This article is directed at people who are in recovery and want to safeguard against slipping back into prescription drug abuse. When you’re done reading this post, we hope you’ll be motivated to do these things:
1. Recognize the importance of a doctor who truly knows you.
2. Understand the dangers of hiding information from the doctor.
3. Find a doctor comfortable with the treatment of pain and addiction.
4. Develop a pain relapse prevention plan.
The sad fact is that most doctors are not well trained to treat addiction. They are trained to be trusting. They are dedicated to relieving pain and emotional distress. Since there are a lot of medications available to treat pain and suffering, doctors are readily willing to prescribe these medications.
Most opiate addicts know which doctors give pain medications and which do not. Many addicts will have a list of doctors that they visit on a regular basis to get their supply of opiates. They may even convince themselves that, since the doctor gave them the medication, it is somehow okay.
But you are now in recovery, and you want to stay in recovery. To do this, you will need to have a very honest discussion with a primary care doctor. It is up to you whether this is your old doctor or a new one. If you have been kicked out of a practice for drug-seeking or if you quit going to a doctor because he was “on to you,” then that MAY be just the doctor you should choose. You need a doctor with a strong sense of ethics.
It is absolutely essential that you are honest with the doctor. You need to be honest about your addiction, your history of lying to doctors to get medicines, and your desire for the doctor to help you make good decisions in the future. This will take some courage, but remember: 9 times out of 10, your doctor will sincerely want to help you.
In other words, it is important to find a doctor that truly “knows” you… warts and all. This includes any medicines that you may take for your addiction such as Suboxone or Vivitrol. You should keep a list of all your current medicines in your wallet.
It may be easier to write your doctor a letter and take it with you to your appointment. Do not just mail it. Your doctor will need to match your face with the letter and its contents. Here is a sample letter:
Dear Dr. Jones,
I have a problem with addiction to opiates. I am new in recovery and I am looking for a doctor that knows my history fully and will help me stay clean and sober. My addiction means that I am pretty good at lying, and I may have even lied to you. If I have, I am sorry. Here are the ways you can help me:
- Note on my chart that I am allergic to opiates.
- Do not give me any medications that might be addictive or habit-forming. This includes opiates and other medications such as Valium, Xanax, Soma, and Ultram.
- Periodically ask me how my recovery is going.
- If I present with pain, please use non-addictive medications. If you are uncomfortable doing this, please refer me to someone who you trust and who specializes in treating addicts.
- If you believe that I must have a pain medication, then only give a prescription to my significant other (spouse, parent, child, etc.) and only give it for one week. Do not give me PRN medications and do not refill my medicine without seeing me first.
- Feel free to do random drug screens as you see necessary. If I resist, I have probably relapsed or thinking of relapse.
- If you are concerned that I may have relapsed, you have my permission to notify my significant other.
- Relapse is part of addiction. I do not want to relapse, but I will need your help if I do. Please tell me now if you are uncomfortable with this.
Sincerely,
A Person Devoted to His/Her Continued Sobriety
Obviously, this is a general letter. Notice that the letter includes not only your history of addiction, but more importantly a plan should you relapse. If you have a particular chronic pain issue, include ways that your doctor can help when that pain worsens. It is much easier to develop a plan when you are not hurting rather than when you are in pain. This is called a pain relapse prevention plan.
Not every doctor will be comfortable handling your condition. Feel free to ask your doctor whether there are any addictionologists in your area. You can check this website for a directory of board-certified addiction specialists: asam.org.
If you suffer from chronic pain, you can also research pain management doctors. Be very careful, however, because many pain specialists are more interested in procedures or opiate management than non-opiate pain management.
Lastly, it’s up to you to find the right doctor… a doctor who knows how to help someone who struggles with addiction. Just any doctor will not do. You need to do your homework and see them before you get into trouble. We both know that it is easy to find a doctor who will give you anything you want. But what you really want now is sobriety and a better life. Find a doctor that will help you achieve these goals.
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StepWorks’ medical director, Dr. Thomas Ingram (Elizabethtown, KY), is a SAMSHA-certified addiction doctor and family physician. For further information about StepWorks, call 1-888-982-1244 and speak with a member of our treatment team.