I took a risk by being honest w/ my pain doc...

[bingey]

I'm on methadone but haven't seen a doctor or pharmacist or "care" worker in a month or so.

As far as I'm concerned all Rx short of fent patches are just a pain in the ass.

 

[Quasimoto]

Unfortunately there is a thing with some male doctors where they don't take their female patients seriously, especially when it comes to pain for some reason.

Sadly, I've also experienced the reciprocal of this as a male with female doctors.

One time I asked a female doctor for a hormone test because I thought my testosterone was low. She literally laughed in my face and belittled my concern. That was an awful experience.

Doctors of every variety have their biases and preconceptions ;(

 

[516CAZ]

I've noticed that all pain management clinics are awful post 2016 CDC guidelines/DEA crackdown. I live in a major urban center with a population of 7.5 million and was told by a sympathetic pain specialist that were are only 5 pain specialists left in the area that still prescribed schedule 2 drugs. So if you do the math that's 5 clinics to serve 1.5 million people (20 percent of Americans have chronic pain) - this doctor gave me me their names but of course they are all full. All the pain specialists have switched to schedule 3 bupe and this is where they all want to take their practice as it is not scrutinized by the DEA as much due to higher schedule - but they can't switch YOU to buprenorphine because you are already on a full agonist opioid and the risk of making the switch/precipitated withdrawal is something they don't want to assume. they also know your pain won't be managed after switching from a full agonist to dupe so you wouldn't be a good outcome for them. They just want to replace their schedule 2 patients with new opioid naive patients they hook on buprenorphine. That's the goal, that's the DEA-stress free dream for these pain doctors.

As to a solution to your doctor issues, I've alway found that primary care doctors are FAR more willing to prescribed opioids than pain specialists (post DEA crackdown). The caveat is that the doses will not be as high - but I've heard of some pain specialists giving fucking joke doses anyways so it could be better than what you get. You get 5 pills a day (of what I don't know). If it's 5 10 mg hydrocodone per day, that might be at the upper limit of what I've found primary care doctors willing to do, but its without all the hassles pain clinics put you through.

The demographics for doctors most likely to prescribe are as follows. Whenever I've had to get a new doctor I found one on literally the first attempt that would prescribe using this formula:

1. old as humanly possible. 75+ year old primary care doctor
2. male (may be different since you're female, but I don't know)
3. office in rich neighborhood
4. Not asian/indian

Of course the way you come off also plays a huge role. You have to be extremely knowledgeable about your disease, all of its known treatments both medicine and non-medicine treatments, and be able to basically know more about your disease and its treatments and speak above that doctors own level of understanding of that area of medicine....this isn't as hard as it sounds unless you're dealing with a doctor that is an expert in one specific disease, which a primary care doctor definitely won't be. I made another post in my history recently about leading a doctor to the narcotic script by way of process of elimination of all other shitty drugs and interventional treatments that don't work. Taking the doctor through the story of how you've tried all these things has the double effect of showing you are extremely knowledgable about the disease and have tried all kinds of things and its about just finding relief and not narcotics, but you've eliminated every other option at that point and all the doctor has left in his tool kit is narcotics. you always have to come off as seeking pain relief and functionality by any means available, as soon as the doctor see you're focused on narcotics specifically its over.

2016 seems accurate as to when I also noticed a shift in docs that will prescribe the pain relief I need. None of my PCPs have been willing to, so I've had to subject myself to pain clinics. Thank goodness for that doc you had that was at least honest about which places you could try. Good to know about the bupe situation- thanks! I have definitely been nervous to switch out any of my current providers. It's not perfect, but this has been the best medication regimen I've been on thus far.

Re: your formula- I'm half Asian... so I'm feeling half offended... or I would be if it weren't 100% ACCURATE LOL! Almost all of my current providers meet #2, 3, and 4 criteria. I was just saying in a different reply that, honestly, I've had better treatment from males (not this pain guy, for some reason *pout*). They're more susceptible to my charm? LOL!

