I am on several meds for mental health and thrroid problems. But no illegal drugs. Why did I fail my drug test?

Wow, another board member, catsmeow (thanks!), sent me an email saying I might want to read your post, and she was certainly right. I have no idea where this doctor received his pain management training but it either wasn't in any modern setting with modern findings, or he slept through the classes and lectures. But he sure doesn't know much about handling chronic pain patients, neither pain, nor mental health wise.

First of all, a short acting med like you were getting, the Hydrocodone 5mgs and Acetaminophen 500mgs is not a long-term pain control med, which is exactly the problem you were having with it. These typically take as long as 20 minutes to start working and they only last about 4 hours, more or less, depending on your pain level and how bad or out of control it is. For total pain management, these types of meds should only be used as a med for breakthrough pain, that way it works fast and last while, until the long-acting med you should be taking can kick in.

So ideally, a patient in a real pain-management program who has been cooperative with their doctor's and is down to narcotic pain control as their only remaining option, which is usually the only way you end up in pain management, is on something long-acting like a version of Oxycontin or MS Contin that are time released to last 12 hours, or perhaps something like Avinza which comes in a 24 hour release form, then you should have a shorter acting med, like that one you had, like I said above, that could be used in between doses or at moments when that long-acting med just isn't handling all of your pain. So any doctor who expects a chronic pain patient to rely on Hydro 5/500 for all of their pain relief just doesn't know much about pain, and he should not be handling anyone's pain management. Now, the normal dosing for this is not even one every 8hours like he had you on, that would be a dosing schedule used for someone with very mild to moderate pain, perhaps an arthritis sufferer who isn't in pain all the time and doesn't need constant pain control.

The correct dosage of these, either for short term control of bad pain from say an auto accident injury, broken bone, or as a breakthrough med should be every 6 hours, and it can be taken, if needed and doctor approved, as often as every 4 hours for those with serious pain issues. Now, his blow-up because you talked to your case manager, and had her talk to him about it, is just childish, he wasn't listening to you and you had every right to have an advocate on your behalf speak up for you. My husband was in intensive case management for a few years after he left from being hospitalized for depression, and I know she would and was able to go to bat for anything he needed her to handle, that is what these people are there for.

Obviously this doctor has an ego problem, a god-complex it seems, and has trouble with anyone questioning his authority. The fact that he would not even talk to you about your problems with the med not handling your pain is a dead give-a-away that he is a know-it-all who thinks he knows all there is to know about it, and that he even thinks he knows you, your body, and your pain levels better than you do. What a ridiculous attitude.

You are of course, in no way obligate to let him see your mental health records, it is none of his business what you told your therapist, so I sure hope you didn't sign them for him. If you did, make sure you keep your therapist updated on how he treated you and why he claimed he wanted to see those records, if you also explain that you signed them under duress because of his anger and feeling threatened, they may cancel his order to get copies of them, or if they have already sent them, they can prevent him from getting any future information that you do not authorize. As to firing him, yes, you have every right to do that and to go see a different doctor, if you have a family doctor, or talk to your therapist, or case manager, they might be able to find you a better doctor nearby that can help you and provide you with a referral for treatment.

You are never obligated to continue treatment from any doctor that you feel is volatile, not listening to his patients, and who is not adequately meeting your needs. I don't know if you signed a pain management contract when you began seeing him, it is a standard agreement that most pain management clinics or specialists have new patients sign, stating they agree to cooperate with suggested treatments, to give any med or therapy a fair chance to work before wanting to move on to something else, and that you will not accept pain prescriptions from any other doctors or ERs while you are under their care, unless they authorize such. However, even if you signed a contract like this, you, the doctor, or his representatives, may legally break said contract at any time, for any violations of the listed agreements, or any general problems that you, or they, just feel are not being handled correctly there or can't be handled there.

So just like a doctor is not ever obligated to treat you, except for when you are rushed to an emergency facility with a life-threatening condition, neither are patients obligated to continue under any doctor that they are not happy with for whatever reason. Now, as to reporting his behavior YES make sure that you do. Not only should he be under someone's scrutiny for his behavior, but other referring entities in your area, such as your family doc, therapist, case manager and etc. should also be aware of his actions, treatment of patients and his general attitude, so they stop sending people there.

