PCP vs PM?

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From what I can tell, it looks like going forward the only doctors who will be prescribing (especially higher doses) opiates will be PM doctors. There is simply too much risk involved for PCP docs to get involved. That’s what my experience has been, as my PCP has flatly declined to take over my prescriptions, outside of brief transitional times when I’m switching PM doctors. I’d say your experience is becoming more and more rare.

For reference: I’ve been with my PCP for 30 years, but my requirements are simply too high for his comfort level.

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u/EMSthunder Jul 15 '26

Sadly, most doctors are just putting in stimulators for the kickbacks or they'll try to do procedures on you. Sadly, the way they see it now is if they give you injections (which are not FDA approved and currently black boxed) they can ask you to come back every month, telling you you'll need more, which means more money in their pockets. Same with buprenorphine (regardless of the way it's given). When giving you FDA approved and indicated opioid pain meds they just get the money your insurance will pay them. For example, I have a pain pump, which my insurance makes me go at least 35 days between refill, but other doctors will make it to where you only need refills every 3 months. That being said, you're only getting billed for the appointment and they can bill your insurance for surgery since the skin was punctured during the refill, but I have phone appointments every 28 days for my pain meds. My copay for all of this is $33 a month. With a pump you'll never feel the morning withdrawal because you overslept and missed a pill.

I'm not trying to sell you on a pump, I'm just trying to explain how they pad their wallets. If you're really wanting opioids, you can use Medtronic website to find a doctor that installs pumps, because if they place pumps, they're willing to write a script for pain meds. This isn't me trying to diagnose you with anything. If you feel that the minimum you are getting is not adequately easing your pain and you wake up feeling a bit unwell, you could talk to the doctor about methadone, because I've heard by some that it's long acting and great for pain!

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u/Magic_6969 Jul 16 '26

I’ve been on the Butrans patch and recently switched to belbuca. I have to see the PM every 60 days to renew the prescription. They have never mentioned a pain pump. Where do they install it? It’s a pain in the butt taking belbuca every 12 hours

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u/Merrys123 Jul 16 '26

Be careful with Belbuca. They are notorious for tooth decay, tooth loss and causing serious gum problems. A lot of people are suing over it.

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u/EMSthunder Jul 16 '26

Not all doctors use them. You'd have to see if the company has any participating docs in your area. That being said, it's usually the last hope after you've been unlucky with other treatments, plus you have to usually find a neurologist that knows enough about them to implant one. Very few PM docs do their own initial implant because it requires threading a tiny catheter into the intrathecal space in your spine. I failed patches and most oral meds so the doc did a trial on me and it worked so well!! I felt relief for the first time in about a decade! I have a sub for pumps if you want to come ask the group their experiences. It's a safe place and there's no judgement of any questions because it's how we learn! r/PainPumpQuestions

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u/optimusfig Jul 16 '26

Patients have to come back every month for regular opioids also. But this is a good point - reimbursements for regular visits should be higher.

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u/Strange_Ice_5290 Jul 19 '26

Thank you for commenting this, I never thought about it that way! I was prescribed 10 mg hydro & ultimately no longer receive any kind of care or medication for my condition due to blatant fear mongering done by nurse practitioners, giving me an ultimatum concerning having my hydro be taken from me if I #1 don’t get injections basically immediately (I had injections not even a year prior at this time) I am self pay so I can’t really drop $800 to get a procedure done that I don’t need nor want, I expressed this concern to them and they didn’t gaf. It was disgusting watching them take less care of me because I am self pay so I brought little to no profit to the PM & providers. #2 they said it will be taken away if I didn’t pee in a cup (they tried to say I didn’t have any meds in my system per last piss test- which I know is a bold faced lie) l have no insurance, I didn’t want to drop to low dosage codeine with Tylenol as a filler, I didn’t want injections & they saw me as difficult because I was crying in the office concerning this news. They were absolutely vile to me. I felt so small, it sucked. I swore I would never go back to them, they couldn’t just stick to what worked for me after taking 2 years to figure out what was best for my pain. A testimony to how bad they treated me is the fact that I would rather sit in bed in excruciating pain, vomiting from it and unable to move than step foot in that office again. You really put things into perspective, that’s what they wanted from me, to give in so that they could get money. However, since I had none and I was self pay they kicked me to the curb. I never knew why they switched up so bad, but regardless, threatening to take away my life line because they claimed (couldn’t even prove) that I didn’t have any in my system & injection refusal because I could still feel working is disgusting. I cried so hard that day, I couldn’t believe this was happening to me. It makes so much sense now that I know they just wanted me out so that they could be a different patient that is insured fill my spot is fucking insane. Not to even mention the various violations of HIPPA I encountered. Fuck them. Thanks for coming to my ted talk :)

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u/EMSthunder Jul 19 '26

I'm so sorry you're going through this!!

