Chew on this: in many countries, opiate painkillers simply do not exist. Not even auto accident victims or cancer patients get them. The entitlement many Americans feel toward obtaining these drugs is really astounding, in light of this.
Even in the US, many doctors believe in scripting opiate painkillers only as a last resort, for acute pain that's utterly debilitating, or when guaranteed analgesia is needed to perform a surgical procedure. The US DEA is unequivocal about this: Opiates are to be scripted as little as possible. I don't think ANYONE should show up at ANY doctor's office, no matter their presenting complaint, EXPECTING to be scripted them; they're the only treatment indicated for pretty much no diagnoses.
Many doctors believe in being parsimonious with the scheduled substances because their career is on the line. They don't want to be a target for doctor shoppers. Nor do they want to be investigated by the DEA, or brought before the Board. Enabling an addiction, also, clearly violates the Hippocratic Oath.
Let's go over the examples you gave me. I am to show you that opiate painkillers are clearly implicated in few, if any, of them:
1.) Last summer I pulled a muscle in my back playing baseball. Walking was difficult, but I made it to the University clinic. I told him I was taking Aleve but it hurt my stomach and wasn't working. He felt around, and told me to continue taking Aleve. <--- Like he didn't even hear me.
Opiates are almost never used for muscle strains. Anti-inflammatories like ibuprofen are first line, and easier on the stomach than naproxen (Alleve). Rest, ice, compression, and elevation (RICE) are the standard treatment. You should have no pain if you're following this regimen, and aren't flexing the muscle. I see no need for opiates since you're not in constant severe pain from this injury.
2.) Last month I go in with a painful dry, non-productive cough. I tell the Dr. I'm taking Robatussin but it doesn't agree with me and fails to suppress the cough. The Dr. tells me to get rest and plenty of fluids. The obvious prescription would be for codeine or hydrocodone syrup. Doctor fails yet again.
This may come as a surprise to many, but no purported antitussive has showed any efficacy over placebo. I'm actually surprised DXM is even still available and sold as an anti-cough medication. All codeine does is depress breathing and decrease diaphragm contractility. For a nonproductive cough, that keeps you up at night, try an anti-itch medication like diphenhydramine, which will also knock you out. I really hope the doctor looked into the underlying cause of that cough, because that's not something to ignore.
3.) Finally, this week I find a family Dr. and tell her I'm experiencing tooth pain from an exposed nerve. I tell her I have a dentist appointment next month. She actually says, "Well next month is just around the corner" and ignores my pain.
This is the one case you mentioned where I think opiate painkillers might have been appropriate. All you needed was short term relief, for a highly debilitating pain that was going to be taken care of soon. My question is, why did you not contact your dentist about this? I'm betting your general practice doc shied away from scripting you a strong painkiller here, because he wasn't at all familiar with your case and your dental history. I don't know enough about dentistry to say any more about this, though.
In fact, I've never gotten a percocet prescription, even when I got my wisdom teeth pulled, got stiches in my nose from being in a fight, and stabbed myself (deep) in a kitchen accident and got stitches without any freezing.
Opiates are more standard for dental surgery, but still not guaranteed. When I had my wisdom teeth out, I was given a nerve block / local anesthetic, and 2 scripts: one for high dose Ibuprofen, one for codeine. I only took one codeine pill, and it was all I needed. I probably could've done without it. (I was a kid at the time.)
In terms of wounds, I've never heard of opiates being scripted. Irrigating the wound with a local anesthetic or a nerve block, such as lidocaine, is all that's needed to put in sutures.
I've NEVER been prescribed pain medication stronger than T3's no matter what my complaint is. Do you see this as being part of our culture? I mean, I almost feel guilty describing pain to a doctor because they either play it off, or become uncomfortable at the suggestion. It's not like I'm a junkie. These were valid medical concerns. I feel I should stop telling my physicians when I'm in pain.
On the contrary, if you're clearly not an abuser, and never have been, you might consider asking the doctor very frankly if he'd write you a script for a narcotic painkiller. Beating around the bush about this looks very suspicious. True, he may say no, in which case you should just drop it. But being upfront about this and asking very neutrally will make it much more likely he'll take you seriously as someone requesting a THERAPY, not a "drug". Don't seem too excited, or too knowledgeable, about opiate painkillers -- this makes you look like a drug seeker too, from a doctor's perspective. It's kind of like asking a girl out: make your intentions clear, and you MAY get rejected; fail to make your intentions clear, you WILL most likely get rejected.
I think it's becoming more trendy (for lack of a better term) for doctors to simply pretend narcotics don't exist. I call these doctors "homeopathic-lite" doctors because they refuse to use drugs to treat certain symptoms of their choosing.
Indeed. Scripting opiates carries a heavy potential liability, that many doctors don't want to be saddled with.
Where do you see narcotics 20 years from now? Are we going to treat cancer patients with tylenol and hugs?
With any luck, by then we'll have painkillers that are as effective analgesics as opiates, but without any mental effects or abuse potential, and we'll be able to phase out this highly controversial class of drugs. Then us doctors will be able to practice without the walls of suspicion and mistrust that opiates build between us and our patients, and between us and the government's regulatory bodies.
