I was on a pain contract before and my doctor said that I broke my contract by going to the E.R. so I'm no longer on the pain contract and she has tried to precribe Tramadol(ULTRAM) for me before but the pharmacy said I could't take it at the time because of two other meds that I was on and I asked my doctor again if she could prescribe it for my pain but since its an opiod and I don't have a pain contract anymore she can't prescribe it for me! ok, I understand that since I no longer have a contract with her she is unable to prescribe me any narcotic drugs but I don't understand why she can't prescribe it to me if its only a narcotic-LIKE drug please help!!!
I'm confused by your whole question. Usually docs only make you sign contracts when they're trying to detox you off opiates. And if you have legitimate pain issues, and I mean they can be proven with real tests like X-rays, CT Scans, MRIs, and you went to an ER for a good reason and the doc threw you out, then I call that a bad doc.
I also don't know if you mean the pharmacy is refusing to fill a script because of another opiate they think you're taking, or is it your insurance is refusing to pay for it?
So I'm all confused on that.
But I want to tell you what I know about Tramadol/Ultram. First of all, those are the same thing. Ultram is it's Brand name and Tramadol is the generic name. Regardless of how you classify it, Trammies are VERY addictive. I used to help people do a detox and I almost had more people coming to me who were hooked on Trammies than I did Vicodin and Percocet put together. This is because too many docs think Ultram/Tramadol isn't addictive. But it is, and from what my people told me the withdrawal from it is worse than Vics and Percs. So be careful with it.
Also, these words: opiates, opioids and opiate like drug are used wrong most of the time. Maybe I don't know the correct usage neither. The latest thing I read is an opiate is only a drug that is completely organic. So that means very few pain pills being sold are true opiates. And then I read that technically, as soon as the lab produces the drug as partially synthetic or entirely synthetic it's called an opioid. That would mean almost all the popular pain killers sold are opioids. And then to understand an opiate like drug requires the knowledge of more chemistry than I have. So in my chemistry stupid opinion I believe an opiate like drug is a drug that chemically is very different from a real opiate, but it shares the characteristics of opiates, meaning it kills pain and it's addictive. But I may be wrong. So don't quote me.
Tramadol is considered to be opiate like because it plays on the same opiate receptors on the brain as a true opioid does.. I would imagine that under the pain contract you were not allowed to take narcotics either. All opioid are narcotic but not all narcotics are opioid. Most PM doctors make you sign a contract that while under there care you are not to get narcotic prescriptions from any other doctor and that if you do have to go to the ER you are to notify the PM doctor first. Also you have to get all prescriptions filled at the same pharmacy. The contract is to be signed by every patient under the PM doctors care. Not just people who are weaning off meds or are addicts. It is a precaution that doctors have to take in order to protect themselves , but also to protect the patient.
To wrap it all up... Tramadol plays on the same opiod receptors in the brain that true opiods do. It is less addictive than other opiods but it is addictive none the less. In fact if you look in the Tramadol support group on this site you will find many people that are or have been addicted to Tramadol. That is why the doctor won't prescribe it to you after you broke the contract. Maybe a fresh start with a new doctor could help you. Just be sure you fully understand the contract so you don't run into the same problem.
I will try to explain 2 answers here. First to nevaehandtashia, Ultram to my understanding as described to me by a Pain mgmnt doctor is synthietic, & does not actually become opiate like until it mixes with your body chemicals. That is why is became so popluar for doctors to write for it. They were pretty fooled by the drug company reps into prescribing it not realizing all the problems it can cause the patient. The contract you are speaking of is required now by the FDA for all doctors prescribing any & all pain meds. Too many of prescription drugs are ending up on the street, & this is their way of cracking down. If they are going to write scripts for pain meds, they must have specail schooling to be able to do this. A lot of the Internists don't have the time or aren't willing to go back to school to take the required training..
My own physician had to have me sign a contract & do a urine test just for a prescription for Xanax so we ended up just letting my pain mngmt doctor take over that script along with the pain script. I hoope I have explained this to your satisfaction, & answered Thor's query also.
