Feature: Pain Patients, Pain Contracts, and the War on Drugs

Pain contracts. Pain management contracts. Medication contracts. Opioid contracts. Pain agreements. They go by different names, but they all mean the same thing: A signed agreement between doctor and patient that lays out the conditions under which the patient will be prescribed opioid pain medications for the relief of chronic pain. (To see a standard pain contract, click here.)

http://stopthedrugwar.org/files/oxycontinpills.jpg
Oxycontin pills
For some of the tens of millions of Americans suffering from chronic pain, opioid pain medications, such as Oxycontin or methadone, provide the only relief from a life of agony and disability. But with the Office of National Drug Control Policy's ongoing campaign against prescription drug abuse and the Drug Enforcement Administration's (DEA) ongoing crackdown on physicians it believes are prescribing opiates outside the bounds of accepted medical practice, the medical establishment is increasingly wary of pain patients and adequate treatment of pain is a very real issue for countless Americans.

In recent years, doctors and hospitals have turned increasingly to pain contracts as a means of negotiating the clashing imperatives of pain treatment and law enforcement. Such contracts typically include provisions requiring patients to promise to take the drugs only as directed, not seek early refills or replacements for lost or stolen drugs, not to use illegal drugs, and to agree to drug testing. And as the contract linked to above puts it, "I understand that this provider may stop prescribing the medications listed if... my behavior is inconsistent with the responsibilities outlined above, which may also result in being prevented from receiving further care from this clinic."

"Pain agreements are part of what we call informed consent," said Northern Virginia pain management and addiction treatment specialist Dr. Howard Heit. "They establish before I write the first prescription what I will do for you and what your responsibilities are as a patient. They are an agreement in order to start a successful relationship that defines the mutual responsibilities of both parties. More and more states are suggesting we use agreements as part of the treatment plan with scheduled medications. Such agreements are not punitive; they protect both sides in functional way."

If Heit sees a cooperative arrangement, others disagree. "This is really an indication of how the current DEA enforcement regime has created an adversarial relationship between patients and physicians where the doctors feel the need to resort to contracts instead of working cooperatively with patients," said Kathryn Serkes, spokesperson for the Association of American Physicians and Surgeons (AAPS), which has been a fierce critic of criminalizing doctors over their prescribing practices. "The pain contracts are a tool to protect physicians from prosecution. He can say 'I treated in good faith, here's the contract the patient signed, and he violated it.' It's too bad we live in such a dangerous environment for physicians that they feel compelled to resort to that," she told the Chronicle.

"Patients aren't asked to sign contracts to get treatment for other medical conditions," Serkes noted. "We don't do cancer contracts. It is a really unfortunate situation, but it is understandable. While I am sympathetic to the patients, I can see both sides on this," she said.

"There is no evidence these pain contracts do any good for any patients," said Dr. Frank Fisher, a California physician once charged with murder for prescribing opioid pain medications. He was completely exonerated after years of legal skirmishing over the progressively less and less serious charges to which prosecutors had been forced to downgrade their case. "The reason doctors are using them is to protect themselves from regulatory authorities, and now it's become a convention to do it. They will say it is a sort of informed consent document, but that's essentially a lie. They are an artifact of an overzealous regulatory system," he told the Chronicle.

"When this first started, it was doctors using them with problem patients, but now more and more doctors and hospitals are doing it routinely," Fisher added. "But the idea that patients should have to sign a contract like that or submit to forced drug testing is an abrogation of medical ethics. Nothing in the relationship allows for coercion, and that is really what this is."

The pain contracts may not even protect doctors, Fisher noted. "When they prosecute doctors, they can use the pain contract to show that he didn't comply with this or that provision, like throwing out patients who were out of compliance. The whole thing is a mess."

http://stopthedrugwar.org/files/michaelkrawitz.jpg
Michael Krawitz (photo courtesy Drug Policy Forum of Virginia)
It is a real, painful mess for a pair of veterans trying to deal with chronic pain through the Veterans Administration -- and it is the drug testing provisions and the use of marijuana that are causing problems. Michael Krawitz is an Air Force veteran who was injured in an accident in Guam two decades ago that cost him his spleen, pancreas, and part of his intestine. Krawitz also suffered a fracture over his left eye, received an artificial right hip, and has suffered through 13 surgeries since then. He had been receiving opioid pain medication at a VA Hospital in Virginia, but things started to go bad a year ago.

"Last year, I refused to sign the pain contract they had just introduced there, and they cut me off my meds because I refused," Krawitz told the Chronicle. "Then I amended the contract to scratch off the part about submitting to a drug test, and that worked fine for a year, but the last time I went in, they said I had to do a drug test, and I again refused. I provided a battery of tests from an outside doctor, but not an illegal drug screen. That's when my VA doctor sent an angry letter saying I was not going to get my pain medicine."

Krawitz has provided documentation of his correspondence with the VA, as well as his so far unheeded complaint to the state medical board. As for the VA, some half-dozen VA employees ranging from Krawitz' patient advocate to his doctor to the public affairs people to pain management consultants failed to respond to Chronicle requests for interviews.

