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Thursday, June 23, 2011

Narcotic contracts. Am I patient or potential felon?

I was at my pain doc's yesterday. While I was there I looked at the pain opiod therapy policy paper given to many patients. Theirs was titled as policy. I have seen them elsewhere titled as contract.

I understand all the problems related to pain medication, especially now that prescription drug abuse is allegedly at an all time high.

I hate that it, along with the "war on drugs", is being taken out on pain patients.

My meds are at the lowest level of narcotic. I have been lucky in that my doctors have always understood my request to try more potent meds. Invariably they do not help and I just go back to what I have been taking for years. I have never been asked to sign a contract about how I will take and use these meds.

When I read these policies and contracts, even though I have never been asked to sign one, my blood boils.

If I had diabetes or another disorder that required a daily drug I am not seen as a potential abuser and poseur. In fact, now that I think of it, diabetes is a perfect example.

One of the contract promises I have seen reads "I will make my month supply of medication last for the full 30 (31) days. If I use up the drug before the 30 days I will not be able to get more until the beginning of the next 30 (31) day period."

Pain patients can have better and worse days. If a worse day they may need to take an extra pill or two but if they do, then they will not have enough to cover one or two more days until the end of the month period.

A diabetic may eat sugary foods, be under stress or for other reasons their insulin need goes up. To my knowledge they are not told, 'well, tough'. They get the extra medication to make up for the time or two they had to use extra. Why are we treated differently?

"I promise I will not use illegal drugs while taking the medication prescribed by the pain clinic." That should be pro forma for any docs office. After all, every physician should want their patients to promise not to use 'recreational' drugs.

The worst of all, as far as I am concerned, is the extracted agreement to random drug and urine testing.

Because I have pain I have to sign a paper that says I promise not to be a felon. No other specialty requires this. No other specialty treats us as guilty until and unless proven innocent. No other specialty treats us as less than what we are - patients, in need of help, not judgement and implicit name calling.


  1. I actually just found a pain management doctor and yes, they made me sign a narcotic contract. It states the norm: no doctor shopping, no recreational drug use, including pot (which is legal in my state for medical usage!), no alcohol but when I asked about that I was told that it is not included in the drug testing and the reason it is in there is because it can affect the medication - of course! I said that's fine, but I'm going to have a glass of wine with dinner once in a while.

    I don't like the narcotic contract, but I need treatment. This was the first doctor that was willing to help me, so I signed it. I actually just went to fill my vicoprofen today and I am happy they fill 1 day early because I was totally out.

    I live in chronic pain from fibro, migraines, tmj and pretty much every other thing you can think of. Some days I am going to need more than the "recommended dosage". I'm on a pain patch (Butrans) and vicoprofen. The Vicoprofen hardly works so I have to take more of it. I'm stuck because I can't take acetaminophen based meds - what does that leave? Vicoprofen and Oxy - I refuse to go on Oxy! So I'm stuck with 7.5/200 vicoprofen 4 times a day that barely takes the edge off. And I can't even smoke pot if I wanted too because then they would pull my contract and I'd be stuck with nothing. Marijuana has been very beneficial in both fibro and migraine - I'd rather vapor that than kill my kidneys and liver with all these other pills.

    I swear the health system and all these yo-yos out there killing people over Oxy are giving the legitimate people who are truly in chronic pain - like can't get out of bed in the morning, can't work - can't hardly keep plans with people because they are sick all the time pain a bad rap - those are not the people abusing the narcotics. Those are the people who need them to have a better quality of life - no, they are the people who need them to HAVE a life!

  2. I so totally agree. I recently signed one of those contracts, but I hate having to do so. It's incredibly demoralizing and I just don't think they're the right approach. But I love the providers I'm working with at that clinic, so I'm choosing to put up with it.

  3. I completely agree with you! It is so unfair to those of us who live with legitimate pain on a daily basis. I have RA AND Peripheral Neuropathy...Intense stabbing pain 24 hours a day. Would I sign a ridiculous medication "contract" just to get meds that will help me? Yes. However, as Diana said, it is demoralizing.

  4. Jackie says:

    I don't live with pain, but I do want to give my support to you. I agree with everything in your post today, and in the above responses as well.

    And then did you read the articles this week about some of the the pharmaceutical companies closing down their CNS (central nervous system) divisions? There is a piece about it on the blog "Thought Broadcast"

    This means that pain research funding has been sharply curtailed, as has research in my area of interest ( bipolar/depression). Some companies are getting out of the business altogether. The implications of that seem to be very hard to grasp for people who don't live in pain, or have mental illness. "Oh well, we already have enough drugs to treat that" and "Oh good, drugs are bad for you anyway" seem to be the most common reactions.

    Thankfully, all is not lost as Japanese researchers continue to work on pain medicine.

  5. Alicia, Diana Lee and Eileen,
    I am so sorry you are in pain.
    That is the thing; it is the bad guys, the few, who have made it so much harder for the rest of us.
    It is definitely demoralizing (great word) and essentially blackmail, sign the contract or no meds. The opposite of the kind of care most other people get.

  6. Jackie, I did not, I don;t know why but have not got mail about thought broadcast in what seems like a few weeks. I will definitely check it out.
    It is amazing to me since it seems there is higher diagnoses of chronic intrctable pain and bipolar and other psychiatric illnesses that do seem to respond to meds. Usually when there's money in 'them thar hills' they chase it.
    Im assuing as always money will ultimately rule the day and they will continue to find more meds for both issues.
    At least some one sees that there is a reason to pursue it.

  7. I feel for all of you. I too suffer with severe neuropathy pain and have been trying to find someone who will help me. I've been to many doctors but they just don't seem to understand the pain I am in. They think a little dose of fentanyl will take all the pain away. If you ask to get a higher dose then you are labelled a drug seeker. So tired of all these doctors who claim to care. It really angers me that the people who abuse these drugs don't realize what this does to people who suffer with real pain. On a level of 1 to 10 my pain is 9/10 day in and day out. If I had cancer or was a dog I would not have this problem. Soooo sick of of this system. I too feel i moralized by signing a contract. :0(

  8. I agree with you about the contract and I am so sorry about the level of pain you have.
    My stimulator did help with some of my phantom pain. Have you looked into the possibility of that? (or maybe a morphine pump)? Sometimes that can hekp when they seem to have given up.