When he starts losing business and wondering why, maybe he will learn something. I am not sure what state you are in, but you can contact the Doctor's medical review board in your state, you should be able to find their information by doing a quick internet search, and a short phone call or email to them is all it will take to get the information you need to make a full report on him. I know it might seem to some people that it would be simpler in the long run to just walk away and seek treatment elsewhere, but sometimes when a doctor has this type of attitude it just isn't that simple.

This "doctor" (and I am using that term very loosely at the moment! LOL!) can be putting anything he wants to in your patient file and of course, since you don't usually look through your own file at each visit, you have no-way of knowing what he has put in there. I am really sorry if this upsets you further, but you really need to know this so you can protect yourself, but he could be putting notes in there saying you are a drug addict, or you are showing drug seeking behavior and etc. and that is why he wouldn't give you different meds or up your dosage.

It sure seems like he assumes that everyone using his service is an addict instead of a pain management patient, and if he has that listed in your records from his office, it could create real problems for you in the future when you try to see a different pain specialist or need additional treatment. More than anything else in your file, other doctors rely on the information put in there by your treating doctors to get a true assessment of you. It is just the way things work in the medical community.

Now, if you try to get a copy of your records from him on your own, they are allowed to sensor, which means they can remove any items they don't want you to see, by claiming that such information could be mentally damaging to the patient. So even if you got a copy and they look fine, you have no way of knowing what he is sending to or telling other doctors about you. So, the smartest thing to do would be to have your family doctor request copies of his records, one you have apprised them of the situation, or to have your therapist obtain them.

That way you can sit with them and look through and check what he is putting in there. You can't hide the fact that you were seeing him for a period of time from a new doctor or pain program you might go into, but your regular doc and/or therapist can help you make sure that the new doctor in question only receives updated and correct information on you, and not any of his silly accusations. Now, another way to protect yourself, do not be shy about inviting any new doctor you see for treatment to check you out as thoroughly as they want, be honest with them, let them feel comfortable treating you.

Even if he tries to say you are an addict or drug seeker, you can easily let a new doctor access your information through your files, as well as medical and pharmaceutical databases, so they can see he was the loopy one, and that you only took the meds as prescribed, even though they didn't help. A few minutes is all it will take for them to have your name punched up in the DEA database, which records all pharmaceutical transactions and see that you were not trying to abuse meds, or do doctor or pharmacy hopping. Even if this is something you did in the past, by being honest and open now, you can prevent them from being worried that you are still doing it.

But seriously, this doctor is acting like he is treating a bunch of addicts, and not people with real medical problems. He is acting like he is operating a rehab facility rather than a pain management clinic, and if he isn't going to provide the treatment and help he is supposed to, then he should go do something else. I mean if he is that miserable doing pain management and not really helping anyone, there is nothing making him stay in that speciality.

I really feel sorry for what you are going through here, and I totally sympathize. This advice is not coming from just another board member, I am a chronic pain patient myself, an am disabled due to a degenerative spinal condition. No matter what I take med wise, I am in pain everyday, all day, due to a nerve root impingement of my sacral nerve.

Anyway, sorry my post is so long winded, I just wanted to explain some things, and let you know that you are not alone in having bogus pain management problems. Most doctors are great and really care about helping people, but there are those bad apples that get greedy and just want to get whatever money they can out of you or your insurance, and they could care less what happens to you, or if you are really in pain and need help. Very sad, but true nonetheless.

If you do a search online, you will find other people with similar experiences and it is very, very sad and tragic. It scares some people away from getting the help they need, and because of the people who have abused meds, and played the game of doctor and pharmacy hopping, all docs must now be cautious and wary when they treat someone in pain and they have to make sure you really do need these pills and be ready to explain that to the DEA at any time if they give you that prescription. Thus many docs just don't want to deal with prescribing anything beyond a schedule III or IV drug, which is what you were getting since it had the Acetaminophen in it, some, like your doc apparently did, also convince themselves that there just isn't any pain that bad to warrant heavier meds, and if the patient says they are still in pain in spite of his mild prescriptions, then they must be a drug seeker.