For Krawitz, who has used marijuana medicinally to treat an eye condition -- he even has a prescription from Holland -- but who says he is not currently using it, it's a fight about principles. "I will not submit my urine for a non-medical test," he said. "The VA doesn't have the authority to demand my urine. It's an arbitrary policy, applied arbitrarily. The bottom line is that we vets feel very mistreated by all this. Some of us have sacrificed limbs for freedom and democracy, and now the VA wants to make us pee in a bottle to get our pain medication?"

The imposition of pain contracts is not system-wide in the VA. A 2003 Veterans Health Administration directive on the treatment of pain notes that "adherence with opioid agreement, if used" should be part of the patient's overall evaluation.

Krawitz is preparing to file a federal lawsuit seeking to force the VA to treat him for pain without forcing him to undergo drug testing. For Tennessee vet Russell Belcher, the struggle is taking a slightly different course. Belcher, whose 1977 back injury and spinal fusion had him in pain so severe he couldn't work after 2000, was cut off from pain meds by the VA after he tested positive for marijuana. Belcher said he used marijuana to treat sleeplessness and pain after the VA refused to up his methadone dose.

"It's a wonder to me that some vet ain't gone postal on them," he told the Chronicle. "They pushed me pretty close. To me, not signing the substance abuse agreement is not an option. If you sign it you're screwed, if you don't sign it, you're screwed. I complained for months about the dose being too low, but they said that's all you get and if you test positive for anything we're kicking you out. When the civilian doctors would find marijuana on a drug screen, they told me they would prefer I didn't do that because it was still illegal, but they didn't kick me out of the program. I was using it for medicinal purposes. I have tremendous trouble sleeping, muscle cramps that feel like they'll pull the joint out of the socket. I had quit using for a long time because of this mess with the drug testing, but then they wouldn't increase my pain medicine. I thought I have to do something; it's a matter of self preservation," he said.

"The pain clinic at the VA has discharged me from their care and said the doctor would no longer prescribe narcotics for me unless I attend the substance abuse program," Belcher continued. "They aren't going to be satisfied until I spend 30 days in the detox unit." While Belcher would like to join Krawitz in taking on the VA, in the meantime he is looking for a private physician.

When asked about the veterans' plight, Dr. Fisher was sympathetic. "They made Krawitz sign a contract under duress with forced drug testing as a condition of his continued treatment," he pointed out. "That violates basic rights like the right of privacy. There is no suspicion he is a drug addict. They want to treat all patients as if they were criminal suspects, and that has little to do with what the nature of the doctor-patient relationship should be."

Dr. Heit, while less sympathetic than Dr. Fisher, was decidedly more so than the VA. When asked about the cases of the vets, he explained that he would be flexible, but would also insist they comply with the terms of their agreements. "In the end, you have to choose whether you want me to do pain management with legal controlled substances or you want to use illicit substances, but you don't get to choose both," he said. "I don't disagree that marijuana may help, but the rules are it's an illicit substance. I can't continue to prescribe to someone who is taking an illicit substance."

And here we are. Patients seeking relief from pain meet the imperatives of the drug war -- and we all lose.

Permission to Reprint: This article is licensed under a modified Creative Commons Attribution license.
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ADHD meds too?

I'm a mom in my mid 40's who was diagnosed with ADHD four years ago. I was put on Adderall then, and have been taking it regularly ever since.

I have to get a paper scrip from my primary care provider each month - no refills on Schedule II, you know - which is a HUGE pain, but do-able. I call, they write it up, I pick it up and take it to the pharmacy. Unless I'm sick, I normally just see my provider for my yearly women's exams - where we also discuss my ADHD, meds, other health concerns.

Today, I called to get this month's Rx, and was told that I now have to have a monthly appointment with a "behavioral specialist" in order to get my Rx. I was told this was a new policy for anyone on narcotics.

What's up with this?? Is this related to this pain medication issue? Are they gonna make me sign one of those lame contracts? I smoke pot (it helps with my chronic migraines and TMJ) - will they kick me off my ADHD meds because of it? What if I have a med MJ card (I live in Oregon)? I'm in the process of getting one... Will that help or hurt?

I'm freakin out, what a drag. Any advice would be much appreciated. My "behavioral" appt is Monday.

Thanks.

Perhaps you wouldnt have so

Perhaps you wouldnt have so much trouble with "attention deficit" if you werent smoking pot. I imagine that if you had been honest with the physician who prescribed the Adderall to you that you were regularly using marijuana they probably would have recommended you to stop and see if your difficulty with paying attention went away.

You apparently don't know

You apparently don't know much about pot or ADD. First off, it doesn't matter how much you smoke pot, you'll never exhibit any of the symptoms of ADD. Second, you don't just walk in and say 'I have ADD' and get handed pills. There is a decent testing process a doctor will go through before the diagnosis is laid out there. Third, Attention Deficit is a whole lot more than just being unable to pay attention.

To the original poster, I wouldn't tell them that you smoke pot. Thanks to the stupid drug laws pot remains illegal and while a doctor may share our views on it's usage, he still is bound by law to go by the rules. Save yourself and him the hassle and leave it out of the equation. It's not the cause of your ADD and it's not effecting your ADD. If they make you sign the stupid contract it will say in there that you can NOT smoke marijuana or they will stop treating you. