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're regularly taking something stronger than Codeine, 25+ a month? Yikes.

The only thing that immediately comes to mind is Fentanyl, and that's like a "pheweee, serious business, end of life" type drug.

Addiction to pain killers is increasingly becoming more and more of a problem in the UK, and your GP wouldn't be doing their job if they didn't at least start to record-keep your request.

The OP has said it's not Fentanyl.

If someone is running out of painkillers maybe its because they no longer work so well and the pain needs investigation. A more appropriate response would be a face to face consultation and a pain team review. Patients do get addicted and dependent to meds but there is help available for that, it doesnt matter what drug if is, paracetamol or strong opiods. Managing the pain so a patient can live a normal life is the priority.

I have to take co-codamol and Diclofenac every night to sleep because of pain. I have 2 unrelated musculoskeletal conditions, one of which requires an operation to fix (rotator cuff) which of course won't happen for ages now, the other one (arthritis, lower back) I'm under the pain clinic for and was scheduled for a nerve block by the pain clinic until Covid hit.

Until recently I was happy with just Diclofenac at night, and occasionally on a very bad day if I was doing a lot physically I would take another. But both conditions have worsened considerably in the last couple of years or so hence the increase in pain meds. They tried me on Amytriptaline, I was days from losing my job when I realised how badly they were affecting me & stopped.

I would LOVE to be off pain meds, but even the ones I take only reduce it. Recently the spinal nerve block procedure has been put on the NICE "don't offer this any more" list, so goodness knows what I'll do. I have to somehow get through the months until they at least fix my shoulder before I reduce the meds.

I was only being prescribed 100 co-codamol every 2 months, and needing to take 2 every night (sleeping I would stiffen up & be woken by the pain otherwise, or find I'd been lying on my bad shoulder in my sleep so pain) needs more than that. When I got a "top up" prescription and collected it, there was a note saying I needed to talk to my GP to get my next routine batch.

Plenty of people are on fentanyl patches without being nesr the end of their life.

Have you had any other treatment for your pain such as physical therapies like acupuncture or CBT?

If you are taking something stronger than morphine, the risks to your long term health are significant and you do sound as if you addicted.

Maybe you need to discuss other ways of dealing with the pain that are not based on drugs?

Have you asked?

Going back to my previous post, you do really need support around managing the condition that is causing pain.

A lot of pain is muscular-skeletal. You might benefit from a TENS machine, massage, physio, acupuncture (on the NHS in some places.)

You might also benefit from mindfulness and similar practices to help you cope.

Or hypnotherapy.

If it's not a joint/ skeletal issue, it must be something else and the question is have you had surgery, is that an option, what's going on that perhaps could be treated?

@ShamanYou Looking at your other thread, it's just possible that the issues you are having with panic attacks and insomnia are being caused by the strong opioids you are using. I'm not medical but strongly advise you look at the two issues you have and perhaps see a connection, unless you had a separate health issue that existed pre-opioid use and required pain relief.

I know you are asking about pain relief, but just wanted to let you know that I see a lot of positive improvement comments by fibromyalgia sufferers in a FB group I'm a member of for intermittent fasting. It really seems to help them enormously, with many coming off meds. Google '16:8 fasting' and Dr Jason Fung Obesity Code, or the new Amazon book Feast Fast Repeat by Gin Stevens for the science behind it (autophagy).

I am not sure this is critical of you, so much as recording that the addictive drug is ceasing to be as affective as it was and causing you to ask for more of it to achieve the same result that you used to gain from less. I could be wrong, it seems to me that you need to understand it in a medical context. You are not being accused of seeking out recreational drugs, but you are dependent on a very addictive drug for your pain relief and indications of dependency probably needs to be recorded.

Have you been offered referral to a pain management service? I know that might not be possible at the moment but in my experience, it helps GPs see the difference between patients with genuine chronic pain and those that are using pain medication for the wrong reasons.

A friend of mine in Australia has fibromyalgia and arthritis in her hips. She's just been refused another scrip for her pain meds, and been given one for paracetamol instead.

I sympathise op as there are some conditions for which only opiates will do.
I had a lot of my bowel removed having had bowel cancer and the only way I can lead a normal life is by taking codeine. Otherwise I have about 20 seconds to find a loo which means basically I can’t leave the house.
I don’t know what I’d do if the GP stopped it.
It also removes anxiety and I no longer dread things but I appreciate doctors won’t prescribe it for that.