I hate the word "narcotic" when speaking of pain meds. It is actually an antiquated word and it speaks of illegal substances since "narcotic" is often used by law enforcement for illegal drugs. Narcotics generally refers to a drug or substance that produces stupor, complete insensibility, or sleep. It can be drugs derived from opium, cannibis, belladonna derived drugs and also even alcohol, although alcohol is not usually classed with narcotics, it could be technically. In law enforcement, it also refers to cocaine, ecstasy, heroin, and a host of other drugs that alter a persons state of mind. Opioid or opiate is a better way to describe pain medications. Opium has been used for social and medicinal purposes for thousands of years to produce euphoria, analgesia and sleep and to prevent diarrhea.
Several pharmacologically active compounds are derived from the opium poppy, Papaver somniferum, including morphine, codeine, papaverine, thebaine and noscapine. Opioids is the term given to natural or synthetic drugs that have certain pharmacological actions similar to those of morphine by the interaction with some or all opioid receptors.Tramadol is not derived from opium and is very chemically different than opioids. It is more closely related to antidepressants in that it affects serotonin. It is "opioid like" though because it acts on the same pain receptors as opioids do. These are the mu, delta and kappa receptors. Not all opioid analgesics act on all receptors. Most of them effect the mu receptor though. Since Tramadol acts on these receptors it is considered "opioid like" and therefore still has all the addictive properties of opioids. In the beginning they did think since it was not derived from opium it was going to be less addictive than most opioids. It didnt take long to find that this was not true. As others have said a contract is used to protect both patient and Dr and it shows as a document to state the Dr has counseled you in the dangers of opioid drugs and you are promising to abide by certain agreements to obtain these meds like using one pharmacy, not obtaining these meds from any source other than your PM Dr. Emergency situations are handled differently by different Drs though and I usually encourage people to discuss this with their Dr prior to signing a contract so they know how a Dr will handle emergency situations. Some dont mind if drugs are given in an some emergency situations. Some want to be contacted prior to their patients being given any opioids and some dont want their patients to receive any pain meds that they did not prescribe, period! So always be sure you bring this up to any Dr handling your pain management. Your Dr was one who decided you violated your contract by receiving meds without notifying her. Perhaps it was the circumstances. If you had been in a severe car accident and needed immediate pain relief that may have been excusable but if it were just a flare of your back pain, say, that is something that you could have called her for advice first and if she said "Go to ER" then she would have gave permission and even on weekends Drs are usually available by answering services so it being weekends is usually not a good enough excuse to go to ER without contacting your PM Dr. Once a contract is violated then the Dr genrally wont give anymore opioids and in this case she feels like opioid-like drugs count too. You can either abide by this or you might try things over with a new Dr. As far as the pharmacy saying you could not take Tramadol because of other meds you were on. that was probably due to a drug you were on that affected the serotonin. Too many drugs affecting serotonin can cause what is known as serotonin syndrome and drugs that do this are contraindicated to be taken together. I hope this explains some of the differences between narcotic, opioid and opioid like!
I can answer this question for you and I will try and do it in the simplest possible way. Most PM doctors that have you sign a pain contract require that they be informed of any ER visits even if they were for something completely unrelated to why you are seeing them. The reason that she can not prescribe Ultram (Tramadol) is because according to the FDA it is classified as a "Narcotic". Therefore, because of that classification and the fact that you broke your pain contract with her she can no longer prescribe anything that is considered a "Narcotic" to you. Now, having said that I am wondering what it was that you went to the ER for... without to much information if it was for pain that was regarding the reason that you see her and you received either a narcotic injection or they wrote you a prescription for a narcotic then depending on your contract legally she is not allowed to give you any more prescriptions for pain medication.
