ptsd Can My Pcp Abruptly Stop My Pain Management Meds?

[TiredSgt]

I have withdrawn off of percoset before. You can do it yourself by reducing your dosage over a few weeks. The VA pain clinic doctors did tell me that I never should have been on opiates even though I have a SC DX of chronic pain disorder. How many hydrocodones do you take every day? I have a feeling you don't take that many. You are not a drug addict by any means. If you still have the drugs you got from the other VA give them to the doctor when you see him. Did you sign a certified mail receipt for both sets of drugs? The VA should probably have tried you on a long acting type of opiate. The trouble with many of those (morphine, methadone, fentanyl) is that you build tolerance to them as well. They have more side effects also including notorious constipation for morphine. I would tell the doctor that I was confused about where I would be getting my hydro and was afraid I would not get it on time so I took what was mailed to me. The VA gets their underware in a knot because they believe that most vets will sell their drugs for money if they get the chance. If you had taken a drink a day before your last urine screen you would be in trouble as well. I think I would just begin to taper off on my own and go see a regular doctor and explain your problem and see if you can get scripts from him for the vicodin. The VA will be watching you like a hawk in the future. The VA has screwed with me over opiates and getting them on time. It really bugs me as well. I tell them that I take the exact dose so that if it is two days late in getting to me it is a big deal. They sent my opiates to the wrong address one time and blamed me for it.

Yes, I did sign an orange card the postman brought for both packages of meds, so in their eyes, I'm guilty. As far as alcohol, I've not drank a drop in over 10 years, not even a sip of beer or wine - zero. I take 5 or 6 Lortab 10's per day, I'm prescribed 5 a day, but sometimes take an extra here and there, I'm sure everyone is guilty of this at some point.

I called the detox facility today, they can accept me Friday morning (April 1st 2011) at 8:30am, they told me I have to be in "day 2 of withdrawals" and no more Lortab after Tuesday night, I told them about my heart condition and they told me that chronic withdrawals don't start until day 3 or 4 and peak-out at day 7, so don't worry. They're going to prescribe me a drug called Suboxone, starting at 8mg per day and over a course of 2 months wean me off completely, I'll stay approximately 2 weeks "in patient" for counseling, meetings or whatever they do?, then return to my home for weekly follow-ups/meetings. I told them "ok, see ya friday then." The first place that wanted to accept me told me over 3k dollars, which I was prepared to pay, but this place is a bit cheaper, with the same guarantee of freedom from opiates.

When I go see my doctor this coming week, I'm taking every narcotic pill in my house and placing them on his desk. I'm going to tell him that IMO, it's malpractice to prescribe dosages of hydrocodone 10 x 5 a day to ANYONE for 7+ years. I'm going to also remind him about the statement "this medication is not to be prescribed for more than 21 days." The VA has turned me into an accidental opiate dependent person (addict, I hate that word), they knew what they were doing, they also knew it was wrong; although it happens a million plus times a month all across America. I want my old self back, even with the pain, it's got to be better than being harassed, threatned and put through hellish withdrawals, not to mention (like you said) "watched like a hawk" because they think I'm selling my meds or abusing my prescription. I'm too old for that and those games. They can have their pills, and their pain contract - I'm officially done with the VA "doctors". I have Medicare and BC/BS, I shouldn't have problems finding a doctor.

I'm more mad than anything, but I also realized that the VA got me addicted to a powerful opiate, now they think they can just "stop". It doesn't work that way, people can die from withdrawals especially those who have heart conditions or very old. And I have chronic heart conditions (ICD/Pacemaker) valve problems, clogs, you name it!

As a final note, it seems I only turn to Hadit.com when I have problems, you guys helped me get my 100% VA AND 100% SSD a few years ago, then I walked away. I'm gonna start participating more and sharing what I've learned with my 12 year fight with the VA and and my 2 year battle with SSD. I'll start answering the simple questions I've read on here, what I done and how it helped me.

