So here is the gig with this. They FDA and CDC now are telling doctors to really cut back on their prescription habits.. Keep in mind that many doctors all of a sudden realize they are in trouble with how much they have written and are over reacting in the opposite direction. This is a natural response with folks realize they are doing something wrong to just up and quit. Of course this dumps all of the legitimate patients on their rear ends after having been made dependent and addicted by these doctors with no where to go.
Whats the right thing to do?? YES we have to be careful writing out opioids but we still have to treat patients properly. The board of medicine specifically says the patient has the “right” to pain control. So we have to do this correctly. How do we do this? here are my thoughts and here is how I do it:
- Make sure you have a legitimate patient. Thankfully most of my patients are long term so I know them well.
- Check the PDMP. this is the state log of every pharmacy when they fill any controlled med. Check out your patient to see that they are not doctor shopping. I love to see that my patients are true to me and it really reassures me to know i dont have to be afraid to prescribe to my patients
- ONLY prescribe what is needed. root canal: prescribe 2-3 days of oxy or vicodin NOT 10!!!. broken foot (maybe 5-7 days). you can always refill and write more.
- focus on treating pain in other ways. We so often forget that we can actually treat pain in many many other ways. NSAIDS. gabapentin, lyrica, etc etc. we usually just assume we have to have pain meds for every little ditzel these days. I broke my ankle in 3 places AND my upper fibula in 4 last year. that 7 fractures all from slipping on the ice. I actually maxed out my aleve and iced it like crazy (with those cool ice water machines) and didnt use a SINGLE pain killer !!. wasnt comfortable but when the relief did come it came faster and more satisfying. You DONT always need pain killers. pain is your bodies way of telling you what to do. in my case, put my leg way up, ice it like heck and relax!!.
- Switch up the pain meds. So if we have to use pain meds, use them for 3-5 days and THEN change it up. Trick the brain so it doesn’t get too used to (and dependent) on any particular med. These meds are NOT totally cross tolerant. they are not the same. if you do 3 days fo oxy, then change it up and do 3 days of vicodin, and then maybe 3 days of nucynta. It tricks the brain because it doesnt see the same thing over and over (its the over and over thing that causes dependence.
AND REMEMBER you will NOT FEEL yourself getting dependent. whey I tell patients they may become dependent they immediately get defensive like “oh that would never happen to me”… I am telling you, you wont feel it. all that happens is over a few weeks time when you try to stop you will get such rebound pain that you’ll think you still need the dumb med. THAT PAIN IS FROM THE DEPENDENCE ON THE MED. THAT PAIN IS “MEDICATION PAIN”.. its not even real pain anymore. NO you aren’t addicted (your not scoring it on the streets). Make sure to read my notes on the difference between addiction and dependence. its a hugely important difference.
Andreas J. Edrich MD