What if Dr Refuses to Continue Prscriptions

Chronic pain is a serious epidemic in the United States. In 2019, more than 20.4% of U.S. adults struggled with chronic pain, and 7.4% of them had pain defined as "high-impact." Chronic pain is one of the top reasons adults seek out medical care and results in diminished quality of life for its sufferers.

Opioid medications have long been prescribed to help people manage their chronic pain and live productive lives. However, the rising tide of the opioid crisis has led to concerns that opioids are over-prescribed. This has led some doctors to stop prescribing pain medication to patients who need it. We break down why.

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Why Does My Doctor Refuse to Prescribe Pain Medication?

If your doctor has abruptly stated their refusal to prescribe pain medication to you, you are not alone in wondering why. There are three main reasons a physician may refuse to prescribe opioids, whether to someone who has never taken them or someone who has been on them for a significant period.

1. Fear of Misuse

Prescription opioid misuse is a significant factor in the development of the nation's opioid crisis. Research shows that approximately 21 to 29% of patients misuse the opioids prescribed for chronic pain. Somewhere between 8 and 12% of all patients prescribed painkillers develop an opioid use disorder, and about 4 to 6% of people who misuse their prescription end up transitioning to heroin.

There is clearly a slippery slope involved in prescribing pain medication, and many doctors want to avoid it altogether.

2. Fear of Legal Implication

The legal landscape surrounding opioid prescription is currently difficult to parse. There have been cases in which doctors are named in medical malpractice suits or even wrongful death suits based on the prescriptions they wrote for their patients.

In many such cases, the doctors truly were prescribing far too much medication, but the outcomes may make legitimate prescriptions seem like too much of a risk for some physicians. Physicians are being told to keep a close eye on what they prescribe and the quantity, but the lack of clear guidelines leads many doctors to become more conservative with pain medication than they need to be. The fear of over-prescribing medication and losing their job and licensure results in much hesitation.

3. Changing Standards for Pain

Doctors who are attempting to scale back their prescribing to avoid any chance of breaking prescription regulations for opioids may change the way they evaluate their patients' pain. Where a doctor may have once prescribed 50 mg of oxycodone for shoulder pain described as a seven out of 10, they may suddenly decide that you should taper down to only 25 mg, or that pain below an eight or nine does not warrant painkillers at all.

Doctors have increasingly been tightening their standards for opioid prescriptions as the addiction crisis worsens and more regulations are introduced at state and federal levels.

Speak directly with your doctor about why they've prescribed you certain medications and why they won't prescribe you others. Some additional reasons why your doctor might not prescribe pain medications include:

Drug-seeking or disruptive behaviors from patients
Personal beliefs and values
Moral obligations to assist in ending the opioid epidemic

Whatever the reason, your doctor should be transparent with you, and you have a right to know why you're taking certain medications over others to help manage your pain.

Current Rules for Opioid Prescriptions

There are currently no nationwide federal laws regarding opioid prescription regulations. The Centers for Disease Control and Prevention (CDC) has released prescribing guidelines for opioids, but they are just that — guidelines. Enforceable laws about opioid prescriptions are down to individual states, and many of the laws enacted are incredibly restrictive.

For instance, New Jersey's law on opioids prohibits authorized prescribers from issuing an initial prescription for more than five days. There are no exceptions to the rule, including for the management of post-operative pain. Additionally, the prescription for acute pain must be for the lowest effective dose. The next prescription can only be written no less than four days after the initial five-day prescription. If the initial dose was not enough to be effective, the person must wait for several days to get an updated prescription.

Laws like these often make doctors afraid to prescribe opioids at all and cause them to write prescriptions that may not be effective against a person's pain level. Refusal to prescribe pain medication leads to unnecessary suffering and can, in some cases, drive patients to seek other illicit forms of opioids to keep withdrawal at bay.

