Discontinuation of Low Dose Naltrexone Prescription by New Primary Care Physician
33 years old, 5 feet 8 inches in height, 135 pounds. Current Medications: Creon, Baclofen, Triptans, Nurtec, Memantine, Slynd. Medical Conditions: Chronic Migraines, various joint issues, and Exocrine Pancreatic Insufficiency (EPI). Approximately two and a half years ago, I relocated across the country. My family remains in my previous location, so I frequently visit. For some time, I was receiving care from both my former and current primary care physicians (PCPs) due to the complexity of my health needs while I transitioned to a new medical establishment in my city. After a few years with my current PCP, I believed she was honoring all of my prescriptions. However, I discovered that my previous physician was still managing my compounded prescription of low dose naltrexone, which I rely on for joint pain and have been prescribed for around five years. When I contacted my new PCP about continuing this medication, she declined and suggested that I see a pain management specialist instead, which she would facilitate. It’s worth noting that I have no record of substance abuse. From what I understand, naltrexone poses a minimal risk and I have been stable on it for an extended period. I find it perplexing that she feels comfortable prescribing a variety of gastrointestinal medications, muscle relaxants, and iron infusions, yet hesitates to continue this particular medication. For context, both of my PCPs are Internists, not Family Medicine specialists. I’m reluctant to consult an additional doctor simply for the sake of it. Summary: My new PCP has refused to continue my 4.5 mg naltrexone prescription that has been part of my treatment for the past five years, leaving me puzzled about the rationale behind this decision. What am I overlooking? I’m feeling quite taken aback and uncertain about this situation.
Answers (1)
3/17/2025, 4:40:54 PM
OpenHealth AI
It sounds like you are facing a challenging situation regarding the continuation of your low-dose naltrexone prescription, which you have relied on for joint pain management. Your feelings of confusion and concern are completely valid, and it's important to understand the reasons behind your new PCP's decision while also advocating for your health needs.
Understanding the Situation
Naltrexone, particularly in low doses, is often used off-label for various conditions, including chronic pain management. Your new PCP's reluctance to continue prescribing it might stem from factors like:
- Clinical Guidelines: Some physicians prefer to follow specific guidelines and protocols which might not support off-label use, particularly if they are not familiar with its benefits or lack comprehensive clinical data.
- Patient Safety: Your PCP may want to ensure that all medications are managed under the supervision of specialists who can directly address chronic pain issues comprehensively.
- Transition in Care: Since you have recently relocated and transitioned to a new medical system, your PCP might prefer to reassess your entire care regimen to ensure it's appropriate and effective.
Next Steps You Can Take
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Open Dialogue: Consider scheduling a follow-up appointment or initiating a conversation with your current PCP. Express your concerns about discontinuing naltrexone and discuss the specific benefits it has provided for you. Share any supporting evidence or studies that underline its effectiveness for your conditions.
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Request a Pain Management Referral: If your PCP insists on referring you to a pain management specialist, consider proceeding with this. Specialists may have more experience with medications like naltrexone and could be more open to continuing it within a broader pain management strategy.
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Explore Comprehensive Care Options: If you feel that your current PCP is not aligning with your health needs, it might be worth looking for another healthcare provider who is more familiar with or supportive of low-dose naltrexone and its use in chronic pain management.
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Gather Documentation: Bring records from your previous physician that detail your treatment history and the effectiveness of naltrexone. This can help bolster your case during discussions with any healthcare provider.
Remember, your health and comfort with your treatment plan are paramount. It's okay to seek second opinions or advocate for the continuity of care that best supports your well-being.
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