Thanks again guys/gals. If you have any suggestions on how I should deal with my doctor this coming week, I'd sure appreciate the input. I don't want to be harsh with the guy, but on the other hand, I'm NOT going to be accused of dealing/abusing/selling/fraud, etc. I'm gonna tell the truth, (the bottle came in the mail, totally out of the blue, so I took them and put some away for "stash"). The VA made me what I am, either help me get back to normal (no opiates) or show me the door, and I'll never walk back through it. It's obvious my doctor is mad, he wants answers and he's also spoken with my previous doctor from my prior state I used to live in).

I am considering filing a section 1151, coupled with a lawsuit against the V.A. and my previous 4 "doctors" for NEVER giving me a thorough exam (NO MRI, XRay, nothing - just doses of opiates), also, I feel they owe me something for 7 years of pain/suffering, creating an opiate dependent person, then "cutting me off", damaging my neuro-system in my brain with large dosages of pills over the past 7+ years. I'm quite sure my doctors "notes" includes exams which never happened, I have NEVER had a VA X-Ray or MRI for my back (upper or lower) past the year 2004, I just told them it "hurt" on a scale of 1-10, I told them 7 or 8, then it started...a big ole' bottle of pain killers. LOTS of them, over the years, that was their answer to my pain...give him a 'script and get him out of here....next! Whatever wrath I face tuesday with my VA doctor will be re-dealt 1000 fold before the end of 2011.

When I moved FROM Florida to the previous state I lived in for 2 years, my very first VA appointment lasted approximately 5 minutes, he mostly read his computer, asked how my meds were doing, he pecked my knees with a rubber hammer and that was it. Follow up exams (every 6 months for med re-newals) were 3-5 minutes long tops, no exam, no xrays, no nothing...just refilled all my meds and out the door, just like hearding cattle in/out, in/out. They (the VA) have awoken a sleeping giant, I know the games they play, the false notes, the false exams, all I have to do is prove it, which will be quite simple.....show me an xray, mri, or any shred of physical evidence that warranted 7+ years of high dose opiate treatment? Is a lawsuit or 1151 even plausible? IDK? I have to do some calling around monday. In fact back in 09, I wanted to placed on a non-narcotic pill called Tramadol, this is noted in my records also, I was refused and kept on Lortab 10. in 08 I told my psychiastrist I felt I was addicted to hydrocodone, he noted this in my record and also my cardiologist "recommended discontinuance" of opiate treatement - this is also documented in my cardio files in the year 2009. What does the VA do? Give me some more opiates!

I need some advise, the pills aren't the issue anymore, it's what they've done to me, changed my personality, turned me into an accidental addict, changed my natural body chemistry and when I asked to be taken off YEARS ago, I was given MORE. Indeed, Nobody stuffed them down my throat, but to anyone on opiate treatment, you KNOW HOW IT IS...you CRAVE THEM, and after just a few months, your body NEEDS them, and you fear withdrawals. IMO, this is neglegence, malpractice and abuse of patients, not to mention they (opiates) ruin lives, even it taken as prescribed - if you can't flush them, you're an addict. And being an addict is not fun.

thanks for reading my rant. One Very Tired Ex-Sgt

[john999]

Sgt

Make the VA do the right thing and withdraw you! You can get the script for Suboxone yourself. It is a narcotic as well. I took it and it made me itch like hell. I think you are over-reacting to this. I would not hand some private guy 3000 bucks if it is was my own money. It sure as heck does not take two months to get off your dope dose. I got off much more powerful drugs in a week cold turkey. It was not fun and I did learn the meaning of the phrase "kicking the habit". I would take 5.5 pills a day for three days and then 5 pills for three days and so on and you will be clear in about a month. You do not have a horrible habit. You are not taking 25 lortabs a day like an addict. You have chronic pain. Make the VA treat you for it. Give them back the stash and tell them you are thinking about suing them for malpractice. They made a grave error by sending you this double dose of dope. It is on them like when they sent my narcotics to unknown address in Maine by mistake.

[TiredSgt]

Sgt

Make the VA do the right thing and withdraw you! You can get the script for Suboxone yourself. It is a narcotic as well. I took it and it made me itch like hell. I think you are over-reacting to this. I would not hand some private guy 3000 bucks if it is was my own money. It sure as heck does not take two months to get off your dope dose. I got off much more powerful drugs in a week cold turkey. It was not fun and I did learn the meaning of the phrase "kicking the habit". I would take 5.5 pills a day for three days and then 5 pills for three days and so on and you will be clear in about a month. You do not have a horrible habit. You are not taking 25 lortabs a day like an addict. You have chronic pain. Make the VA treat you for it. Give them back the stash and tell them you are thinking about suing them for malpractice. They made a grave error by sending you this double dose of dope. It is on them like when they sent my narcotics to unknown address in Maine by mistake.