This is weird that you're describing my own strategies! I always make sure I come in armed with research from good sources. I bring my "quick points" notebook and prepare myself with priorities and bullet points for the appointment. In my life before chronic illness, my career involved a science-adjacent background, plus medical facilities management/real estate. This has helped me to better deal with doctors and their personalities. Sometimes, there are curve balls though... It often works in my favor that I have multiple lesser known chronic diseases. I can hit them with stuff they likely haven't read about. AND, I have tried all of the treatments (almost) for my particular health issues and track them on a detailed spreadsheet, which I've pulled up to show them a few times.

Thanks for your insight!

 

[LucidSDreamr]

Almost all of my current providers meet #2, 3, and 4 criteria.

#1 is the most important one by far. Extremely old doctors. For two reasons;

1) they have no fear of the DEA because they are going to work till they drop dead and realize they will soon anyways and it’s also a very bad look for the DEA to jail an 80 year old that’s been doing the same thing for 60 years and now it’s suddenly an issue? And losing their license isn’t a big concern either because they are almost done in life and career anyways. A 45 year old doctor losing his license lost his whole career.

2) older doctors were not indoctrinated with anti opioid propaganda

 

[516CAZ]

I honestly wouldn't play it like that. evoke pity instead, cry if you can (being in withdrawal helps with this btw), mention about how your life is falling apart because of the pain. As soon as a doctor with this sort of dynamic gets it in their head that you aren't deferential and scared of them..it's over.

I'm leaning towards showing up on Thursday like I don't know anything is the matter. Liiiiiiiike I didn't pick my appointment date as I would normally schedule a follow-up (every fucking month ); he was the one like, "I'm making you an appointment on Tuesday and you can be there or not blah blah blah bring your pill bottle and be ready for a urine test blah blah blah." LOL... I'm saving my last pill to take either the day before or the day of, so it will show normal levels on a drug screen.

 

[LucidSDreamr]

I'm leaning towards showing up on Thursday like I don't know anything is the matter. Liiiiiiiike I didn't pick my appointment date as I would normally schedule a follow-up (every fucking month ); he was the one like, "I'm making you an appointment on Tuesday and you can be there or not blah blah blah bring your pill bottle and be ready for a urine test blah blah blah." LOL... I'm saving my last pill to take either the day before or the day of, so it will show normal levels on a drug screen.

I would save the last pill for the count because if you have zero pills it won’t be clear if you finished off the bottle that morning or a week ago.

Most doctors don’t know this and it’s documented in the scientific literature - but urine is not a suitable matrix for extrapolating doses and dosing times from, doing so is bad science. Blood is the only matrix for doing this accurately.

If you search google scholar on this topic you’ll find the scientific papers that say so. But proving a doctor like this wrong isn’t going to do you any favors based on what you’ve said here.

 

[516CAZ]

You can still most likely take DXM as long as it's mot recreational doses. They will see the amount in your system and will be able to determine if you were abusing it or not.

I once popped dirty at my outpatient treatment facility for opioids and I hadn't had any in years besides the buprenorphine that they were prescribing to me. The UA Lab tech was like "that's strange. There ARE a few things that could cause a false positive. Certain drugs can trigger a false positive, poppy seeds..)

I cut him off there as I had been eating poppy seed muffins almost every night. So they had me UA again and they sent it to a lab for analysis. The results showed that the level was low enough that it was indeed the muffins.

If your doctor tests for DXM then its almost certainly not just a UA with a test strip. They're likely sending it to a lab so they should see the level of the drug.

Yes, they send it out. I get notifications from the lab they use whenever they have a new report. Idk if the doctors know we can so easily get access? Or, most of them probably think all of their patients are too stupid to bother.

 

[516CAZ]

I'm on methadone but haven't seen a doctor or pharmacist or "care" worker in a month or so.

As far as I'm concerned all Rx short of fent patches are just a pain in the ass.

I wish my body liked fentanyl, but it doesn't.

 

[516CAZ]

I would save the last pill for the count because if you have zero pills it won’t be clear if you finished off the bottle that morning or a week ago.

Most doctors don’t know this and it’s documented in the scientific literature - but urine is not a suitable matrix for extrapolating doses and dosing times from, doing so is bad science. Blood is the only matrix for doing this accurately.

If you search google scholar on this topic you’ll find the scientific papers that say so. But proving a doctor like this wrong isn’t going to do you any favors based on what you’ve said here.

I think I need to take the last pill the morning of because they're going to see it's not in my system if I don't. Whenever he runs a UA, he always asks me if I took it that morning. Plus, Thursday is supposed to be the day I run out... but then that makes me think if I should take it the night prior? Thoughts?

 

[chippermonk]

For what it's worth ( and it doesn't sound like your case), I have an HMO ( Kaiser) and it seems like they are more cautious about prescriptions than my friends with private practice doctors. It seems like it's a corporate policy to be followed by all their prescribers, to be very conservative with prescriptions. Even when I had a script for Ativan a few years back, they were giving me one script for 15 of the 0.5 mg ones that I filled a couple times a year and then they decided that that was too many and cut me off. WTF! How could anyone ever get addicted when taking so few! Or when I broke my ribs and got no pain pills at all. Stupid...

 

[Conky]

Sadly, I've also experienced the reciprocal of this as a male with female doctors.

One time I asked a female doctor for a hormone test because I thought my testosterone was low. She literally laughed in my face and belittled my concern. That was an awful experience.

Doctors of every variety have their biases and preconceptions ;(

What was the reason? Some docs out there think that having a beard = normal test levels.

And FYI in USA you can get private blood work without a doctor being involved. And you get the results via email. Shouldn't cost too much for total test levels and free test levels.

 

[LucidSDreamr]

I think I need to take the last pill the morning of because they're going to see it's not in my system if I don't. Whenever he runs a UA, he always asks me if I took it that morning. Plus, Thursday is supposed to be the day I run out... but then that makes me think if I should take it the night prior? Thoughts?

If you’ve been taking pills every day and you don’t take any on Wednesday and Thursday you should still easily test positive on Thursday. Especially if you dehydrate yourself before (don’t go overboard just don’t over hydrate). If you don’t test positive say that it might be below the cutoff because you had to ration and ask for the raw lcms chromatograms from the lab (for the substances in the next paragraph) and I can show you how to easily prove that your system contains the drugs and metabolites but they were just below cutoff levels. Interpreting these chromatograms will strike terror in your doctors mind having flashbacks from when here barley passed chemistry but he won’t be able to deny it.

You’re on hydrocodone right?

Do you know what the lab cutoffs are for hydrocodone hydromorphone and Norhydrocodone? (Latter two are the Metabolites of hydrocodone)

 

[516CAZ]

For what it's worth ( and it doesn't sound like your case), I have an HMO ( Kaiser) and it seems like they are more cautious about prescriptions than my friends with private practice doctors. It seems like it's a corporate policy to be followed by all their prescribers, to be very conservative with prescriptions. Even when I had a script for Ativan a few years back, they were giving me one script for 15 of the 0.5 mg ones that I filled a couple times a year and then they decided that that was too many and cut me off. WTF! How could anyone ever get addicted when taking so few! Or when I broke my ribs and got no pain pills at all. Stupid...

I'm actually on Medicaid. Isn't that crazy?

That's stupid what happened to you. Sorry *hug*

 

[jasperkent]

The demographics for doctors most likely to prescribe are as follows. Whenever I've had to get a new doctor I found one on literally the first attempt that would prescribe using this formula:

1. old as humanly possible. 75+ year old primary care doctor
2. male (may be different since you're female, but I don't know)
3. office in rich neighborhood
4. Not asian/indian

While these things might be generally true, it's yet another case of YMMV.

My ex-girlfriend's last pain management doc was a 40-something Indian woman whose office was in a very middle-class area.

She was prescribing rather large amounts of methadone for my gf's back pain (old auto crash injury). She also just happened to be a very compassionate woman, which I think is the biggest factor.

