How Can Docs Legally Refuse to Script You Meds

D

daddysgone

Bluelighter
Joined
Oct 22, 2007
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I know this is just an idealogical question, and that we arent going to shake up the position and change the status quo, but ive been thinking of something lately that truly bothers me on a number of levels, but primarily due to my perception that it represents a profound infringement on my rights as spelled out in the Declaration of Independence. Im sure many people here find themselves in the same situation, but I will speak specifically about my experiences, since I am best acquainted with those details.

I am not a chronic pain patient. In fact I rarely have any physical pain. Nor would i say that i truly "abuse drugs". I take opiates. I take them in small doses, I dont continually chase some elusive high, and moreover, I have kept my dosage constant for over 3 years. I am one of the many many people that just feels "normal", "at my best", and just flat out human when i have some opiates in my system. Again, I must stress that I dont take large doses that leave me nodding out and useless. In fact, at the doses I take, I feel energetic, social, and like a happy, functional human. I am UNABLE to attain these basic human states when Im not taking opiates. Im sure MANY people here have similar stories- I simply dont feel "right" when not on opiates, and I feel like my true self while on low doses of opiates.

So, after much thought I decided to discuss this with my primary care physician. I was completely honest, and explained everything in detail. I explained the the dozen or so medications she has prescribed to me in the past for my various problems have been like a placebo in comparison to what opiates provide for me. So , I put it very simply to her. I said, "A major component of medicine is finding a medication which treats the symptoms of a patient and improves their lives-is that not correct? She agreed and so i then told her, "OK, so Im telling you that after years of searching for medications which might help me, I have found one that improves the quality of my life 100 fold. So, by what logic can you decide to scrap the one class of medications that actually provides my life with normalcy and happiness?"
She paused for a minute and then conceded that everything I said made perfect sense. And then apologetically told me that there is just no way that she could prescribe me opiates unless it were for physical pain issues. She seemed genuinely torn but ultimately said her hands were tied and she could lose her license for prescribing opiates off lable like that. I completely understand her position, and did not expect her to answer differently.

However, this whole situation sparked some thoughts I had regarding my rights as a US citizen. Are we not all promised the right of life, liberty, and pursuit of happiness. Now I understand that this right doesnt allow us to go off and do whatever we like (rape, theft) in the name of our pursuit of happiness. But my, and others medical condition is a far cry from this. The whole concept just seems to intrusive and over-stepping. I have found a medical solution...the one medical solution which has, for whatever reason, returned a sense of normalcy and comfort to my life for these past few years. The idea that the government can step in and disrupt my "pursuit of happiness" merely because the medication which is of use to me, is not approved for my particular condition....that just seems to go against everything our country stood for.

So, aside from my venting here, Im curious if anyone here can explain how the governments wish to intercede regarding what medications I can take, takes precedence over my attempt at the "pursuit of happiness"?? ANYONE?-DG
 
well offlabel uses are generally iffy for doctors at best. Offlabel prescriptions for controlled substances are almost unheard of unless there is a strong precedent.

She could lose her license or get sued/arrested if she gave you opiates for some vague complaints of malaise.
 
No, you are not promised life, libery and the pursuit of happiness. That phrase is contained in the Declaration of Independence. The DoC is not the law of the land. It was a proclamation declaring that the colonies of the new world rejected Colonial rule under the British. The law of the land is the United States Constitution. I suggest you read it and learn what your rights really are.

daddysgone said:
Are we not all promised the right of life, liberty, and pursuit of happiness.
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wow, had you at least maintained the facade that you were in pain then there would be no problems. Doctors are not there to supply an opiate dependent patient with whatever they want. You didnt have a VIABLE medical condition to go to the dr in the first place, apparently. The gov really has nothing to do with this. Medication insinuates that there is something to medicate.
 
