I went to my usual appointment for my four-weekly opioid pain medication scripts and my GP was sick

This is what happened...spoiler: I don't have my pain medications yet and may have to go without for a month

On Thursday, 26^th October, 2023, I arrived for my appointment with my GP to renew my prescriptions for my opioid pain medications, as I do every four weeks.

She was away, sick.

That’s not her fault, doctors are people, they get sick.  The receptionist was clearly expecting an explosion, but I am always polite.  It is not her fault. It is not anyone’s fault.

But this left in a situation where I had three days’ worth of medication, and my GP would not be back until Monday, the 30^th of October.  That would leave me two days with no pain medication.

The receptionist then explained that there was only one doctor at the practice currently, because the other two GPs were in Sydney on a course.   Bad luck, bad timing, an unusual set of circumstances.

She called my pharmacy, to ask if they would cover me for two days, until my GP returned on Monday.  That was a HARD no. 

I understand.  But I also do not agree, because I have been going to this pharmacy for over five years, they have access to all my records, I have never asked for a script early, or ‘lost’ my script, or had the dog eat it…never anything close to a ‘red flag’.   I am a complaint patient, always.  And we’re talking about four 20mg oxycontin (slow-release oxycodone) pills here.   I believe the pharmacist should have given me the four pills, it would have been the simplest solution and it would have saved an awful lot of anxiety and stress. And money.

But she refused.  So that was not an option.

The receptionist said I would have to see the only remaining doctor, but she was fully booked.  But she would fit me in on a phone appointment, between 6pm and 7pn that evening.  She said she could not guarantee that the doctor would prescribe my medication, that would be entirely up to the GP.  And she would likely charge me after hours rates, which would be $100 out of pocket.

Did I wish to continue?

Well, yes. I have no choice but to ‘continue’.  I thanked her very much for fitting me in and helping sort the situation.  She thanked me for being so reasonable.

And I went home.

I have to admit, I was feeling very anxious about it all.  I know that many GPs do not prescribe opioids under any circumstances.  I’ve never met this GP, she’s never met me. And although she has access to over ten years of my medical records, she is under no obligation to prescribe to me. I am not her patient.  It is not an emergency.

Although it did feel like an emergency to me.

I was not concerned about going into withdrawal, I have gone without my opioid pain medications in the past for more than four days, and I didn’t experience any withdrawal symptoms.  I do believe that there should be a duty of care though.  And people on medications that cause withdrawal when stopped abruptly should not have to endure withdrawal, when their doctor is away, or they can’t get their medication for some other reason, through no fault of their own.

But who’s duty of care is it?

At this point, it appears no one’s.

At 7pm a different receptionist phoned me and asked me what I needed the appointment for.  I explained that my usual GP was away, sick I presumed, and I had been unable to get my regular script for oxynorm (immediate release oxycodone) and oxycontin refilled. I was hoping this GP would cover me for the few days until I could see my regular GP. 

The receptionist told me to wait while she spoke with the doctor.

She returns, and questions why my script is for 5mg tablets, but I am taking two, an effective dose of 10mg.

I explain it’s a long story, that I was trying to taper, so my pain doctor changed the script from 10mg to 5mg so I could try lower my dose.  The taper was not successful and I hadn’t returned to see my pain doctor just to change the script, because that’s a $300 appointment.  So I continue to take two tablets for break through pain. 

She told me to wait while she spoke to the doctor.

She returned, and says the doctor says she cannot change the prescription to 10mg tablets.

A little perplexed, I said, sure, that’s fine, I understand.  Not a problem.

She tells me to wait while she speaks with the doctor.

She comes back on the line and says “The doctor will need to see you in person.”

Internal sigh.  But I put asmile in my voice and say “Of course, that would be great.  What time tomorrow (Friday)?”

Oh she’s fully booked tomorrow. It wil have to be Monday.

I remind her that the whole point of this phone appointment is that I will run out on Saturday, and I don’t have enough medication to last until Monday. On Monday I can see my regular GP.

Oh, yes, of course.   She asks me to wait while she talks to the doctor.

She comes back on the line.  Please come in at 9am and doctor will fit me in.

Keeping the smile in my voice, I thank her.

And then she says “And doctor says she can only do ONE box, no more!”

Of course, thank you, I say. I only actually need four pills.

Yes, but only this ONE time.  Only once.  You cannot come back again.  But she will fit me in this time.

Ok, thankyou.  Again, a little perplexed. I’m not wanting her to take over my care. I just need a fill-in script.  But the point is, she’ll fit me in.  That’s brilliant.