Hey, thanks for the reply, maybe I am over-reacting a bit, but honestly, the VA did in fact turn an ordinary guy into a dope addict and that's the bottom line. Long term opiate usage alters the brain and usage over 5 years does permanent damage that can never (at my age) be reversed, opiates totally shut down your receptors and your body forgets how to produce natural opiates, because they're being replaced by synthetic opiates. I don't know much about this area, I just started reading about it, but they're not good. Besides, No xrays, no mri, no ct scans, no "physicals", dude, they just gave me Lortab 10's like it was halloween candy. This is not (IMO) medicine, like I said earlier, the MOST I ever received as far as a "physical" was concerned was a couple taps on my knee with a rubber hammer. He did mention that I'm in Afib and I told him that I'm always in Afib 99% of the time. I've lost all respect for VA doctors in general.

I'll take your advise and take my PCP my stash because I'm going the suboxone route starting on friday (unless my PCP has an alternative plan that is pain-free and withdrawal free) to get me off these chemicals. I've slowed waaaaaaaay down on my Lortab intake since three days ago, I'm down to 3 1/2 per day and I feel just fine (#10's). But when I go lower, my nose runs, my body aches, my eyes water, my skin crawls, I get grumpy with my wife, I ache, itch, can't sleep and my mind races. This pill I'm seeking Friday called Suboxone takes all that away and most importantly, the cravings.

I doubt the VA prescribes Suboxone? That's on my list of phone calls come Monday. The only reason I can't quit cold-turkey like everyone else does, is because of my heart condition - the spikes in BP, racing heart, anxiety could be my death ticket, that's not a chance I'm willing to take.

I think the VA has mis-dosed me, got me addicted, and done irreversable damage to my body on a molecular structure. I've found cases where the VA has overdosed patients and the spouse has sued for wrongful death/malpractice/over medicated, etc, and won - you can do a simple Google search and pull up hundreds of cases. I realize my Lortab addiction is not that strong, but take into account I have a heart of 75 year old man with a "longetivy" of 5-10 years...(per the VA of course). But the fact remains, I'm addicted because of the VA doctors and years and years with not one single shred of physical evidence to support opiate treatment at such high levels.

I'll leave it alone and quit bugging you all - but I will post key and important updates as this saga unfolds, I can't really do anything till Monday and Tuesday after my appt with my VA PCP. I have lots of research to compile, tabulate and organize into a manner appropriate for presentation to my attorney. She got my SSD in record time and doesn't particularily care for the VA's treatment of patients anyway. I'm sure she'll find my case unique, intriguing, attractive and possibly lucrative.

Google Medtronic Sprint Fidelis Lead Settlement - they settled out of court for 263 million dollars last year, I have 3 of their faulty leads implanted......it all started with ONE guy complaining.

[Michellee]

So are you still having pain? I mean your willing to go to detox but what about your pain? Sounds like your saying in addition to everything that you don't need all these pills and the pain pills are more of a problem. Personally, I would love to not to need my pain pills (management) cause most of us know that we will pay later for long term use. But the other side of that is that a certain level of pain can be quite harmful too. It all depends on how much pain your system can handle. I had unmanaged pain in the past that would jack up my blood pressure cause me to throw up, faint and almost commit suicide. My pain was so unbearable between on scale of 1-10 its around 8-10. I have no diagnosed heart disease, nor high blood pressure px. I don't know how your pain tolerance is but obviously when they perscribed your pain meds you must have communicated that you needed them for a high level of pain. So I am curious as to what your going to do for pain management or alternative to pills after your detox or maybe I missed something. I think your jumping the gun and need to take one step at a time. I think its a good idea to go to Patient advocate and maybe even the medical director and explain what happen here. I can understand the automatic renewal and the mail situation but then you then turn it around and start sounding like your blaming someone for treating you with long term pain management (pills and your mad because of it)?? Did you not need it and ask for pain management? You can refuse pain management. I have not heard of the VA forcing anyone to take pain meds. Now if your saying you don't need it anymore and want to do detox that's your right but I wouldn't I bring that issue along in response to what your doctor is doing. Your right being pulled off so abruptly and if you are addicted as you stated can cause serious complications.