 

[516CAZ]

If you’ve been taking pills every day and you don’t take any on Wednesday and Thursday you should still easily test positive on Thursday. Especially if you dehydrate yourself before (don’t go overboard just don’t over hydrate). If you don’t test positive say that it might be below the cutoff because you had to ration and ask for the raw lcms chromatograms from the lab (for the substances in the next paragraph) and I can show you how to easily prove that your system contains the drugs and metabolites but they were just below cutoff levels. Interpreting these chromatograms will strike terror in your doctors mind having flashbacks from when here barley passed chemistry but he won’t be able to deny it.

You’re on hydrocodone right?

Do you know what the lab cutoffs are for hydrocodone hydromorphone and Norhydrocodone? (Latter two are the Metabolites of a

I'm on oxycodone. I took 1 yesterday, so now I have just the 1 left. I know I've seen the cutoffs listed somewhere before. I'll need to pull a few reports.

 

[LucidSDreamr]

I'm on oxycodone. I took 1 yesterday, so now I have just the 1 left. I know I've seen the cutoffs listed somewhere before. I'll need to pull a few reports.

5 mg or 10 mg?

You took one yesterday and been taking multiple ones every day before that?

In any event if you decide to take some the morning of to be totally sure it’s in your piss take it 4 hours or more before your sample collection and maybe just take half so you have a half pill to at least show you’ve been rationing them and didn’t finish them all a week ago (which I know the urine test will show but still)

Also when is your refill due? This is insane if you’re already past the 30 day refill and it’s well known that pharmacies can dick you around for up to a week.

Just like police training includes being tazed I feel like medical students should be hooked onto opioids and benzos then cut off cold turkey and have to go through one withdrawal just to realize what they are doing to people. I honestly don’t think they have any clue most of them what a withdrawl is. People like to describe it as “a bad flu”. It’s so much more debilitating than that.

 

[516CAZ]

5 mg or 10 mg?

You took one yesterday and been taking multiple ones every day before that?

In any event if you decide to take some the morning of to be totally sure it’s in your piss take it 4 hours or more before your sample collection and maybe just take half so you have a half pill to at least show you’ve been rationing them and didn’t finish them all a week ago (which I know the urine test will show but still)

Also when is your refill due? This is insane if you’re already past the 30 day refill and it’s well known that pharmacies can dick you around for up to a week.

Just like police training includes being tazed I feel like medical students should be hooked onto opioids and benzos then cut off cold turkey and have to go through one withdrawal just to realize what they are doing to people. I honestly don’t think they have any clue most of them what a withdrawl is. People like to describe it as “a bad flu”. It’s so much more debilitating than that.

15 mg, 5/day. I had to ration the last week, taking 2 daily, then 1 yesterday, then half today. (I tried very hard not to today, but the withdrawals were getting bad and I had to make it to a different doctor's appointment today. ) My refill is due on the 15th.

I totally agree with you about the training. They really have no idea what we're actually experiencing!

 

[516CAZ]

Do you know what the lab cutoffs are for hydrocodone hydromorphone and Norhydrocodone? (Latter two are the Metabolites of hydrocodone)

All I can find on the reports I have is oxycodone 50 ng.

 

[LucidSDreamr]

iAll I can find on the reports I have is oxycodone 50 ng.

its ng/mL....but 50 is very low, you'll have no problem pissing for oxy if you've been taking 30 mg per day then 15 yesterday then 7.5 mg today.

so in total your script is for 75 mg oxy per day? that's pretty damn good (for these days)....I'd try to make it work with this doctor if you can. finding a script that good elsewhere (especially at a primary) will be hard.

 

[516CAZ]

its ng/mL....but 50 is very low, you'll have no problem pissing for oxy if you've been taking 30 mg per day then 15 yesterday then 7.5 mg today.

so in total your script is for 75 mg oxy per day? that's pretty damn good (for these days)....I'd try to make it work with this doctor if you can. finding a script that good elsewhere (especially at a primary) will be hard.

Yup, 75 mg/day and I'm pretty young. It took me a few years to get him up to that much, but he's seen me go through major spinal fusion of half of my spine, physical therapy, neuropathy, many failed therapies, early onset arthritis, etc.

So, you still think save the last 7.5 mg to bring to the appointment?