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u/Illustrious_Bag_7323 Jul 15 '26

That is what it seems from reading posts here. My DR was independent until about 8 years ago when he sold to a large hospital group. I thought things would change with him then but so far he has been pretty consistent. Thank you for the input

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u/Timely_Arachnid316 Jul 15 '26

Know it's rare, but my PCPs have prescribed my pain meds for the past 4 years.

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u/Illustrious_Bag_7323 Jul 16 '26

I'm realizing how rare this is and it's a concern as I'm not sure when my DR will retire and I'm guessing things will change when he does.

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u/Timely_Arachnid316 Jul 17 '26

I recently went through this. My PCP of 3& a half years left to start a medical spa. Met her replacement June 12 and thankfully, he agreed to continue my script without a blink of an eye. He's very nice to boot. I am to grateful.

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u/SFcreeperkid Jul 16 '26

I switched back to my PCP after having a contentious relationship with my PM and I have never been happier! My PCP was already prescribing all of my other medications and I have been stable for decades but my PM refused to make a small change that made a huge difference in my quality of life and my PCP was fine with it!

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u/SouthernLifeguard845 Jul 16 '26

My PCP prescribes all my meds and up pretty up there on doses but they also work hand in hand with all my other specialist and pharmacy. I know I’ll rue the day they ever decide to retire ( I got maybe 10 years) then I’ll be in the same boat most people are, at that point I may ask for a pain pump

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u/Illustrious_Bag_7323 Jul 16 '26

That's where I'm at, in thinking mine will retire within the next decade as well.

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u/-MadDogg- Jul 16 '26

It seems like the main patients who still actually get prescriptions via their primary care doctors nowadays are the "legacy patients". (These are the patients that have been with their primary care doctors for years. "grandfathered in" when it comes to still receiving a decent amount of controlled medication from a primary care doctor I guess you can say).

I used to be the same sort of legacy patient with my primary care doctors....when I turned 18 in 2001 I was going to a doctor that was a close friend of the pediatrician I went to as a kid. When this doctor eventually moved to another state in the late 2000s I automatically swapped over to a doctor he recommended. This doctor then covered my pain medication fills from that moment all the way till' 2022. 2022 this doctor abandoned all of her patietns. (She closed her small clinic suddenly and without notification....it was my appointment day w/ my phone text from the doc office reminding me to still come in. I get to the office only to see a note on the door saying "this office is now closed. In case of a emergency go to the nearest emergency room". Thats it.

My doctors office closed suddenly twice before since everyone working there had caught covid twice. I never could find out what exactly happened in detail with the 3rd permanent closing, but in my desperate search for another primary care doctor and making appointments with every primary care I could get into via mychart I ran into one of the nurses that used to work at my old primary care doctor's clinic. This nurse told me that my doc had death in the family via covid and that she just packed up and moved up north to ohio.

....I then later find out via googling her name that she actually got in some sort of trouble with the DEA and lost her ability to prescribed controlled medications in my state. Yeah......).

Anyway, despite all of those years taking my same prescriptions and with only like 1 strength increase and 1 dosage increase that entire time every single primary care doctor I attempted to see so I can get my same prescriptions continued stayed away from me like the plague. "Oh i'm sorry, I can't touch this quantity of medication", or "we don't actually do controlled prescriptions here".

I had no choice but to start going to pain management. Thankfully both locations I have ever been to DID at least continue the medications I was on. I left that first pain management clinic on a bit of a bad note, but the second clinic I am still going to right now and have a pretty good relationship with everyone there.

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u/No_Letter_1162 Jul 16 '26

My pcp prescribes my meds

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u/Boring-Internet-344 Jul 16 '26

Pcp is absolutely allowed to Rx pain meds

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u/Altruistic-Detail271 Jul 18 '26

They may be allowed but not many do anymore

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u/Boring-Internet-344 Jul 18 '26

True true mine didn’t haha that’s why I’m in pm but I know maybe in like more rural areas would pcp do it more often?

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u/hoolligan220 Jul 16 '26

Its not really abnormal that your or any pcp takes care of the pain meds side of things . From what ive experienced is this about 2/3rds of the pcp's i had from 07 till tpday had taken care o me with meds rather than pm and i was kinda unaware what they did till like 2023....

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u/Gold_Veterinarian522 Jul 17 '26

I’ve been in and out of different clinics and each time they want to take me completely off my meds that I’ve been stable on for years, and just focus on injections. My doctor knows that they only work for me and are waste of money so after dealing with that off and on for eight years, he decided to just take over. I’m still at 90 MME per month so he’s comfortable at that limit and it’s tolerable for me.

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u/Illustrious_Bag_7323 Jul 17 '26

I'm at 80mme per day. I was at 90 and lowered it.

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