking my pain meds. I looked right at her and told her, “With having to reschedule my appointment, the pain meds weren't going to show in my system since the month she was checking for, was the month I couldn't come in. She shut up right after that and never said a word to me about it.
Jennifer M.: One time I had a test, 5 mins later they said I tested positive for Hydrocodone, I take Oxy! I laughed and looked at them like why would I take hydro when I got Oxy! They retested me and low and behold, they were wrong. Always put your foot down or get a new doc.
Amanda L.: I dealt with this in the ER a couple weeks ago where I was accused of not taking my meds because my opiate level was negative. They ran a 9-panel and not a 12, otherwise, they would have seen that my oxycodone level was indeed positive, so frustrating!
The responses bring up such valid points. With every pain case being different and opioid addiction being so prevalent, doctors are having more difficulty navigating the waters regarding pain suffers and addicts.
In this three-part series, we will explore the following real-life examples that include:
- Metabolic rates: Different people have different metabolic rates, therefore process meds at different speeds. If you have a relatively low dose and a high metabolic rate, you may have 'used up' and passed them before testing
- Negative stigma. Pain patients are constantly being accused of doctor shopping or drug dealing.
- Lab error. Urine drug tests can give out false positives
- Incomplete. The lab ran improper or not full panel test.
Steve T. nailed it when he said, “different people have different metabolic rates, therefore, process meds at different speeds.” We all have different body types and because of that, a 250-pound man may metabolize the same painkillers differently than a 125-pound female — although it's not weight that decides this all, it's your actual insides.
Jennifer Le, PharmD, MAS, BCPS-ID, a professor at the University of California San Diego explained, “The liver is the principal site of drug metabolism. Drug metabolism rates vary among patients. Some patients metabolize a drug so rapidly that therapeutically effective blood and tissue concentrations are not reached; in others, metabolism may be so slow that usual doses have toxic effects.”
Let's follow this exchange:
Brittany S.: You could always bring in your pill bottles and show him there is exactly the right amount of pills that should be left, so that should have some sort of standing. Then he knows if you have them, you're not selling them and if there is exactly the right amount left then you're taking them as prescribed. Just bring them in and tell them you want them to do a pill count on all your meds.
Lisa M.: He prescribes 28 days at a time and your monthly appointment is always on the 28th day —so there's never any left.
Brittany S.: You should have what he prescribed this month though. You can also ask them to test how you absorb things because I had to go on a pain patch AND pills because I don't absorb all of the pills so I don't get the full effect and they don't stay in my bloodstream as long as they should. Many ways to prove him wrong. Another way is to ask for a blood or hair follicle drug test and a blood drug test is more accurate than urine and a hair follicle test goes back for 90 days and it will tell them exactly each day what was in your system based on your hair follicles. They can see if you didn't take meds or you did and for how long and all that.
Lisa M.: That would be WONDERFUL! I have been wondering about how my metabolism affects my meds. Plus I'm a "big" girl, so I've often wondered if I might need more meds than the average bear. I already know he wouldn't take that into consideration (reason: possibly upping my doses) because he's already told me he won't increase my meds, I guess ever. I've been on these same meds so long and don't really feel any effect from them. And anytime I tell him my meds aren't really helping my pain much, he just says, "Well maybe we should just discontinue them then." This guy is a real jerk.
Brittany S.: Yeah, being bigger shouldn't affect it too much, I'm also overweight and mine is solely because of my absorption issues, not my metabolism though. Some people just don't absorb the whole amount of the pill into their blood so it doesn't give you enough and it is out of your bloodstream quicker. The patch has been amazing because it's constantly sending meds into me and I don't have to worry about absorbing anything because it all goes right into my blood system.
Caption: Weight actually does not play a factor in metabolic absorption rates of pills. So even if you're physically fit or indulged in one too many office cookies, that's completely irrelevant.
So since it's your "1st strike" is he still going write your scripts or is he done writing them? They usually give you another chance and if that's the case, tell them to call you in randomly once during the month for a drug screen and pill count and they can verify it for themselves. Sucks it has to be that way but unfortunately a lot of doctors are put under a lot of pressure to make sure that all the patients are taking the pain meds as prescribed and for good reason so it is only logical that if it's coming up not in your drug test for him to think that you're not taking it but the blood and hair follicle drug test are pretty much spot on accurate especially the hair follicle test because it goes back 90 days and they can tell exactly if you took more than one day than you had another or hadn't taken them for a while and then just took them before the doctor appointment which some people have done so then the meds are technically in their system for it they have a drug test or whatever.
So I would just call them back tomorrow and tell them you want the more invasive, and more accurate drug testing done and if he is really wondering if you're taking them or not, he shouldn't have a problem doing them. Also him saying that they can just discontinue the meds if they're not working, that's kind of a common thing because the doctors don't want to write scripts and Rx pills if they don't work, but he should also find something that does but a lot of Drs will just consider taking the meds off if they're not working anymore.. It's a really shitty situation but you should be able to rectify it by any of the above tests
Another warrior added her two cents.
Norma L.: You can have a lot of fat in your blood which can affect the outcome of the drug screen. The food you eat to what you drink can affect the outcome as well. I learned that a long time ago. Or, if they do a urinalysis you can ask to see the results then and there. I do. Because there's a scale on the outside of the urine cup. Eating fresh fruits and veggies and drinking at least 35 ounces of water a day should keep you regulated. Ask the receptionist for a copy of your medical records or if they have a patient portal you can get your results there. I would do everything I could to prove him wrong. Good luck!
Dr. Howard S. Smith, department head of anesthesiology at the Albany Medical College in Albany, New York, said this regarding patient metabolism of opioids:
“Patient characteristics and structural differences between opioids contribute to differences in opioid metabolism and thereby to the variability of the efficacy, safety, and tolerability of specific opioids in individual patients and diverse patient populations. To optimize treatment for individual patients, clinicians must understand the variability in the ways different opioids are metabolized and be able to recognize the patient characteristics likely to influence opioid metabolism.”
His point: Doctors need to understand how people react to drugs in different ways. This brings us to another important aspect — losing your script for opioids.
And, it's not the medical communities fault per se, but something needs to be done. We can say that for sure. What we can do is bring to the table certain things you can do to stand your ground —to put your foot down. If you have the knowledge, you have the power.
Stay tuned for part two.