Talking to your doctor

The doctor who started you on opioids is usually not the doctor who can help you finish. This is not because they were bad. It is because the system trained them in prescribing and not in tapering, and the field has changed faster than many practices have. You will likely need a new doctor or an honest conversation with a current one.

Before the appointment, write down four things. One: your full history with opioids — how long, how much, who prescribed, when you decided to stop. Two: what you are asking for at this appointment, specifically. Three: what you are not willing to accept. Four: who is supporting you in this.

Examples of what to ask for: a referral to an addiction medicine specialist; a prescription for non-opioid pain management options (gabapentin, certain antidepressants, topical treatments); a referral to a pain-trained physical therapist; a discussion of suboxone or naltrexone if appropriate; a clear plan in writing for what to do if pain spikes.

Examples of what not to accept: a refill 'just to get you through.' A new opioid prescription for a 'different' kind of pain. A dismissal of your concerns. A doctor who has not heard of opioid-induced hyperalgesia. A doctor who tells you the pain is in your head — it is in your nervous system, which is in your head, but that phrasing usually means they are not equipped to help.

If your doctor is the right doctor, they will say something like, 'Tell me what you need from me. I am going to refer you to colleagues who specialize in this. We will work as a team.' If your doctor says anything less than that, find another doctor. You do not owe loyalty to the person whose well-meaning prescription started this.

Bring someone with you to the appointment if you can. A partner, a sponsor, a friend. Not to talk for you, but to witness the conversation. Addiction shame distorts memory of medical appointments. Having a second set of ears protects you from later second-guessing what was said.