I don't know about in Canada, but in the US most treatment centers will do assessments for free. Generally they take a detailed history and based on the factors they assess, determine what - if any - level of care would be appropriate going from 'early intervention' (generally brief classes for people who are using drugs and at risk for addiction but their use isn't causing problems that warrant traditional treatment), outpatient, intensive-outpatient (sometimes combined with Partial Hospitalization) and inpatient treatment.
This link is a lot of information (and is from the
American Society of Addiction Medicine but I guarantee that if they don't use the exact same system, it's nearly identical) and will give you an idea of what they are assessing for and what criteria they use to place patients in the various levels.
I have no idea if you are strictly using your opioids therapeutically; oftentimes pain patients (especially with a history of substance abuse) rationalize their use truly believing it's completely to treat pain (even when exceeding their prescribed doses, supplementing their scripts from outside sources or using other routes of administration). Even if you are strictly using your medicine appropriately, almost everyone with chronic pain experiences psychological distress that near-inevitably will exacerbate the physical symptoms and most benefit from counseling to help deal with the psychological issues that derive-from or preceded the physical problems.
It's also essential that chronic pain is treated from every angle it can be because no singe treatment modality is THAT effective alone so the best (and what should be the ONLY) method to treat chronic pain is to attack it from every angle. Opioids are far more effective in treating pain when medications that attack it from other angles are introduced such as anticonvulsants for nerve pain, NSAIDS for inflammation, muscle relaxants, antidepressants such as SNRI's and tricyclics can address not only some of the resulting mental distress but the physical pain, local anesthetic patches and others.
Aside from medication, pain should be treated non-pharmacology with a variety of treatments (oftentimes dependent on the specific condition) such as transcutaneous electrical nerve stimulation (TENS), steroid injections, nerve blocks, radiofrequency ablation, acupuncture, massage/physical therapy, neuro- or biofeedback, counseling, guided meditation/relaxation and many other options. The best outcomes are seen when pain patients try as many treatments as they can to find a regimen that maximizes effectiveness and minimizes side effects.
Oftentimes when doctors get patients that are resistant to non-opioid approaches, they tend to view them much more suspiciously. Drug-seekers often give excuses for why all other medications aren't suitable and push to be prescribed opioids. Some legitimate patients are either skeptical that other treatment options would be effective because of how much pain they are in or past experiences leading them to believe that other options won't be sufficient but to doctors it's nearly impossible to distinguish this from drug-seeking behavior so to build trust with your doctor, it's essential that you are open to treatment suggestions beyond just opioids and even better if YOU bring up with the doctor other treatment options to pursue (to supplement, not replace the opioids).
I have chronic pain from nerve damage in my left leg and had very similar experiences with doctors and I have training and education in addiction counseling as well. If you have any question or would like to speak privately about anything, please feel free to send me a message.
