Training Guide

Quality Healthcare is Your Right

Special Issues

Pain Management

Pain affects everyone differently. Pain is your body’s way of telling you something is wrong. It is often a sign that you need treatment to address the cause of the pain. 

Doctors can be suspicious when a drug user says he/she is in pain and needs pain medication. They may think you are trying to misuse the medicine. On the other hand, experts tell doctors that they should never withhold pain medication when it is truly needed—so don’t give up hope that a doctor will help you. 

Working with your doctor to address your pain can be a sensitive issue. You may need to negotiate with the doctor to make a plan that works for you and the doctor. 


Keep a Pain Journal: Write down when, where, and how much pain you have. Consider rating your pain on a scale of 0 (no pain) to 5 (the worst pain you can imagine). This will help your doctor to understand the level of pain you are in and help to track if the treatment is working for you. 

  • Record exactly how the pain is changing your daily activities. For example, is the pain keeping you from sleeping, working, or eating? 
  • Include a list of what you have done to help manage your pain, heating pad, over-the-counter medication, cooling the area, resting, etc. 

If you do not want to take opioids because you are concerned about relapse or cravings, be honest with your doctor so that you can work together to think of other options. 

Some ways that doctors treat pain may include: 

  • Diagnosing the cause of the pain and treating that condition. 
  • Discussing different options for controlling pain including stress reduction, physical therapy, acupuncture, as well as opioid and non-opioid based medications. 
  • Making more appointments to closely monitor your level of pain and medication use.
  • Testing your urine for illicit substances. 
  • Recommending counseling. 

Be Careful with Common Pain Relief Medicines! 

It is important to talk to your doctor if you are taking Tylenol (acetaminophen). Acetaminophen can be more serious than you may think…and it is common in many cold medicines and pain medicines (Percocet, Vicodin, Ultracet, etc.). Too much acetaminophen can cause very serious liver damage or liver failure. That means no more than 8 tablets of Extra-Strength Tylenol a day (4 grams or 4000 milligrams) and be careful when you take it every day for a long time. If you have hepatitis B or C, you should talk with your doctor about acetaminophen. The general rule is to avoid taking more than 2000 milligrams per day. Drinking alcohol on top of high doses of Tylenol can be damaging to your liver. Ibuprofen (Motrin, Advil) and Naproxen (Aleve, Midol) should be taken with food to avoid stomach ulcers.

Pain management is really important to your overall well-being. It can take time to get pain under control so having a trusting and ongoing relationship with a doctor is important.



Tell your methadone clinic or doctor if you start taking new medication. Some medicines can make your body process methadone slower or faster, meaning your methadone dose may need to change if you start taking new medications. 

If you are on methadone, you may have been told that you cannot take “Talwin.” This is true, but you should also know that Talwin is not used much anymore. So, if you tell a doctor you can’t take it, you are basically telling them that you are on methadone. 

It is important to talk to your methadone program about medications prescribed to you—especially if they might come up in your urine. Bring the bottles to your appointment if you can. 


Reproductive Health and Prenatal Care 

It is important for women to visit the obstetrician/gynecologist for regular exams—even if you are not getting your period. If you are pregnant and using drugs, prenatal care including HIV testing and hepatitis B testing is VERY important for your health and your baby’s health. If you find out that you have HIV or hepatitis B, there are things you can do during pregnancy to reduce the chance of your baby getting it. If you are pregnant, strongly consider getting into drug treatment. Pregnant women usually go to the top of the waiting list for drug treatment. 


HIV and Hepatitis

HIV/AIDS: If you are HIV-positive or have AIDS, it is best to find a provider who has experience working with people with HIV/AIDS. They are more likely to have up-to-date information on medical treatments. It is very important to take HIV medicines exactly as they are prescribed. If you do not, the virus can figure out ways to make the medicine stop working (called resistance). There is public assistance (including medical insurance) for people living with AIDS in New York State. 

Hepatitis C (HCV): Anyone who has ever injected drugs (even once) could be at risk for HCV. There are different kinds of tests for HCV. It is important to understand what kind of tests you are having done. Antibody tests can tell you if you have ever been infected with HCV. But it is possible to have a positive antibody test for HCV and to not actually have HCV infection anymore. Ask your doctor for more information. Everyone who tests positive for HCV antibodies should have additional tests to see what your current HCV status is. There are medicines to treat HCV, but not everyone with HCV needs them. Ask your doctor for more information.


Drug Treatment 

Some drug treatment programs have medical care on-site. There are many different kinds of drug treatment programs, both inpatient and outpatient. It is important to find a drug treatment program that will support your needs. Try and find out exactly what kinds of groups and services are offered. Calling programs before you go can give you a better idea of what to expect. Find out what kinds of drug treatment your insurance will cover and how often they will cover it. For example, if you leave a 28-day program early, you may not be able to go back again for a certain period of time. Some programs will be able to help you with medical detox and some will not. Ask your provider for help finding the treatment program that will best meet your needs.


Mental Health 

If you are thinking about hurting yourself, go to the ER or call 911. Mental health services, like counseling or getting medication, can be accessed at some syringe service programs, community-based organizations, community health centers, and the ER. If you are waiting for your Medicaid or insurance to kick in, ask your psychiatrist if they can get “samples of medication” or help with patient-assistance programs (drug company programs where they give medication to people who need it, but can’t pay for it). If you take benzos (like Xanax, Klonopin, Librium, etc.), be very careful when you stop taking them for a period of time. Coming off benzos too fast may cause medical problems, such as seizures. 


This guide was produced with support from the New York State Department of Health AIDS Institute, the M·A·C AIDS Fund, and the Irene Diamond Fund.