@Allergictoironing I hope you get the treatment you need soon. I had the spinal injections for arthritis and it was a bloody miracle. Good luck!

@Karenista

One only needs to look at the opioid crisis in America to realise why we are being more careful. I’m sorry you are having to deal with excessive pain. I really hope it is alleviated soon

You really think the cause of people OD'ing on fentanyl is due to people with chronic pain seeing doctors? The opiate 'crisis' there, people using heroin, is due largely to their extreme capitalism (it's also a huge issue in some Canadian cities like Vancouver) and despicable treatment of those with mental health conditions; wide gaps between rich and poor are known to cause extreme social ills such as pervasive drug abuse.

Why go to a doctor when dealers have it, no questions asked, for far cheaper?

Yes, Eerie, that's been my experience as well. Pain meds = bad, anything else good. You're not supposed to stop taking ADs cold turkey, so why are those often handed out willy nilly?

I was offered diazepam once during an acute episode of PTSD. I'll never take that shit again! It made me feel even worse. I got offered mirtazapine as I had depression combined with extreme insomnia. I couldn't function at all and the GPs threw up their hands, saying it was that or ni because you can't possibly get anything else to treat the insomnia long-term. Okay, nil it is then. I'd also worked very hard to get to a normal weight and BMI and that shit made me put on weight even though I was still eating the usual amount (I was on Jane plan so the calories were counted) and exercising as usual.

I'm glad I don't have chronic pain.

I'm sure things like accupuncture are fab (I've used it in the past, it really works) but a lot of people can't afford to pay for it.

Or for enough CBT to actually work (not just 6 sessions and voila, you are magically cured!).

[quote Wolfiefan]@Allergictoironing I hope you get the treatment you need soon. I had the spinal injections for arthritis and it was a bloody miracle. Good luck![/quote]
I had them a couple of years ago, almost instant relief, but it's slowly worn off. I'd been waiting a couple of months after being told I could have more, but then Covid

I gather the effects can last anywhere from a couple of months to 5 years.

"I hink it would be fairer to say 'dependance' rather than addiction."
What's the difference?

There is a lot to be said about other options besides drugs, but what the note comes down to is the doctor cannot remember every sign that a patient might be developing a problem, and even more so if you see another doctor another time. So they have to make notes veery time they see what could be drug seeking behaviour. If a pattern emerges than they will need to deal with it.

@Allergictoironing I had mine over 5 years ago. The awful burning nerve pain never returned. I will always have to manage my back carefully but the difference is amazing. Hope your next lot lasts longer!!

@Wolfiefan Mine isn't as much burning as deep aches, with sciatica running down both legs into my feet. But most definitely nerve pain!

@Goosefoot

There is a lot to be said about other options besides drugs, but what the note comes down to is the doctor cannot remember every sign that a patient might be developing a problem, and even more so if you see another doctor another time. So they have to make notes veery time they see what could be drug seeking behaviour. If a pattern emerges than they will need to deal with it.

I agree. The trouble is, the other options that are good are often expensive and/or not covered by the NHS .

@NotEverythingIsBlackandWhite

"I hink it would be fairer to say 'dependance' rather than addiction." What's the difference?

One sounds nicer than the other.

@NotEverythingIsBlackandWhite

"I hink it would be fairer to say 'dependance' rather than addiction." What's the difference?

I would say that I'm dependent on my pain killers, as I wouldn't have a decent quality of life without them. However I know that the moment I've had both my shoulder op & the nerve block done, I won't need anywhere as near as much if any at all. It will cause me no problems to stop taking them. Whereas an addict would still need to take the drugs even if the underlying cause they were prescribed for has gone.

So in a case like mine, dependent = reduce the pain, addict = need to continue even when the pain is no longer there

www.medicines.org.uk/emc/medicine/317

Oramorph is a controlled drug. It’s schedule 2

Whatever the drug is, it's clearly not working as well as it did or your condiiton is getting worse. Possibly related to your anxiety etc.

Do seek a referral to a pain management clinic - they have been very helpful to me in the past, including a 6-week (1 afternoon a week) course in self-managment. Since then all they can do is write to the GP to say yes, keep giving her the drugs, but that authority is useful in itself.