Except…I’d just been told that she was fully booked, so I anticipated a long wait.

Doctors do this.  The want to make you wait.  They want to see IF you will wait and how long you will wait.  Just how badly do I want these opioids?

Well, I experience constant, severe, disabling pain without my opioids.  I experience that pain for part of every single day of my life, so I know what I am in for.  Tolerating it for six to eight hours every day sux. But tolerating that pain for two days straight will be truly terrible.  If I have to wait a few hours, then so be it.   

But also, that’s a bit cruel.

It’s exactly the same as what the ED does when they get chronic pain patients, who are having an acute pain flare.  They ignore us for hour upon hour, see how long we will wait.

I know that I will be sitting there looking very normal. I don’t show pain outwardly.  I’ve never been that way. I am introverted, and the more pain I am in, the quieter I get.  To anyone watching me, I’m sure I appear perfectly fine. Calm.  Relaxed even.

But I am not relaxed. I am breathing, meditating, and suffering. But I look just fine.

Friday came and went and I didn’t think about it. No use worrying about things I can’t control.

Saturday morning, I arrive just before 9am.  She calls me in at 9:55am.  I am pleasantly surprised, that is a relatively short wait.

She is curt, cold even. She speaks to me sternly and asks me what I need.

I explain, my usual GP, her colleague, was away sick on my appointment day.  I needed a script to tide me over until I can see her, however, I checked the appointment app this morning, and she is now listed as away until the 27^th of November.  So I need this month’s cover AND next month as well.

She says she cannot do that.  Checks the computer and tells me my usual GP will be in on Monday. But she has no appointments free.  But she will have to fit me in. 

Ok. I just need the four pills to tide me over until Monday.

She asks me to go through my entire pain history.  The rheumatoid arthritis, the cauda equina, the spinal fusion, the peripheral neuropathy, and the recent CIDP diagnosis.  She asks about anti-inflammatories, why I can’t take those?  Stomach ulcer, eosinophilic esophagitis, and kidney function. She asks what other pain treatments I have tried…surgeries, cortisone injections, radiofrequency ablations, physiotherapy, hydrotherapy, exercise, acupuncture, heat packs, cold packs, psychological therapy, CBT, ACT, mindfulness, mediation…

At the end of all of that she noticeably softens.  She is kinder. She tells me she is sorry, but these are schedule 8 drugs, and she is required to check everything.  She gives me a physical exam, looks at my hands which are suitably swollen today, and takes my blood pressure.  

My BP is very high, I tell her its ‘white coat’ syndrome, I always get nervous with new doctors. And we laugh. 

She writes my scripts, one script for one box of 20mg of oxycontin, that will cover me for two weeks. And ONE box of oxynorm 5mg.  I usually get eight boxes every month.  One box will last me until Tuesday. 

That’s OK, I just need to see my usual GP on Monday. She needs to fit me in. 

This GP tells me to speak to the receptionist and they will arrange it.

AS she hands me the scripts, she gets stern again. She tells me that she cannot prescribe more, ever. This is a ONE TIME thing. She only has permits from the government to treat eight patietns with long term opioid therapy, and she cannot take me.  There are other people ahead of me in the queue.  And do NOT come to her again for a fill in script, she will NOT write it. This is a ONE TIME thing.

I’m a little taken aback, but I understand.

I do not blame her. The government has made prescribing opioids so onerous, so difficult…its why many doctors refuse to prescribe at all.

This has been an unpleasant experience.  Its not my fault, not my GPs fault, not this new GPs fault…it’s the government’s fault.  The pendulum has swung far too far, the dangers of opioids have been exaggerated to ridiculous levels and their benefits minimised. 

Many doctors believe that all chronic pain patients are not in pain, they are just addicted.

Many doctors believe that chronic pain is never severe enough to require opioids.

Many doctors have been taught a lot of rubbish. 

I thank the GP for fitting me in and for providing the prescription, I appreciate it, and understand how difficult it is.

I ask the receptionist if my GP is available on Monday or Tuesday.  I’m told she is only in on Monday, but she is fully booked, and then she will be on holiday for a month.

I tell him I need to see her on Monday, because I need my scripts, for both this month and probably for next month, because I will run out before November 27^th.  I explain the whole story, again.

He says he will leave a message, but he is the weekend receptionist and does not work on weekdays.  He tells me that sometimes messages don’t get through, Monday mornings are busy, so if I haven’t heard by the afternoon, call them.

Noted.

No way am I waiting until afternoon. There is no way I’ll be fit in if I wait until then.  I will be calling at 8:30am and asking for an urgent appointment with my GP.

