Doctor Shopping for Pain Relief
Since I cannot get proper pain relief from my pain clinic, is it wrong or illegal to obtain opioid meds from another doctor since my primary doctor refuses to increase my dose as my tolerance grows? All I am doing is providing myself with the proper amount of medication. I had to educate myself, and I am not abusing, just trying to live a somewhat normal life post cardiac surgery, L4, L5 herniated disc, etc!
—M. Johnson, MBA
It is never wrong to request, and expect, sufficient medication to adequately control your pain. It is always wrong to withhold information from any practitioner who prescribes pain medications for you, and this includes information about pain medications you have received from another prescriber. Deceiving a prescriber by failing to disclose this information puts you and the prescriber at risk legally and medically. It is not uncommon for a patient to be prescribed pain medications by multiple practitioners -- for example, a rheumatologist, an internist, and a pain specialist -- all of whom communicate with each other. While it would be preferable for a single practitioner to do all the prescribing, in consultation with the other practitioners, multiple prescribers can work together effectively if they communicate well. Unfortunately, it is also not uncommon for patients to visit 3 or more practitioners who prescribe pain medications and do not communicate with each other because the patient pretends that each practitioner is the only one prescribing pain medications. Patients do this because they fear that none of the practitioners individually will prescribe sufficient medication to provide relief of pain. The patients are not drug-seeking, they are relief-seeking. This is sometimes referred to as "pseudoaddiction." In many states, this is illegal under "doctor shopping" laws that have been enacted to address the growing problem of drug diversion. The best approach, to avoid legal problems, is to talk openly with your prescriber about your undertreated pain and to find a practitioner who will titrate your medication up to the effective dose that does not cause adverse effects. Ultimately, it may be best for you to accept that medication will not completely free you from pain, no matter how many different practitioners you see, and that you will have to use nondrug modalities to augment your pain medication. Finding a single practitioner to coordinate all pain management therapies is the best thing you can do.
Question
Since I cannot get proper pain relief from my pain clinic, is it wrong or illegal to obtain opioid meds from another doctor since my primary doctor refuses to increase my dose as my tolerance grows? All I am doing is providing myself with the proper amount of medication. I had to educate myself, and I am not abusing, just trying to live a somewhat normal life post cardiac surgery, L4, L5 herniated disc, etc!
—M. Johnson, MBA
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Response from David Brushwood, RPh, JD
Professor, University of Florida College of Pharmacy, Gainesville, Florida |
It is never wrong to request, and expect, sufficient medication to adequately control your pain. It is always wrong to withhold information from any practitioner who prescribes pain medications for you, and this includes information about pain medications you have received from another prescriber. Deceiving a prescriber by failing to disclose this information puts you and the prescriber at risk legally and medically. It is not uncommon for a patient to be prescribed pain medications by multiple practitioners -- for example, a rheumatologist, an internist, and a pain specialist -- all of whom communicate with each other. While it would be preferable for a single practitioner to do all the prescribing, in consultation with the other practitioners, multiple prescribers can work together effectively if they communicate well. Unfortunately, it is also not uncommon for patients to visit 3 or more practitioners who prescribe pain medications and do not communicate with each other because the patient pretends that each practitioner is the only one prescribing pain medications. Patients do this because they fear that none of the practitioners individually will prescribe sufficient medication to provide relief of pain. The patients are not drug-seeking, they are relief-seeking. This is sometimes referred to as "pseudoaddiction." In many states, this is illegal under "doctor shopping" laws that have been enacted to address the growing problem of drug diversion. The best approach, to avoid legal problems, is to talk openly with your prescriber about your undertreated pain and to find a practitioner who will titrate your medication up to the effective dose that does not cause adverse effects. Ultimately, it may be best for you to accept that medication will not completely free you from pain, no matter how many different practitioners you see, and that you will have to use nondrug modalities to augment your pain medication. Finding a single practitioner to coordinate all pain management therapies is the best thing you can do.