DrGonzo899 said:
wow, had you at least maintained the facade that you were in pain then there would be no problems. Doctors are not there to supply an opiate dependent patient with whatever they want. You didnt have a VIABLE medical condition to go to the dr in the first place, apparently. The gov really has nothing to do with this. Medication insinuates that there is something to medicate.
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I understand what you are trying to say here, however, my objection is the following: Who has the right to dictate what consitutes a VIABLE medical condition in relation to a specific medication? Patients who experience physical pain are deemed eligible to receive opioid scripts. Ok, that is straight forward and makes perfect logical sense. But in cases where things are not as clear cut, do you truly feel that one individual (the doctor), should have the power to deny another individual (the patient), a medication which the patient feels either alleviates certain symptoms, or simply improves the quality of his or her life? I understand that medications are approved for specific conditions, and that prescribing them (especially controlled substances) in situations other then those approved, presents legal and other dangers for the physician. I am not arguing that things are not this way. What I am opening up for discussion, is if things SHOULD be this way.
Although in this day and age, we accept it is a given that one individual (a doctor), dictates what another individual (a patient), can and cannot ingest for any given medical condition, for the majority of human history, this was not at all the case. Up until the last 80 or so years, an individual had the right to treat himself with whatever he saw fit, without exception. Your great grandfather would have found the idea that he had to procure legal permission from a doctor in order to purchase medicine, as non-sensical as having to receive permission to buy food.
It just seems to me that in a free country, what right could be more basic then the right to your own body. How can one argue that he truly has freedom as an individual, when he is not even granted the right regarding what he can put in his own body?
I also understand the REASONS why the government has decided to control the sale and use of medicine. If we were all free to walk into a pharmacy and purchase anything we wished, I have no doubt that our society would experience higher addiction rates and other problems associated with certain medications (incidentally Im equally sure we would see a DECLINE in certain negative aspects associated with illegal drug use)-however I really feel this is beside the point. In a truly free society, freedom isnt taken away simply because it carries with it certain unwanted consequences. In a free society, these consequences are accepted as the price that accompanies freedom.

For instance, could anyone argue that our country would be better off if the government limited the number of children that those living below the poverty level could have? A family living in poverty doesnt have the resources to raise one child, let alone five. The children of these households become a financial burden to the state and statistically are far more likely to engage in criminal activity. Despite these negatives, the government and society accept that the right to bear children is a basic human right and cannot be controlled or punished by the state.

Why then is this right to one's body, not extended to the realm of medicine? If an individual wishes to treat themselves with a medication, controlled or otherwise, why do we find it acceptable for someone else to tell them they cannot do so? It seems so simple and basic to me, I just find it surprising that so many others are essentially arguing that they don't feel they should be granted rights over their own body.
 
daddysgone said:
I understand what you are trying to say here, however, my objection is the following: Who has the right to dictate what consitutes a VIABLE medical condition in relation to a specific medication?
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A trained medical professional has this right.

There is no fundamental right to select the medication of your choice, so I am not sure what you mean by "legally."

As for the last analogy: bearing children is an intrinsic biological process. Obtaining manufactured pharmaceuticals drugs is not, so I don't think the two are comparable when it comes to the government's right to regulate.
 
Typically, we don't encourage "legal philosophy" types of discussions in this forum, however there have been quality responses here so I see no reason to close it.

The OP's argument is an old one: does government have the inalienable right to dictate how a person can treat their health issues? Your argument goes beyond even that of scheduled drugs and into the areas of pharmaceutical herbs and "unproven" homeopathic protocols. In these realms, we have entities like the DEA and FDA, who as we all know often don't have the interests of patients in mind at all when legislating regulations (think pharmaceutical company lobbying here).

I guess as a society we must weigh the harm caused by deregulation of health care practitioners (one component being doctors and their DEA licenses which can be revoked after administrative review), and that of patients who may have limited access to protocols that work for them but may be so heavily regulated as to limit their access to them.
 
I appreciate all the thoughtful replies. I also understand that what I've been discussing here is nothing new and Im not blowing anyone's mind with new insight. I suppose that my impetus for wishing to discuss this subject here is that for whatever reason, Ive been thinking about the idea of personal freedom quite a bit lately. And while I respect the opposing ideas and opinions of those who posted in this thread, I just seem unable to get around the idea that when talking about personal freedom, how could there be anything more fundamental then the freedom over one's body. And when considering freedom over one's body, the freedom to choose what to put into your body must certainly be included in this freedom.
It just seems so contrary to me that in a country who defines itself with the word "freedom", perhaps the most basic and personal freedom of all (control over ones body), is not a right granted to us.
Our insistence regarding personal rights extends so far in this country that I have the ability and legal right to go out and purchase a small arsenal of firearms. It seems absolutely comical to me that I could more easily obtain a legal handgun, then I could a bottle of morphine.
 