[TiredSgt]

So are you still having pain? I mean your willing to go to detox but what about your pain? Sounds like your saying in addition to everything that you don't need all these pills and the pain pills are more of a problem. Personally, I would love to not to need my pain pills (management) cause most of us know that we will pay later for long term use. But the other side of that is that a certain level of pain can be quite harmful too. It all depends on how much pain your system can handle. I had unmanaged pain in the past that would jack up my blood pressure cause me to throw up, faint and almost commit suicide. My pain was so unbearable between on scale of 1-10 its around 8-10. I have no diagnosed heart disease, nor high blood pressure px. I don't know how your pain tolerance is but obviously when they perscribed your pain meds you must have communicated that you needed them for a high level of pain. So I am curious as to what your going to do for pain management or alternative to pills after your detox or maybe I missed something. I think your jumping the gun and need to take one step at a time. I think its a good idea to go to Patient advocate and maybe even the medical director and explain what happen here. I can understand the automatic renewal and the mail situation but then you then turn it around and start sounding like your blaming someone for treating you with long term pain management (pills and your mad because of it)?? Did you not need it and ask for pain management? You can refuse pain management. I have not heard of the VA forcing anyone to take pain meds. Now if your saying you don't need it anymore and want to do detox that's your right but I wouldn't I bring that issue along in response to what your doctor is doing. Your right being pulled off so abruptly and if you are addicted as you stated can cause serious complications.

Nice post and some good points! Yes I do have back pain and cervical spine injury (on the 1-10 scale) my pain hovers around 4-5 on a daily basis, when I over-do it, the pain esclates to a good 6-7 point at which point I take my pain pills and lay down for an hour or so. I have DDD and two herniated discs and a bone-spur in my neck bone that pinches a nerve when I bend my neck at a certain angle, so yes, I do indeed need the pain meds for medical reasons.

What I don't like is the dependency part, and being suddenly cut-off. As for pain management after my Suboxone detox, I don't know? It's NOT going to be opiate based and that's for sure. They do long-term damage: Effects On Brain Chemistry: Opiates have also been shown to cast a long-term negative effect on brain chemistry. Through constant stimulation of key pleasure centers within the brain, and its reward system, opiate users are conditioned to want more and more of the drug. In extreme situations, sudden withdrawal by chronic users in poor health may prove fatal. This phenomenon makes it impossible for users to quit without help, as their never-ending euphoric state leaves them unaware that they are addicted. Such euphoric feelings may last for years.......

The article goes on and on, many pages of the negative side-effects of long-term opiate use, it's way too much to copy/past here, it's an easy Google...the bottom line is this: In the long-run Opiates RUIN lives, not save them. They've even been proven by the AMA to increase pain, not decrease pain. The doctors can label it "Pain Management" or "Management" all they want, but the bottom line is they're deadly, they destroy your brain, do permanent damage, your body gets addicted and your mind becomes psychologically dependent upon opiates and you cannot function "normal" without them and your receptors that produce "natural" opiates die. You become an addict for life. Is this life?

I bet there's members in this forum who've sat down and counted their pills out to the date worrying about running short, waiting on the mailman, counting the days till their 'scripts arrive, postponing engagements or other activities because of pills. It's not your fault, it's the V.A.'s fault, and they should be held accountable just like Medtronic Sprint Fidelis was made to be held accountable to the tune of 263 million (out of court settlement). Cha-Ching for me $$!

There's other management practices available for pain besides pills, how about getting to the root of the pain? Nerve blocking shots, nerve deadening singes, surgeries to alleviate the root of the problem. That's not the VA way, the VA way is prescribe and overdose patients on Pills, I've seen it for decades. The pills aren't my issue anymore. My issue with the VA is over prescribing pain killers in general, they killed my dad with oxycottin and morphine and other deadly cocktails of pills, same with my wife's father, same with my uncle and my step-father (suicide from VA prescribed pills) - all dead because of VA over prescribing pills instead of finding and eliminating the root of the pain. Well, it's not going to happen with me. I have rights and recourse in action.

