Advice on Requesting Opioid Prescriptions
When my back pain became severe and constant, the opioid crisis was only beginning to make national news. I was prescribed Vicodin at the start, but when my governor signed a bill limiting prescriptions for opioids, I was suddenly cut off. While I cried and begged in doctors offices to get the medication back, I was told to just exercise more.
Eventually I was allowed to have tramadol, which is a synthetic opioid and is not as addictive. Most doctors will use this medication now before even touching drugs like Vicodin or oxycodone. I highly suggest, if you haven’t already, to aim for this drug if it’s an option. The only limiting factor is the pills only go as high as 50mg. At first I was given only one pill. I had to argue with different doctors for gradual increases to get to my current daily dose of two pills in the morning, and 2 in the evening. Most people in severe pain are going to need more than a couple of pills a day.
Still, it wasn’t enough, at least not on days when the pain got really bad. So one day I found myself asking my doctor for a supplemental Vicodin prescription. I felt confident this doctor would say yes. Why? Because I had “doctor shopped”, meaning when I went to one pain clinic, I left after I realized they did not prioritize my treatment and one doctor even implied it was all in my head. Luckily my search for an understanding and sympathetic doctor ended at the next pain clinic I went to. They had already agreed to increase my tramadol and encouraged frequent injections instead of arguing with me that it was unnecessary. Plus he told me flat out my pain was real and they will do their best to manage it. (If you live in the Boston area and want to check it out, just send me a message)
So ultimately, the first step is getting a doctor who wants to help and doesn’t put their ego before your treatment. Otherwise the doctor will be to preoccupied with the legal restrictions placed in them to even consider it.
Next, when you’re asking, make sure to emphasize your preference Not to take these drugs and that you do not like the way they make you feel if you have taken them before. Add your concern for constipation and addiction. I have IBS-C, my use of this medication had to be limited or I will be blocked like a dam. It’s not fun. This shows you take the drug very seriously and are not a “drug seeker”, which you need to do because addiction isn’t the only risk.
Unless your pain is at levels where you can’t function otherwise, do not request a daily dose. (However know that if you need daily doses I support your endeavors and do not judge your need for pain relief) Tramadol or whatever else you use for pain medication should be your base pain medication, if it is possible. Opioids should be for your really bad days, again if it is possible. This is for two reasons. Opioid medications, in my state at least, (check with your own state or country’s laws) are restricted to a week supply. Most pain clinics won’t want to have to give you weekly RXs that you cannot put refills on. My doctor gets around this by writing the RX as a daily multiple dose so I get 40 pills. Those 40 pills are then supposed to last me about 8 weeks. They won’t last if I take them daily, but it works for taking care of my flare ups and bad days. For those who need daily doses of opioids, look to your state or country’s palliative care laws, in many cases they allow for exemptions on opioid restrictions.
The other reason you should avoid daily opioid use, if you can, is not just because of the tolerance build up, constipation, and addiction risk but also opioid induced hyperalgesia. It is a side effect under which your pain actually increases, thus requiring even more opioids. Avoiding daily use helps reduce the risk of inducing this rather unpleasant side effect.
Furthermore, when it comes to requesting these medications, stress how much you want to do more physically and how much the pain holds you back. Exercise can reduce pain for certain conditions, when done right, but for the most part it often increases our pain. Fun activities that require lots of physical effort can be too hard to do in pain or become painful flare ups for days after. Having Vicodin allows me to be more active and recover faster afterword. When I told my doctor how busy I was in June thanks to Vicodin, he was really happy and felt the Vicodin was doing what it was supposed to do.
Lastly, keep a record of your pain so if your doctor wants to know approximately how many bad days you have, you can give him an answer. Plus most doctors like that I record my pain and keep a journal with all my medical stuff. This will go miles into showing your responsibility and help you avoid being labeled a drug seeker.
If you’re unsuccessful, don’t give up. There are doctors out there who get it and do want to help. I know it’s easier said than done, and that in some places it can be really hard to find alternatives, but just know you have power over your healthcare. You shouldn’t have to keep seeing someone who doesn’t truly have your best interests at heart. In a perfect world, those who suffered from chronic or constant pain would not be denied the pain relief we so desperately need.
I hope this helps on your effort to obtain meaningful pain relief, and I encourage others to comment with their own advice.