I understand your frustration but in a different way. I have Fibromyalgia and 2 buldged discs and degenerative arthrits in my lower back. All before I even turned 30. Opiods are basically taboo at the dr's office. Even at pain management. My rhemo dr wants to start weaning me off of my pain meds and it frustrates me to no end. Her reasoning is that she doesn't want me getting hooked on narcotics at the age of 30. Which I understand. BUT, my pain medication is the only thing that helps me function, takes my back pain away, allows me to be a mother, a pto member and have the hope of being employed again. She thinks that my medical issues mentioned above are not enough to have to be on pain medication. I've been in physical therapy since the begining of the year, go to biofeedback dr and do my physical therapy every day at home. I am in no way, not trying to help myself get better. So the frustration here is that I have the physical pain and still am having a battle to stay on medication so I can be a functional person. How can she ethically refuse to put me on pain medication when it so clearly helps with the pain? I think that instead of visualizing everyone as potential addicts they should look at each patient individually. Aren't they the ones that explain that everyone is different and everyone responds to medications, treatments differentally? Well then stop looking at me as a potential junkie and look at the pain I am in instead and treat it.
 
^ Maybe you can fire the old doctor and find someone willing to treat you in a more empathetic fashion. Good luck.
 
To answer your original question daddysgone, the doctor is legally allowed to prescribe you anything that he/she deems medically necessarily for your treatment and care. The FDA does not have the power to regulate off-label prescribing.

The thing is, the doctor may be worried about a possible investigation about malpractice. I think however, that this doctor is staying completely within bounds, and only prescribing one (you) patient a narcotic for off-label use, it will be completely fine, without any consequences. I think the only reason that a doctor would get in trouble for this is if it ends up hurting the patient and they sue (unexpected side effect), or if they are basically giving everyone narcotics for whatever ails them.

BTW, there are documented cases of using oxycodone for treatment of depression, even though 5 out of the 6 patients had opiate abuse histories. Those studies alone would probably help build a case based on sound medical reasoning for prescribing you daily narcotics for depression.

So, you may be able to find a doctor willing to do this for you, or maybe you can bring up some of these points with your current GP. Good luck.
 
You have to understand that a doctor assumes a certain degree of profession and legal responsibility for the care that they provide you. They are committed to doing what they believe is in your overall best health interests. Giving you opiates for anything other than pain treatment would create a significant risk of addiction. I would be wary of any doctor that gave me opiates for a simple request that taking them made me feel normal. I don't think I'd want that doctor treating me.
 
OP,

The question for your doctor wouldn't simply be whether your opiates make you feel better. The question is whether this kind of treatment is most effective for you--that is, has the greatest benefits and the lowest risks.

It sounds like you're using opiates to treat some form of anxiety or depression. I don't doubt you feel better while taking opiates, but the question is whether this is the best long-term form of treatment for you.

Given available studies on safer and more effective treatment regimes, and on the dangers of addiction, your doctor made a completely reasonable decision.

Now... if you've been using opiates for so long that you need some form of maintenance treatment, that's another issue, and something to explore with your doctor. Did you tell her that, for the past three years, you've been using opiates to self-medicate? Did the two of you explore how this use might have impacted the success/failure of other medications to treat either the anxiety or depression, or both?

These are all things to explore further with her. Given the facts as you've described them, however, what she did doesn't come close to medical malpractice.
 
AfterGlow said:
You have to understand that a doctor assumes a certain degree of profession and legal responsibility for the care that they provide you. They are committed to doing what they believe is in your overall best health interests. Giving you opiates for anything other than pain treatment would create a significant risk of addiction. I would be wary of any doctor that gave me opiates for a simple request that taking them made me feel normal. I don't think I'd want that doctor treating me.
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Couldn't have possibly said it better myself. Opiates are addictive and that's why they make you feel normal. Unless you have a legitimate reason to take them other than to feel like a normal person, I think the doctor was completely in the right for refusing to give you drugs. That's what a dealer is for.
 