Clarification of Prescribing Guidelines

It's important to know that it is not recommended for your doctor to refuse to prescribe opioids if you have already been taking them for the long term. The Department of Health and Human Services (HHS) has published guidelines recommending a highly deliberate approach to reducing opioid intake for patients who have been undergoing long-term treatment with these medications.

Adm. Brett P. Giroir, MD, assistant secretary of health at the HHS, remarked, "If opioids are going to be reduced in a chronic patient it really needs to be done in a patient-centered, compassionate, guided way."

The Risks of Quitting Opioids Abruptly

If your doctor abruptly discontinues your pain medication, you are in danger of going into opioid withdrawal. The signs and symptoms of opioid withdrawal include:

Anxiety or agitation
Difficulty sleeping
Nausea and vomiting
Abdominal cramps and diarrhea
Sweating and fever
Trembling
Rapid heartbeat
Changes in blood pressure
Confusion
Hallucinations
Seizures

Although these symptoms are not usually life-threatening, experiencing them alongside the resurgence of your chronic pain can be debilitating. The guidelines from the HHS emphasize that focusing too hard on reducing opioid intake in people with chronic pain may produce unintended and unwanted results. A careful stabilization from use of opioid pain medication should be individualized for each patient and usually involves the physician:

Monitoring temperature, blood pressure and pulse.
Taking urine or blood samples to get a clear picture of all substances in your system.
Obtaining information that may help optimize stabilization from other health care providers or family members.
Recommending other types of therapies for pain.
Prescribing medications that help manage common withdrawal symptoms and ease discomfort.

One of the options in the new HHS guidelines is for stabilization to be achieved through the use of buprenorphine. Buprenorphine was originally introduced for use in medication-assisted treatment (MAT) for opioid addiction. The HHS now recommends it for people struggling to address addiction to prescription painkillers — even if they do not meet the criteria for opioid use disorder. The buprenorphine prevents withdrawal and helps minimize the cravings for opioids that come with dependence on the drugs.

Alternatives for Pain Management

If you're managing chronic pain and your doctor has refused to prescribe pain medication for any reason, there are alternatives you can use to get relief. Your other options include:

Seeking out a pain management specialist: Many primary care physicians want to help you control your pain, even if they can't prescribe certain pain medications. Physicians are referring patients to pain management specialists who have an in-depth knowledge of the new guidelines. It's important to note that many of these specialists have long wait times and are not always comfortable taking on patients with certain medication types and doses. Speak with your doctor to determine if this is a suitable option for you.
Joining a support group or online community: Support groups are valuable tools that allow you to speak openly about your chronic pain and seek out insight from others who understand what you're going through. You can learn helpful information on what alternative treatments have worked for others and share your own tips with members of the chronic pain community.
Trying out a drug-free method for pain relief: For some people, there are drug-free alternatives that can help you manage your pain, such as exercise, yoga, mindfulness meditation and a nutritious diet. These methods work better at controlling chronic pain for some individuals than others, but they are a helpful asset.
Staying aware of your patient rights: Your physician is allowed to deny you a prescription for pain medication, but you also have the right to learn about your other treatment options and choose the option best suited to your needs. Speak with your doctor about a referral to a pain management specialist or ask what other alternatives are available.

Talk to HCRC About Your Pain Management Needs

Chronic pain is something every physician should take seriously. At Health Care Resource Centers, your experiences matter, and our compassionate care team can help you find the right balance of pain medication that allows you to live your life in as much comfort as possible. HCRC is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) as a trusted source to bring you quality care and resources for opioid-addiction related information. Our programs are also certified on a state and federal level.

If you are seeking to address opioid addiction or switch to pain management with a buprenorphine treatment program, HCRC is ready to help. We offer medication-assisted treatment for opioid addiction at multiple locations across Maine, Connecticut, New Hampshire and Massachusetts. Call (866) 758-7769 for more information on our programs, or fill out our contact form online to learn about the next steps.

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