GP labelling me a drug seeker

[ShamanYou]

I take various medications including some powerful painkillers. I had a telephone conversation recently where I asked for the quantity each month to be increased as I've been running out. I was receiving 25 doses a month and can take up to four times daily.

Doctor agreed to increase it, but I find a note relevant to the consultation saying "drug seeking behaviour". The drug is a strong opioid, stronger than morphine.

What does this label mean for my care. Any GP, / Surgery staff views really appreciated.

In total shock still, very upset and struggling.

You are 'seeking' drugs for a legitimate reason... to deal with pain!

Can you ask to speak to the practice manager? They usually deal with complaints.

I have fibromyalgia and even though I rarely take any medication preferring to put up with the pain, it has been increasingly difficult to get instant prescriptions for pain relief during a bad flare. I have to have appointments just to get anything and can only go into the surgery to collect them, they are not automated to my pharmacy anymore. The Opiod crisis has made doctors more cautious about prescribing heavy pain relief, there have been stories of people suddenly getting their doses reduced, and going to A&E and then being labelled 'drug seekers' I daresay it's on my notes too as I was twice refused any relief at all despite cryibg down the phone and after making an appointment in which I requested a lower dose drug, I could take more regularly was reluctantly given amitripyline and told I need therapy. This despite having not taken anything for 5 months.

I would contact the practice manager with a complaint, but it's not just you. It's happening to many people. I ought to check my own notes.

I work in asurgery only admin so obviously my knowledgeis limited. Sometimes when we open a patient record a patient has a note on their front screen saying medication must not be issued early as overusing ( this is on the front page ) sometimes their is a note on saying dont issue certain meds ( Benzos ect) this is usually written on as a message from a recovery project ( because they are prescribed certain meds from them ). Some patients get daily or weekly scripts this is to limit supply either because they have problems managing meds/ may take more ect. Obviously we dont look in record or see consultations so if it's written in your record I would imagine other GPs would see it. If you arent asking for medications early or saying you have lost them / stolen ect and just order your prescription as needed I imagine they will just regularly monitor and prescribing. You absolutely could ask to speak to the GP regarding this or even ask to speak to the practice manager to discuss in more detail.

Sadly the UK has seen a significant incrrase in pain relief medication known to be extremely addictive resulting in people with very serious addictions. This is becoming almost as bad as drug abuse with increase number of people requiring to go to rehab.

Doctors have to flag when patients are coming to ask for an increase in dose getting, firstly because it could indicate a risk for addiction but also because sadly there is a market for this drug and vulnerable people being pressured to ask for more drugs by someone for them to then go and sell on the street.

It just mean they will monitor your behaviour in terms of the drug for your own benefit.

Could be concerned about addiction which may be to do with needing increased doses? I would talk to them

It doesn't mean that they think you are addicited or doing anything illegal with the tablets but these are medications that are addicitive and have street value so they will make a note of requests like this in case there's a pattern. Most people don't even realise they are addicted at first, especially as they will have been taking the tablets within guidelines. The doctor has a responsibility to monitor the amount they issue and the frequency in case of any potential issues - there has to be a 'common phrase' that they all use to allow continuity and 'drug seeking behaviour' is the one the computer system suggests basically as it covers everything

You shpuld ask them about it if you don't think it is fair.

It seems reasonable to flag it as a concern for monitoring. We do have a significant and increasing issue with addiction to opioid prescription medication.

Mine give me 100s of co-codomol and never seem to say anything (for pain condition) every 3 months. I wondered about that. Never take very much though so maybe that is why they are OK

@UltimateWednesday

It seems reasonable to flag it as a concern for monitoring. We do have a significant and increasing issue with addiction to opioid prescription medication.

I think it would be fairer to say 'dependance' rather than addiction.

I have been where you are OP and one day you will need to decrease the amount you take. This gets more difficult with each dose increase. Rather than resisting other options, try and try again .. for future you.

I wouldn't worry too much. It is necessary for doctors to monitor how often you order and the actual dosage you are taking. They do this for the patients best interest and should be having reviews with you to look at the pain management and whether it needs to be increased or decreased.

Opioids are powerful drugs as you are aware and abuse as well as addiction is rife. Doctors would be doing a disservice if they didn't monitor frequent requests and inappropriate usage.

The issue with people getting addicted to some medications, like opioids, is with the medication, not the patient!!
The problem is well known thanks to the US being at the front of the curve but I imagine this will be true for all countries that have used these medications willy nilly.

Drug seeking behaviour label would make me very unconfortable too @ShamanYou and I would ask for clarification from the GP as well as a review of the medication with your GP.
FWIW, all the studies on opioids say that people don’t get pain relief from taking said medication after a few months (Ie pain levels are the same in the group wo medication and with medication). The problem is that I ce people have started said medication, they are in utter pain when they stop :( It might be that a revKew with the pain clinic is in order to help you with the pain you have (NOT for a so called over use of strong painkillers)

Where did you done this note?

It does seem reasonable to flag it as a potential concern. Maybe they will contact you to review medication and look at ways of supporting you?

I have to say I am sad to see that I ec again the responsibility is passed into a person, like the patient, wo a second thought about what caused the issue in the first place.

Opioids are KNOWN for their addictive/dependency effect. They are KNOWN to cause major issues. Why are GPs and consultants taking responsibility and
1- acknowledge they got it wrong by prescribing them in the first place
2- stop prescribing them
3- automatically offer other types of pain relief and work with patients to get them off them
4- avoid the labelling as a drug addict but recognise the issue with with the medication instead - something that well known and well documented.