I know that docs do have to be careful, since I always ask questions about everything, my doc has explained to me the full procedure and the files they have to keep for the DEA and how they can lose their license if they don't. Every month when I go in now for my med review appointment, I watch as she has to Xerox copies of the scrips she gives me, so they have them all on file if they need them. She even showed me the pharmaceutical report they pull on me, and all other patients who are on benzo and/or narcotic therapies, from the DEA pharmacy database, so they have that information on hand, to show that the person wasn't engaging in any suspicious behavior, just in case the DEA would ever ask or be investigating someone.

You will even find some posts on here, from quite a few people, who through no fault or abuse of their own, ended up being reported as participating in suspicious behavior and being red-flagged to all docs, hospitals, and pharmacies by the DEA. It is a nightmare for them to get it straightened out again so they can get the treatment they desperately need and deserve. Sometimes they just shared a name with someone else, sometimes they had prescripions stolen or they accidentally ran out a little earlier than the DEA thought they should because their pain was out of control and they had to get by until their next docs appointment, so all the rest of us have to suffer because of the abusers.

Many people also just assume that if you take narcotics you are an addict, many people don't understand chronic pain and how anyone could need drugs that potent for long-term usage. I have had my own father lecturing me about the meds I am taking and how addictive they can be, and he knows how bad my condition is, but he has never been there, so he doesn't comprehend what it is like to always be in pain. This is a man who wouldn't take anything stronger than Tylenol and his use of that was one dose over about 7 years.

So what I am saying is, as long as you are under treatment, be it a permanent thing, or just temporary because your condition, or the injury that is causing your pain will eventually heal and get better, you will always have to deal with someone who is a jerk about it and doesn't understand why you need strong pain meds. Unfortunately for you, you ran into a doctor who has that attitude, as I said, he obviously doesn't get it, and really doesn't comprehend, nor care to understand, chronic pain even on a short term basis. So when you see someone new, even if you are certain that a med or treatment won't help, you will still have to cooperate and give it a try, you will have to prove yourself to them as being in control, not drug seeking, and willing to cooperate to get the best treatment possible for your condition.

Your new doc might want you try to same med for awhile, either on a higher dosage since the Hydro pills are available in up to 10mgs or at a more frequent daily dosing schedule of the same dose, because they will want to try to use something as mild as possible to get your pain under control, before resorting to the heavier and stronger meds. Like I said, they do have to worry about addiction, especially if your condition isn't permanent, so you really have no choice but to go to a different doc, and while you can voice your opinion and tell then what has and hasn't worked for you, you are going to have to be totally cooperative to prove that you aren't just wanting the meds to get high. You are also going to have to make sure you give any med or therapy they try a fair chance to work, before going in and saying you need something stronger.

I can see you were already doing that with this doc, if you were in their for your monthly med appointment, then you were sure on it long enough for it to have reached peak efficacy for you in your body at that dosage and scheduling interval, so you shouldn't have a problem with that at all. But, unfortunately, just like I said before, chronic pain patients with real, legitimate medical problems do have to suffer because of the abusers and the measures that the DEA, docs, and pharmacies have had to take to try to prevent that. However, if you get a good doc this time, who is really educated about pain and managing it, it will not take very long to establish yourself as being fully cooperative and reliable, and they will eventually relax with you and be willing to work with you to get you a med that works.

See there are also many people out there who expect a miracle when they finally get a narcotic prescription for their pain, they expect that drug to work immediately and get rid of all their pain, so they can feel normal again. However, meds don't work that way. When you first start taking it, you will more than likely get some relief, but you do have to keep using it for a few weeks until you get the full benefit of the drug and the worst of the side effects wear off.

I eventually lucked out as a doctor who has taken courses in pain management and is now a specialist in it, joined my doctors practice, so I no longer have to run out trying to figure out who can help me, he is right there ready to advise and sign scrips everytime I go in for my monthly appointment. My information is not guaranteed correct.