Patient abandonment issue in CA - last opiate prescription allowed?

[JT855]

Hi, unfortunately I was dropped as I do not want to go into the reasons why except that I had to take only one more daily due to excruciating pain but was labeled as "self medicating", even when I had honestly told them about it earlier and them not wanting to raise my scrip which ultimately led to me seeing help desperately from outside urgent care due to running out as I had received incorrect information that I was allowed to receive opiate medication (even when I had received clear indication that I was allowed to require outside opiate prescription in an urgent care/emergency situation at the time which was determined incorrect and at the fault of the first receptionist even if they won't admit it) but later found out that was not allowed after I had yelled at them for them giving me the false info and now was labeled as a "drug seeker" unfairly as I would never "doctor shop" and was totally willing to comply with them in order to immediately let them know that I was seeking Urgent Care and that I received opiate medication (once again, I had received an incorrect approval that I didn't know at the time). It's not the complete story as it's missing some details but I don't want to further get into it. I know that the PM doctor has the right to drop me even though I clearly did not abuse my medication but I had to take one more as the pain was too much and plus due to tolerance, even though they're really moving on with their decision based on that I seeked outside help as I was under the impression that I was allowed to as the initial representative over the phone had given me incorrect info. The pain was too much for me to bear for a few days until the PM doc could refill my scrip but later voided once they had told me what I had done was not allowed, which was highly negligent on their part to give me false info as I had confirmed it multiple times if I was allowed to before.

This is in the state of California and on the state medical board website for patient abandonment, the doctor must notify my termination in writing and that he has to give at least 15 days of "emergency treatment". As I am in excruciating pain from both my condition and from withdrawal, is the doctor required to give me one final prescription for opiates to last me for that time as he has the right to terminate the patient-doctor relationship?

I of course am trying now to make an appointment with my PCP as I told his staff of my unfortunate situation. Unfortunately, he's not willing to give me a scrip until he sees me even as I've made an appointment to see him. The issue is that the appointment with him is a month away and he cannot see me earlier as he's booked solid, thus me having to rely on the PM doctor to give me one last scrip enough to last me until my appointment with the PCP. Also, the PCP and the other doctors are booked up for the month. Even though there might be another doctor within the group that's willing to see me and possibly willing to give me a scrip, I am of course worried that once I see my PCP, then he might not be willing to further prescribe me which will certainly be the case if I seek outside help even though the PCP staff says that it would most likely be ok but I am afraid that I would be given false information again.

Of course, I was in a state where I felt I shouldn't have dealt with of unfairly going through withdrawal and not being offered additional medication to last me as that part I felt is immoral and unethical as my pain shot up drastically. These pain contacts are too restrictive as I felt that I was under medicated as my condition is causing me great pain and that the IR opiate medication wore off too fast. Believe me, I tried and had cooperated with them on every other aspect of the pain contract but I had to break that portion as the pain was just too much to bear. I was prescribed 4 tablets of Roxicodone 15mg but had to take one more as I was honest to my PM doc about it as I was in such god awful pain but would not raise my scrip. Also, I was only left with what little the urgent care had given me which was no where near a 15 day supply, let alone a month's worth to last me until my appointment with my PCP. I really tried to be honest and had finally made great effort to reach down to the daily dosage as directed. I wished these doctors would understand that the pain is too great and that I had difficulty lowering because of the pain, tolerance, and withdrawal that it's not so easy to drop down even though I finally did but ironically got dropped after I reached it.

So, back to the main point. the PM did not officially give me yet the notice by letter but that I've received it over the phone from his staff. As I was not given any more to last me to which I find inhumane that I have to suffer as if I was being punished as not only the PM would not give me anymore, but my PCP had threatened to not prescribe me more for the future if I were to seek outside help as I'm trying to see him, clearly this is really messed up against us pain patients; we are clearly suffering as these pain contracts are there to protect the doctors from the DEA. And as I have said earlier, I am not an abuser but had to take one more as I was certainly undermedicated as the pain was just too awful. Does the doctor have to give me one last prescription to last me and if he doesn't, do I have a valid claim of patient abandonment to complain to the CA medical board?