Fentanyl? Is stronger than heroin and does not work well in chronic pain infact it is used for cancer patients and end of life care. I work in chronic pain. Over time you build a tolerance and the analgesia becomes less effective and nerves become more sensitive over time.
Watch tame the beast on YouTube
Watch understanding pain in 5 mins
Make an appointment to reduce your analgesia
Google central sensitisation

Opioids are known for being addictive and leading to dependence. The GO has a duty of care to look out for you as do all medical professionals. They need to be aware of a pattern of behaviour that is concerning. Don't think of it as them going against you, think of it as them protecting you. Most people don't realise they have a dependence to these things which is why the GP has to be on the ball.

It's the war on pain patients.

I don't even (yet) need to take strong pain relief for my condition but I live in fear that if I ever need it, I'd be refused.

Countries (esp the US) failing in treating the issue of drug addiction, and trying to blame it on pain patients, of whom the vast, vast majority use them to have a life, work etc, not to escape from life.

I'd complain and take it as far as you can OP.

Also analgesia only works between 10 to 30 percent and only works on the pain. It doesnt help other symptoms. Get referred to the pain clinic and do the pain management course

I work in healthcare so this is my experience of it

The marker can help guide doctors away from unnecessary prescribing. In this day and age where you see a million different doctors it can be useful to have a marker that discourages them to prescribe without consulting with your gp. Often patients see a new gp, attend a+e etc and get put on an increased dose, or different meds without a follow up plan (which increases the likely hood of dependence), so such a marker would help guide doctors away from the behaviour above where people are given a lengthy prescription with no monitoring

There's a bit of a growing acknowledgment in health care that often patients develop dependence, not because of some sort of moral failing but because prescriptions arent well considered or monitored. Its not really that people are some sort of manipulative addcit that requires scorn, or a judgement on your character. My area mostly involves benzo usage and this is a typical case.
Patient goes to gp for acute anxiety, gp in a rush, limited options (eg funding of mental health teams etc) sees its short term eg around a berevement so give some form of benzo, with (hopefully) plan to see patient again. This helps with anxiety, patient feels listened to and gets patient with significant distress out of consulting room fairly quickly. Patient attends a+e later due to increased anxiety, they up the dose. Gp review never happens, patient takes same level of medication for some time. Due to the way it works then they build up a tolerance to this dose, the dose is then upped. At some point someone reviews the dose and says hang on you were prescribed this for a bereavement 2 years ago, with the idea that its a short course but now you are on the maximum dose (oh and did you know you weren't meant to take it every day?) And the medication no longer works for them, and they get massive withdrawals from this when its changed. As a patient this then feels like someone has deemed you an addict but it just what happens with certain medications that biologically your body just begins to rely on them. Patient hasnt done anything "wrong", but full medication reviews are rare.

Pain meds are vulnerable to this, doctors tend to just add to them in a rush without a)removing meds that have served their purpose or no longer work or b) looking at the bigger picture

Have you had a referral to the pain clinic? That can help go through some of the things that might have been missed. Its amazing how many people for example i see that have been given increasing doses of medication, but no one has ever sat with them to describe alternatives and give them a fair shot.

Are you in the uk? I’d assume not as I’m on morphine (oramorph) and only a consultant can prescribe anything stronger I’ve been told. The pain clinic won’t go stronger (fentanyl patches) as I’m too young/they’re for end of life care. They accept I need them but gp simply can’t and consultant won’t.

I’ve moved up over many years from paracetamol to here. I’ve said to several gp’s now that ‘i get I’m going to look like a drug addict by asking but frankly the pain is so bad I don’t care anymore’. They’ve always looked at me, spoken to me and Checked my notes and worked out I’d very much NOT like to take anything!

Where did you find the note, OP? Written on the prescription? In with your tablets?
It sounds like a statement that would go on your clinical record rather than written as a note and given out to you.

I have EDS, fibromyalgia and some arthritic joints and am in constant pain.

At one point I was addicted to opiod pain killers that my GP precribed for me. When I expressed concern to my GP about being addicted to the drugs I was told that I needed them for pain and not to worry about it. This was maybe 15 years ago.

I came off the drugs myself which was really difficult, but the opiods were plunging me into obesity and a sedentary, extremely unhealthy lifestyle that was making things worse for me and making my health worse.

I appreciate how horrendous it is being in pain all the time, however I think that habitual opiod use can make your existing problems worse, it certainly did for me.

The sedentary lifesyle and the numbing effect of the opiods was sending me into a spiral of ill health.

OP, if you can, I would advise you to try to cut down on your pain meds and to, if you possibly can, get gentle exercise, walks in nature and maybe try art, signing or anything that can help lift your mood and generate your body's natural pain relieving chemicals. Cold water swimming is excellent if you have acces to wild swimming - I appreciate that not everyone does.

I also appreciate that the current scary situation re covid may not be the best time to come off or reduce your meds. Please don't feel pressured at all.

I just wanted to let you know that, whie we are of course all different, you may find that your life and health are much improved if you are able to reduce or come off the opiod drugs.

All the best to you

Mine give me 100s of co-codomol and never seem to say anything (for pain condition) every 3 months. I wondered about that. Never take very much though so maybe that is why they are OK
So what are you doing with them.if you don't really take them?

I didn't say i don't really take them, I said I don't take very much (my dose is low)

The OP is talking about an increase in dose