I pay the bill and sit in my car and exhale.

Its not easy going through your entire history, hoping that the doctor will believe and understand.  I was exhausted.  I still had to get the script filled, and get a few groceries.  And that was my Saturday.  My entire day, ALL my energy, all my upright hours, devoted to getting pain medication.  

And I know how that sounds. There are people that would use that as a criteria for ‘addiction’ and believe I am demonstrating an opioid use disorder.  But anyone who believes that is ignorant and under-educated.

The thing is, after all o that, I’m not much better off. Yes, I have enough medication until Tuesday now. But there is no guarantee that my GP will ‘fit me in’.  I have just kicked the can down the road a ways.

I believe she will fit me in. She is a good doctor; she will not let me suffer needlessly.  The issue is getting the message through to her, trusting that she sees the message early enough that she CAN fit me in.

Receptionists don’t always understand the importance of a situation. It’s a script, big deal, right?  I’ve had my messages ignored by receptionists, either because they didn’t think it was important, or because they were having a bad day and decided to be nasty and throw their power around.

So I am back to square one.

And I am completely dependent on the goodwill of several people on Monday.  Everything has to go perfectly right.  And that is a very stressful, insecure place to be.  IN my world things rarely go perfectly right.

I have enough medication to get me through to Tuesday.  I have already paid $100 for a weekend appointment, and I will need to pay another $95 (out of pocket around $60) on Monday.  If I am lucky. 

If anything goes wrong, I will be without immediate release opioids for a month.  And I will be without extended-release opioids for two weeks, because I have two weeks worth.

Without the immediate release, the extended release does not work, it is too low a dose.  So if I do not get an emergency appointment on Monday with my GP, I will be left without my medication for over a month.

No other doctor will write the script, according to the GP I just saw, no other doctor CAN write the full month’s script. 

This is no one’s fault.   Not mine, not my GPs, not the other GPs, no one’s. 

I talked to my GP when she took over my care and asked her what would happen should she ever be away when I needed my scripts.  Which doctor should I see?  Who should be my ‘plan B’.  She assured me that any of the other doctors at the practice would write the script.  I accepted that.

I’m sure that’s what my GP genuinely believed would happen…but it doesn’t work that way in the real world.  

The government has made prescribing opioids so highly regulated, so insanely difficult, that there is no fall-back position.  It is not easy for another doctor to write the script, it may even be impossible, if what I was told is true. There is so much paperwork, so much bureaucracy and so much oversight.  GPs don’t want that kind of attention placed on themselves and their practice, and I can’t blame them for that.

Those of us who live with constant, severe, disabling pain are now an underclass. The government has created a highly stigmatised, underclass of patients that GPs do not wish to treat. Not because we are not difficult people, but we are difficult to help, because the government has made it so hard to help us, to prescribe opioids.

We are treated with suspicion first, compassionate care second if we’re lucky. If we convinced the doctor that our pain is real and severe, and disabling.  Some doctors are impossible to convince.  They haven’t read the science; they believe headlines and the refuse to believe opioids are safe and effective OR that chronic pain can be severe enough to require opioids.  Most doctors treat us as if we have an opioid use disorder first, and we have to convince them otherwise.  Some doctors are openly dismissive or even worse, openly deride us, and demean us.  Tell us our pain is ‘all in our head’ and refer us to an addiction medicine specialist.  All because we were unlucky enough to develop a progressive, painful, incurable disease that is not cancer.

Imagine how it feels to be constantly treated with suspicion.  Treated as if you’re addicted, rather than in pain.  As if you’re scamming somehow, trying to be deceptive…trying to trick the doctor into prescribing opioids.  This is the climate for people needing opioid pain medication prescriptions.  Even for people who genuinely need this medication for ‘severe disabling pain not responsive to non-narcotic analgesics’ as medicare calls it. 

Doctors have been taught to be suspicious.  Sometimes they are stern, cold…callous even. They have been told they need to be. And therefore, patients suffer, both pain and withdrawal symptoms, needlessly.

This is why I advocate. This is why I rebut the science. This is why I spend all my upright hours fighting this fight.  Trying to get people to pay attention, to listen, to learn.

I believe my GP will fit me in.  But I can’t be sure. And what if she is still stick on Monday? That’s a possibility. What then?

I don’t know.

I can’t worry about it. Again, there is no point worrying about things that are out of my control.  So I will put it out of my mind. 

Until tomorrow, Monday, at 8:30am when I will hit the phone.

I’ll let you know how it goes.