Although claimed by people who don't understand our pain as "opiate withdrawal is not life threatening", we are clearly suffering and I and a lot of other pain patients find this unethical that we have to suffer. I know that regardless of your responses that I can still file a complaint, let alone with the medical groups grievance/complaint department, but not only do I want info from your experiences but also I want to give the PM doctor one last chance to make it right as I respect his wishes to terminate me. The pm doc has not made the official notice as he still has time to prescribe me one final prescription to last me, but if he doesn't, then I am forced to report him as this is just utterly unethical that I have to suffer. It is messed up that people cannot have certain protections to get pain relief if both the PM doc is not willing to prescribe one last prescription to last and that the PCP cannot see me early nor grant a scrip until he can see me, thus people like me in this grueling wait limbo.

[Emme80]

I found this interesting & gave me thought...as right now, I'm being suddenly under medicated while still dealing w/a horrible post-surgical issue. The PM Dr's I was sent to don't have patients on meds., so they gave me a different med., and it's killing me. I could take another pill in hopes to find a possible fraction of relief- but SO afraid to do so, as if I do, I'm not following the directions. I'm too afraid of the "label"...when all it is, is just wanting to "manage" the pain so that I can help my nephew w/ a research paper, take down Christmas decorations vs. being overcome by pain. A shame that being under medicated, not getting pain relief&regents it's not heard or considered, you could be labeled a "self-medicating" drug seeker. I've recently wondered, now I don't drink  alcohol at all, but I know there are many who drink & are alcoholics...drink to "numb"...yet alcohol is not illegal or more controlled b/c of those who have abused it.  It's very dangerous & kills! Yet it's only regulated by age. So why, when there's a medication that can relieve someone of 24/7 pain that literally interrupts life, daily, is THAT so scrutinized and...overly controlled to the point that they make people suffer-because if those that abuse it?
I'm sorry to hear of your situation JT 855... I know I got a lil' off track in thought when reading of your circumstance. It's your situation that makes me dumbfounded w/the extremes that are taken against CP patients. I feel your pain. And you've expressed more than enough w/your Dr. that the pain was not managed...I'm just so let down by this, as you say Tuck, "opioid-phobic climate".
I hope you find ease and relief JR855!!! As well, find a Dr. who decides to not become(out of fear)  a monster to defeat a monster....if that makes sense.

[Tuckamore]

Thank you for your kind words. I've been where so many of you are - and at this point am fighting the same fight! I get it!

I couldn't agree with you more. It's time more of us spoke up and refused to be treated like second class citizens - and unjustly labeled Drug Seekers.

You may find this Journal information helpful. Here's the link:
http://www.medhelp.org/user_journals/show/138942/Addiction-VS-Dependency

Much of the info is from older studies. The entire climate has changed in Pain Management and these facts are often ignored.

I believe that often what PMP or PCP are seeing as Drug Seeking is actually behavior associated with Pseudo-Addiction. They need more education and focus on this condition. Sadly within this new opiate-phobic climate the things learned in the past are being tossed to the wayside.

Pseudo-addiction may occur when CP is not being treated adequately. At those times a CP patient's behavior can border those of an addict. When one is desperate for pain relief we may become clock watchers, waiting for the time we can take that next dose. We may panic at the thought that when our prescription requires it's regular refill the physician is out of town or unavailable. These may appear like drug seeking behaviors when in all actuality they are not. The difference between pseudo-addiction and true addiction is in part that these behaviors stop when pain is effectively treated.  

Be assertive my friend in pain. You should not have to suffer unnecessarily because a medical provider is afraid of treating your pain effectively.

Warn Wishes,
~Tuck

[Tuckamore]

I am so very sorry to hear about your situation. I know it doesn't help - but you are not alone. Many of us, including myself are under treated in the new opiate-phobic climate. My heart goes out to you.

If you do some reading on this site - and check my journals - you'll find that you are facing not just the state of CA - but the DEA, FDA, and now the CDC. It's a real mess. We have no rights.

Your question, " As I am in excruciating pain from both my condition and from withdrawal, is the doctor required to give me one final prescription for opiates to last me for that time as he has the right to terminate the patient-doctor relationship? "

In most instances where a physician terminates your relationship they don't even provide that one last RX. Apparently your state allows for 15 days - most do not. Chronic Pain Patients (CPP) can be left with nothing - no opiate therapy. PMP hide behind those contracts. They fear governmental regulations much more than than they fear litigation regarding patient abandonment! It's a true sad fact.