Now, I would suggest that you find your copy of the contract that you signed, or ask them for a copy of the one you signed and read it to make sure that you did in fact break the contract. I say that only because I see my PM doctor for several reasons and they prescibe my pain medications but do not prescribe all of my "Controlled" substances, ie... Valium, Ambien, but I am tested by them for those drugs since I am on them. I do get terrible migraine headaches and according to my contract, and every doctor has their own version, I am allowed to go to the ER for anything including a migraine headache and I am allowed to receive an pain injection (Dilaudid and Phenergan) to help take the pain away and relieve the migraine. However, I am not allowed to go to the ER for pain related to the reasons that they are treating me for, but I do have to call them and inform them after any visit for any reason. A visit to the ER should not have been enough of a reason to break that contract unless you were there for something that she is treating you for. A PM doc can not prevent you from going to the ER if something is wrong but again depending on what your contract states if you received any kind of pain medication from the ER than you may have violated that contract. I strongly advise you again to get a copy of the contract that you signed and find out if what you went to the ER for broke that contract. Also, it may be time to seek out a different PM doctor, if that is who you are seeing. To do that you will have to tell that PM doctor that you want to be discharged from their care and give you paperwork and your records, which may take a few days, and ask to be reffered to a different PM doctor. If the doctor you are seeing is just a PCM(Primary Care Manager), then ask for a refferal to a PM doctor who can keep track of things. I am sorry that you are having such a difficult time with all of this and I hope that this and all the other answers have helped you out in some way. I wish you the best of luck and as many pain free days as possible.
I understand what you are going threw. For chronic pain, tramadol and Flexeril, are just a little help, but they really go along way to help. It is probly okay to take these on a regular basis. The one and only reason the doctor dropped you and I have been threw this, is because you went to the E.R. and it does somehow break your contract, I know that little thing you forgot they told you when you were in sever pain. It sucks, but it is important and I found that out. I had a F.R.A. done, and then I was on Neurontin and so all was like pain became too sever for me to even walk I wanted to drive myself to the E.R. and could not. It was horrible. So , I told the E.R. guy about it and who my doctor was, and that guy was soooo mean to me. Come down to it, he gave me a shot of Toradol, and because of the medicines I was on I had a drug reaction to it.
I was screaming and they called the cops on me for loosing it, then when I got home I found out, that it was part of the side effect that was bad and I was supposed to be hospitalized for it instead of cops coming. LOL okay so next morning I was still screaming and could not help myself but that the beginning, I was dehydrated, over urinating and went you know in my pants and stuff, then diarrhoea and vomiting then hypersensitivity. So, I called my pain doctor and told him. He did not drop me because it was a holiday weekend and I could not get a hold of him on emergency. that is only reason why but his nurse was telling him to drop me. So when we sign that contract they don't' tell you why exactly you just imagine like I thought they wanted me to not get pills like from two doctors (because drug addicts do that) so, you think well not to worry because you don't abuse your meds. But then I learned alot more, I went searching and found out alot of side effects of some pain meds and they are not pretty, So, what the side effects of tramadol are I'm not sure , they could be anything, I found out the lidoderm and cortisone pain shots cause hypoglycaemia, diabetes and osteoporosis, what a thing. These pain meds are not fun. I wish you the best and just Ib profen is about the safest thing (If you are not prescribed anything that goes against it) research N.S.D.S you will learn so much I never knew how much crap goes with this. I am wishing you a pain free day someday.
If you are looking for and answer to, if it is a drug or narcotic? Yes,, it is,, the diference between other narcotics is that it does' not come out on the drug test, but, it is really adictive if you use it more than a 15 days to a month, also if you are taking more than prescrived.
It haves the worst side efects than a many natcotics like vicodin norco or other prescrived drug pain kilers, i dont advise anyone to go over the limit your doctor prescrives,,some people taking this as a way to get bust,, omg i wish you all the luck in the world when you try to get out of it, my doctor prescrived this to me once for chronic back pain and it work fine but after 3 weeks he put me back on non-narcotic pain kilers and it was hell what i whent to get it out of my system,, then after it was sso hard to sleep sweets all the time nervousnes upset all the time,, and i did not knew that was because i stoped the pills untill my doctor told me that was a side effect when you take it more than 3 weeks,, it comes adictive and he forgot to tell me that,,, duhh!!! so any ways they say it is not narcotic other Dr's say it is,, it does the same efect but it hooks you up in days even with 50mg dosage every 8 hours,, so is u to you!!! good luck!!!
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