Quoted: Issues regarding pain medication and medical licensing

[Doodledog]

This is far outside my area of knowledge. I will leave it to others to respond.

I tried to obtain licensure in a state recently. They somehow had knowledge that I am in pain management (one of the 10 or so states in which licensing agencies have access to the state prescription drug database). My doctor is in the state I just left-only 2 states away (8.5 hour drive). I cannot find a doc in this area (I did try)- plus I go back twice per month anyway to visit my SO, and figured I would keep all my docs-visiting them while I am in town.

I was called into the PHP, and asked questions about all my medications. I answered honestly. They were concerned the boards here would not grant me a license.

After a very bad car accident 2.5 years ago, I almost left medicine, and due to the pain was on the verge of the unthinkable. In a last ditch attempt to hold onto my life and my career, I entered pain management.

My dosage has remained steady with no increases whatsoever for the last 2 years. I do not divert, have never done anything illegal with my meds, don't run out early, don't doctor shop or visit ER's trying to obtain additional meds. Nothing to suggest an addiction problem.

I was told by the state's PHP that because opioids make one "impaired" that I needed a consult from a $3000 3-day drug rehab facility. There are no pain management docs at this facility, only 'addictionologists' and I am wondering if they are overstepping their boundaries in not realizing they lack proper training in dealing with chronic pain patients.

I do not think entering drug rehab for people with real addictions is a wise avenue for me to go down, especially since I have been stable and functional for years now- and literally 'got my life back.' I still have chronic pain when I do not take my meds, just in case anybody asks if I ever tried to go off and realize the problem is gone. I have a 13 year old spinal fusion, and possible adhesions in the area as well; so I am not faking my pain.

I finished residency, and now am worrying that after all these years it has all been for nothing.

Please advise.

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[NotAProgDirector]

This is a somewhat surprising story, as usually if you've done all the "right things" like the OP has stated, the medical board will give you a license. Whether or not being on regular narcotics makes one "impaired" is a very touchy subject. Most chronic pain patients (and the docs that treat them) feel that it doesn't. They feel that they tachyphalax to uphoric / sedative effects, and that the pain control persists. Theoretically this is why chronic pain patients don't usually need escalating doses like abusers do. Others feel strongly otherwise -- that any amount of narcotics must impair a person.

The data isn't great, but supports the first view. The most studied "cognitive test" is driving ability. Most studies are small (usu <50 patients), and compare patients on a chronic narcotic (multiple different drugs have been tested) with healthy age matched controls, and compare ability to perform "cognitive tests", driving simulators, or actual driving on obstacle courses. Most of these studies show no difference, including those on higher doses.

But, what to do in your case? You have several options. None great.

1. You could "go with the flow". Basically do whatever the PHP says to do. It's possible that after this $3000 consult, they would state that you're not addicted, and the PHP would approve you for a license (with monitoring), and that will be all. You should be certain that during this 3 day evaluation you're allowed to continue taking your medication -- the last thing you want is a 3 day rapid withdrawal program.

2. You could consider trying to switch to bupernorphine, if not already on it. This is only of value if the PHP thinks you have an addiction problem. Since they are framing it as an impairment problem, I doubt this is of much value.

3. You could file a lawsuit. Chances are you could claim this as an ADA issue. This will be long and costly. If you win, you at least open the door for other similar physicians in the future. There's also some chance that they could be sued for lost wages, which could be quite lucrative (and might get a legal team on board for a contingency fee).

4. You could get a license in another state, move, and practice there.

My thought is, choose option #1. Perhaps the PHP is simply being very careful. They want to be 100% certain you are not abusing / impaired / diverting. So, they have everyone in your circumstances undergo a 3 day evaluation. You pass it, and you move on.

If they force you to withdraw during the 3 days OR they refuse you after the evaluation, you choose option #4 (which is really your only financial option), and meanwhile consider option #3.