wanktard said:
I understand your frustration but in a different way. I have Fibromyalgia and 2 buldged discs and degenerative arthrits in my lower back. All before I even turned 30. Opiods are basically taboo at the dr's office. Even at pain management. My rhemo dr wants to start weaning me off of my pain meds and it frustrates me to no end. Her reasoning is that she doesn't want me getting hooked on narcotics at the age of 30. Which I understand. BUT, my pain medication is the only thing that helps me function, takes my back pain away, allows me to be a mother, a pto member and have the hope of being employed again. She thinks that my medical issues mentioned above are not enough to have to be on pain medication. I've been in physical therapy since the begining of the year, go to biofeedback dr and do my physical therapy every day at home. I am in no way, not trying to help myself get better. So the frustration here is that I have the physical pain and still am having a battle to stay on medication so I can be a functional person. How can she ethically refuse to put me on pain medication when it so clearly helps with the pain? I think that instead of visualizing everyone as potential addicts they should look at each patient individually. Aren't they the ones that explain that everyone is different and everyone responds to medications, treatments differentally? Well then stop looking at me as a potential junkie and look at the pain I am in instead and treat it.
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In your case, you need to find another doctor ASAP. This is OMHO, but I don't think any doctor has the right to refuse pain medication for his/her patients like you with legitimate lifelong pain. That is just wrong...Maybe look up other pain managment doctors in your area, there are many who are commpassionate, and not a heartless bitch like your doctor..Good luck. I don't know where you live, but if you live in Ca, I may be able to help you find a compassionate doctor because I have family in the medical profession here.. If you live in any other State, go to your Medical Board, and they should have a list on the state website...

LillyF40:)
 
daddysgone said:
I know this is just an idealogical question, and that we arent going to shake up the position and change the status quo, but ive been thinking of something lately that truly bothers me on a number of levels, but primarily due to my perception that it represents a profound infringement on my rights as spelled out in the Declaration of Independence. Im sure many people here find themselves in the same situation, but I will speak specifically about my experiences, since I am best acquainted with those details.

I am not a chronic pain patient. In fact I rarely have any physical pain. Nor would i say that i truly "abuse drugs". I take opiates. I take them in small doses, I dont continually chase some elusive high, and moreover, I have kept my dosage constant for over 3 years. I am one of the many many people that just feels "normal", "at my best", and just flat out human when i have some opiates in my system. Again, I must stress that I dont take large doses that leave me nodding out and useless. In fact, at the doses I take, I feel energetic, social, and like a happy, functional human. I am UNABLE to attain these basic human states when Im not taking opiates. Im sure MANY people here have similar stories- I simply dont feel "right" when not on opiates, and I feel like my true self while on low doses of opiates.

So, after much thought I decided to discuss this with my primary care physician. I was completely honest, and explained everything in detail. I explained the the dozen or so medications she has prescribed to me in the past for my various problems have been like a placebo in comparison to what opiates provide for me. So , I put it very simply to her. I said, "A major component of medicine is finding a medication which treats the symptoms of a patient and improves their lives-is that not correct? She agreed and so i then told her, "OK, so Im telling you that after years of searching for medications which might help me, I have found one that improves the quality of my life 100 fold. So, by what logic can you decide to scrap the one class of medications that actually provides my life with normalcy and happiness?"
She paused for a minute and then conceded that everything I said made perfect sense. And then apologetically told me that there is just no way that she could prescribe me opiates unless it were for physical pain issues. She seemed genuinely torn but ultimately said her hands were tied and she could lose her license for prescribing opiates off lable like that. I completely understand her position, and did not expect her to answer differently.

However, this whole situation sparked some thoughts I had regarding my rights as a US citizen. Are we not all promised the right of life, liberty, and pursuit of happiness. Now I understand that this right doesnt allow us to go off and do whatever we like (rape, theft) in the name of our pursuit of happiness. But my, and others medical condition is a far cry from this. The whole concept just seems to intrusive and over-stepping. I have found a medical solution...the one medical solution which has, for whatever reason, returned a sense of normalcy and comfort to my life for these past few years. The idea that the government can step in and disrupt my "pursuit of happiness" merely because the medication which is of use to me, is not approved for my particular condition....that just seems to go against everything our country stood for.