There is no justification for being an addict, especially an accidental VA induced addict. In 7 years don't you think that someone, somewhere would say "hey, let's take an x-ray, MRI or Cat Scan, let's see what's going on here?" The VA failed in this area. I said my pain is "6 or 7" they said, "ok, here's some more pills." Nice doctoring huh?

Pain is not the same day to day, some days my pain is 3-4, sometimes I aggravate my back or neck and it jumps to 7 or even 8, and on rare occassions I feel little to no pain at all (while on pills of course).

My friend crushed his back digging up a tree stump and messing with a backhoe, his private doctor prescribed oxycottin for 20 days, a couple surgries, a few more pills, put him in physical therapy, gave him a machine that shocks his nerves, a backbrace and more physical therapy, now he's almost back to normal....all without pills! He is pill free to this very day, he deals with his pain, he learned to live with it. He understood that pills cause pain over time, not relieve it. Now, I'm in a boat where pills cause me pain, if I don't take my pills, I hurt, but the pain is escalated due to pills.

I can only speak for the 2 VA hospitals I've visited, yours may be great with great doctors who actually care, but MY experince in MY VA hospitals has not been good, they are simply pill dispenseries, 'script writers with 100's of patients on their case-load per day. I'm just a number, another 'script to stamp.

Now to finally answer your question - yes, I do need "something" to relieve my pain, but NOT opiates, I can't take NSAID or IBprofen, so I don't know what the course of action will be? Long-term damage has already been done to my body - all caused by opiates, opiates prescribed without ONE single shred of physical evidence to substaintiate or support opiate treatment (and getting me addicted). My very fist 'script was given to me very quickly so the doctor could call "Next!" and I was hurried out.

Yes, I am mad, I'm mad at the VA for prescribing pills for 7+ years, I'm mad they suddenly cut me off without warning, I'm mad because I found out what opiates can (and have) done to my body, I'm mad at my doctor for not realizing that a person should be given an x-ray BEFORE prescribing pills, I'm mad at the VA in general for writing scripts to veterans just to get them out of their hair and move on to the next patient, the whole system stinks and they need to be held accountable for their over prescribing habits.

Medtronic Sprint Fidelis Faulty Lead Litigation is the perfect example. Next it's going to be Veterans Administration Faulty Prescription/Opiate Dosing Litigation. It's malpractice (at least in MY 2 V.A. Facilities) and I can prove it.

[GuaymasJim]

TiredSgt

If you go into your appointment spewing this nonsense about the VA "turning an "ordinary guy into a dope addict," you will more than likely get a strong reaction. However, it most certainly won't be the reaction you seem to desire. You have absolutely NO chance of prevailing in a malpractice suit! Every single complaint you have made here is a KNOWN side effect of long term opiate usage.

Like many others on hadit, I have been managing my chronic extreme pain through the use of opiates, non-narcotic medications, diet, lifestyle changes, counseling, and other methods for years. I have been doing it for more 40 years. If you have not been abusing the medications (and I have no reason to believe you have), then you are no more a drug addict that I am; and I am most certainly NOT a drug addict. I find it offensive in the extreme to be labeled a "drug addict" based solely on your obvious lack of knowledge!

There is a huge difference between "dope" and "medication." There is also a huge difference between "addiction" and "tolerance." I suggest you use your internet access to explore those differences. Using these words interchangeably is doing you, me, and tens of thousands of other veterans (and civilians) a horrible disservice! I, for one, resent the hell out of it.

Many of us have fought for decades trying to get AND maintain appropriate and consistent pain management from the VA. Our worst enemies were the entrenched VA bureaucracy and blind ignorance similar to what you have expressed here. In spite of both, chronic pain sufferers won a big battle with the help of the Joint Commission in 2001:

Rapid improvement in pain management: the Veterans Health Administration and the institute for healthcare improvement collaborative. Clin J Pain. 2003 Sep-Oct;19(5):298-305

BACKGROUND: Poor pain management persists in health care. Although common practice errors in pain management have been identified and standards and guidelines for pain management have been published, improvement has been modest. With the goal of rapid improvement in pain management, a joint Collaborative (Veterans Health Administration and Institute for Healthcare Improvement) was conducted from May 2000 to January 2001.

