The Question: I went to have my prescription renewed for Tylenol 3 for one month. I have no family doctor but had been taking one tablet at night as I have pain from a broken ankle in 2009 not treated adequately. This was not OxyContin – simply Tylenol 3 with codeine, prescribed earlier by another physician – but I could not get it at the walk-in clinic. Instead, she gave me a prescription for acetaminophen, which didn't deal with the pain to help me sleep. I can't travel from clinic to clinic seeking meds. Why am I being made to seek out what I need in such a manner that I end up looking like a drug addict?
The Answer: What you should know right off the top is that without a family doctor, you have no one to help you appropriately manage your chronic pain and you will be running into this problem again and again.
Another thing: Though doctors are trained to believe their patients, a request for potentially addictive opioids for non-cancer pain represents a special case. The physician must decide whether that patient is telling the truth about pain, previous use, how many doctors seen and how the medication is being used.
That wariness is further amplified at a walk-in clinic, where the physician can't confirm your history of being prescribed 30 pills per month. Since that walk-in clinic physician had no way of verifying whether you were doctor shopping for pain meds, she opted for the safest choice, which was prescribing acetaminophen.
"Although Tylenol 3 is not nearly as risky a medication as OxyContin, it can still cause addiction and even fatal overdose, especially if taken with alcohol or other sedating drugs," according to Irfan Dhalla, staff physician at St. Michael's Hospital in Toronto, who has conducted research describing the harms resulting from the use of prescription opioids.
Overall, he thought if you had a relationship with a family doctor, it would be reasonable for you to get one tablet a day at bedtime if the pain was well controlled, if you were on a stable dose and it was helping you sleep.
But you don't have a family doctor and that's the big problem here. He suggested you register with Health Care Connect,an Ontario government program. While it may help aid in your physician search in that province, it does not guarantee to find you one.
Dr. Dhalla pointed out something else: This problem wouldn't arise if you were a patient in Britain because primary-care physicians there are obliged to take all patients living in a certain geographic area. In Canada, many patients with chronic pain have difficulty finding family doctors who will accept them into medical practices.
If Health Care Connect doesn't pan out, go to a community health centre closest to you or family health team affiliated with a teaching hospital, especially starting in early July, when the new crop of medical residents starts pouring in and more help is available. Those are your best bets for finding someone to help manage your chronic pain.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.