So, aside from my venting here, Im curious if anyone here can explain how the governments wish to intercede regarding what medications I can take, takes precedence over my attempt at the "pursuit of happiness"?? ANYONE?-DG
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I was right where you are many years ago. I will try to answer you the best way I know how. In the US,, it is against the law for a doctor to prescribe opiates for maintenance unless it is a liecsensed Clinic. I do not agree with this law, but there is nothing we can do about it. Please believe me, I am not judging you because I know where you are at, but if you need opiates to feel normal, you are an opiate addict, you are a functioning addict, and that is not a put down, it means your endorphines are all fucked up and you need opiates to even be a compleate person. I am an addict and I will always need opiates to be normal (whatever the fuck normal is for me) All I know is when I am on methadone maintenance I feel like I did before I ever used drugs, and I guess for me that is normal. The problem I see with you is, I wouldn't want to see you have to be on a methadone clinic unless you think it over very carefully. Methadone is a long term committment that you can't walk away from. It is a powerful long acting narcotic that is used in maintenace because there is little euphoria from it. Hell. I got higher on vicodin...But once you are there, and if and when you decide you want off, it takes a very long time to taper because the withdrawls can last for months. it is called PAWS Post acute withdrawls. For me PAWS never went away. You may want to think about suboxone, but I dont know how long you can stay on it.. If you don't mind me asking what opiates have you used and for how long and how much?? It isn't easy to just walk into a methadone clinic and say you want to get on. You have to prove you are addicted. that would mean a doctors letter stating that fact, then they would put you on a 21 day detox which is bull shit, then you would have to wait a week, go back on the 21 day detox, wait another week, then maybe and it is a big maybe. You could go on maintenance. For 90 days, you would have to attend everyday, give clean urine tests. Meaning only methadone, and any prescriptions you have. After 90 days you will get one take home, then if you do good for another 90 days you will get another take home... It is very hard and you will get pissed off at all of the rules, etc..Does this sound like something you want to do? Please google methadone, read anything and everything about it because it would be one of the biggest decisions you ever make. Like I said, I really would hate to see you on a clinic, but it would be better than the alternatives..If they would stop this insane War On Drugs things would be so different..Before the Harrison act of 1914, most opiate addicts were housewives, judges, lawyers, doctors, dentists, it is only that insane war that made people who use opiates criminals...A methadone clinic depending where you live can cost anywhere from $50.00 a week to $600.00 a month. Medicare pays but most of us don't qualify. I pay $180.00 a month, and it is sometimes hard, but I gotta pay it. Methadone is so inexspensive, but the Clinics charge us for counseling, UA's, yearly checkups.. Here is another website that is really good www.atwatchdog.org
Whatever you do just read anything you can get your hands on, and you will have to let your doctor know what is going on too..If you need to ask me anything about clinics, PM me anytime, ok??

LillyF40:)
 
I know what you're saying. Something that always pissed me off is the disclaimer emergency rooms make you sign sometimes. It's states that they will not do any experimental procedures or experiment on you in any way. But yet if I go to the ER in pain I tell them a certain drug (a opiate) has worked well for me in the past. Many times they have said no we will try this other medication to control your pain. Doesn't that constitute experimenting ? After all I informed them this particular drug has worked well & safely with no side effects yet they choose to experiment by using another medication. The arrogance in the medical profession never ceases to amaze me.
 
I don't see the medical profession as arrogant in this respect. I see them as protecting their licenses, their practices, and their families from regulators' penalties and consumer lawsuits that can arise from their violating the law or going against standard medical practice in order to help a patient. Why should they stick out their necks for a patient who wants drugs? Some doctors make a mint, but many -- especially primary care physicians and internal medicine specialists -- make a pretty poor living compared to the stress level and amount of work involved. They are doing what any of us would do in their situation. Every day ERs and clinics are plagued with drug-seeking patients who clog up their system, cause delays for legitimate patients, cost the hospital and the public a bunch of money, and lie to the doctors. How can they distinguish a drug request that might be legitimate from this onslaught of addicts who are lying to get drugs and treatment they can't pay for and don't need? This isn't a problem caused by the hospitals or the doctors.

The solution is not to complain about doctors, but to try to get the drug laws changed so we have control over our own bodies.
 
prescribing opiates for emotional problems (unless as a low number of prn doses) would be irresponsible in my opinion. long term opiate use is not conducive to happiness in most cases, addiction really fuckin sucks and unless you had tried every form of treatment, including non medicinal ones, i would not give you opiates as a doctor, other than low dose prn as stated above.

however, i do feel drugs should be legal. if pain killers were over the counter no one else would be responsible in any way if you got addicted. if you're doctor prescribed them to you she would be somewhat at fault.
 
Narcotics actually DO have a quite a long history of being used in the medical field for depression. However, perhaps you might think about making an appointment with a psychiatrist. He/she can prescribe medication that can greatly improve and/or maintain the emotional well-being you are experiencing in much the same wasy as narcotics without the side effects and risk of addicition and abuse. Your Psyc. may even keep you on a narcotic until you both are satisfied with a new medication. Just a thought. agood luck to you!
 
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