OBJECTIVE: To improve delivery of pain management to VHA patients and to compare team process and patient report data on key goals from selected study units.

METHODS: Charts were reviewed for outcome and process measures. Measures included changes in percentage of patients with (1) moderate to severe pain, (2) documentation of a pain assessment, (3) documentation of a pain care plan, and (4) documentation that the patient received pain education.

RESULTS: Seventy teams from 22 Veteran's Integrated Service Networks throughout the U.S. participated. Moderate or severe pain on study units dropped from 24% to 17%; pain assessment increased from 75% to 85%; pain care plans for patients with at least mild pain increased from 58% to 78%; and number of patients provided with pain educational materials increased from 35% to 62%.

DISCUSSION: Significant progress toward the target goals was reported during the Collaborative period. This improvement needs to be viewed in the context of a VHA system-wide effort to improve pain management. Data suggest that a program of team formation, goal identification, testing and adaptation of recommended system changes, sharing and feedback of process and outcome information can produce significant change in pain management in a major health care organization.

As some point you told your VA doctor that you were experiencing a high level of pain and were prescribed a medication for that pain which happened to be an opiate. The VA was legally obligated to treat your pain. If you are either unwilling or unable to follow the treatment plan, then you have an obligation to speak up. You obviously have a problem with your pain treatment, so it is up to you seek a remedy. Labeling your fellow veterans as drug abusers is NOT the answer. The correct answer can be found below.

Pain Management: Drug Tolerance and Addiction

Some medications used to treat pain can be addictive. Addiction is different from physical dependence or tolerance, however. In cases of physical dependence, withdrawal symptoms occur when a substance suddenly is stopped. Tolerance occurs when the initial dose of a substance loses its effectiveness over time. Addiction and physical dependence often occur together.

People who take a class of drugs called opioids for a long period of time may develop tolerance and even physical dependence. This does not mean, however, that a person is addicted. In general, the chance of addiction is very small when narcotics are used under proper medical supervision.

Addictive Pain Medications

Opioids, a family of drugs that have effects similar to those of opium or morphine, can be addictive. They include:

• Codeine
• Oxycodone (including brand name OxyContin)
• Morphine (including brand name MS Contin)
• Meperidine (including brand name Demerol)
• Hydrocodone (including brand name Vicodin)
  Who Is at Risk for Addiction?
  
  Most people who take their pain medicine as directed by their doctor do not become addicted, even if they take the medicine for a long time. However, some people may be at a higher risk of becoming addicted than others. People who have been addicted to substances in the past or those with a family member(s) who are or have been addicted to drugs or alcohol may be at increased risk of becoming addicted to narcotics.
  
  How to Prevent Addiction
  
  The key to avoiding addiction is to take your medicine exactly as your doctor prescribes.
  
  Share with your doctor any personal and/or family history of substance abuse or addiction. Your doctor needs this information to prescribe the medicines that will work best for you. Any fears about addiction should not prevent you from using narcotics to effectively relieve your pain.
  
  Remember, it is common for people to develop a tolerance to their pain medication and to need higher doses to achieve the same level of pain relief. Such a situation is normal and is not a sign of addiction. However, you should talk to your doctor if this effect becomes troubling.
  
  You can continue your research:
  
  Pain management standards
  
  On January 1, 2001, pain management standards went into effect for Joint Commission accredited ambulatory care facilities, behavioral health care organizations, critical access hospitals, home care providers, hospitals, office-based surgery practices, and long term care providers. The pain management standards address the assessment and management of pain. The standards require organizations to:
  
  • recognize the right of patients to appropriate assessment and management of pain
  • screen patients for pain during their initial assessment and, when clinically required, during ongoing, periodic re-assessments
  • educate patients suffering from pain and their families about pain management

http://www.jointcomm..._Management.pdf

I'm done.

Edited March 27, 2011 by GuaymasJim