Sadly if our PMP has labeled you as a drug seeker you may have great difficultly finding anyone that will RX opiates for you. You - We, are not given an opportunity to defend ourselves. The PMP is judge and jury. You are guilty of whatever label he determines is fitting. There is no recourse. I wish had had better news - sadly those are the facts.

I think you are taking the right course - consult your PCP - and try to consult another PMP.  There is no easy way through your situation. It no longer matters how extreme our pain - or even the cause. We are RXed what the PMP is comfortable prescribing and that's that!  As I said, my heart goes out to you.

As Sara said, injections of Toradol can help to some degree - but it's a short term "fix" to a long term situation. I've asked for it also as it is not an opiate. Toradol (ketorolac) is a nonsteroidal anti-inflammatory drug (NSAID). Ketorolac works by reducing hormones that cause inflammation and pain in the body. Toradol is used short-term (5 days or less) to treat moderate to severe pain.

Urgent Care may indeed help you again if they have done so in the past. I caution you as these facilities also label patients as "Drug Seekers" or "Frequent Fliers" or "Doctor Shoppers".  Chronic Pain has always been misunderstood by some - and it's even worse today.

I hope you can find a solution. Be ready - this will probably take time and your pain will be even less managed. I don't know the reason you have chronic pain - but possible meds like Lyrica and muscle relaxers may reduce the severity of your pain. They help me - but I too am miserable. Sometimes I can barely get off the couch or out of bed.

I hope you'll keep in touch. I'll look forward to hearing from you again soon. We are here to offer you our support and any information that may help. Support and just being able to vent can be beneficial. Feel free to vent!

Best of Luck - and Take Care my Friend in Pain,
~Tuck

[JT855]

Thank you Tuck, I can always count on you to reply as you are wonderful in proving support to many people.

Unfortunately, the pain doc is not budging and I will probably be forced to complain about him as it's wrong for doctors to mislabel people who request for opiate medication with legitimate pain as "drug seekers". And the PCP is not doing me a favor as he told me via his staff that if I did see an outside urgent care, then I would not be receiving a prescription from him at the end of this month. It is absolutely immoral and inhumane that people have to suffer under doctor's orders in order to get a scrip from him.

[JT855]

I mean providing, not "proving"

[saraj63]

I live in Virginia and we have the exact same problem.  If the PM doctors don't want to increase we just have to suffer.  The only outside relief I'm allowed is to get a shot of Toradol for my back pain because it's an anti-inflammatory and not pain medication.

I would go back to same ER, explain the situation and ask their assistance in getting an urgent care visit with another PM, if they won't do it maybe call your PCP and see if he can get you a referral to another PM doctor in an urgent care situation.  These doctors will bump patients for each other if
your PCP will request it.  

Something needs to be fixed in these situations and I've been in this situation myself twice.  Both times I had to go sit at thee PM doctors office when they opened until they could squeeze me in.  There has to be a better way!

I'll say a prayer for you.  I'm hoping by the time you read this you've gotten some help.  It's a shame the real pain patients have to suffer and be belittled because of the drug seekers.
God Bless,
Sara

[JT855]

Thank you Sara, the thing is I'm allergic (like actually allergic of having itchy skin and difficult breathing) to NSAIDs so I cannot do the Toradol. It's messed up that doctors refuse to go up on our dosage and yet they give us flack when we have no choice but to take that additional pill as the pain is too great and tolerance as well. It's like there is no more common sense and compassion left and yet these doctors and PAs are saying it's "inappopriate and incorrect" for rightfully criticizing and calling them out for exacerbating the adversarial nature of the doctor patient relationship and to unfairly stigmatize people who legitimately request for opiate medications as we are in legitimate pain.

[JT855]

Sorry, I meant to say within the third paragraph that the PCP staff would be more willing to approve that I see another doctor within the PCP group, not an outside one. But of course, I'm worred that I might be given false information and thus screwing myself over like I did with PM which was not right on their part as I had asked over and over if what I had done was allowed before me going to urgent care requesting pain medication. Once again, it's clearly unethical that we have to suffer like this even if we ran out (even though I felt that it should be ethical that I'd be given an understanding and an exception as I had to take more in order to relieve the intense pain, not to abuse - isn't that what PM is for?)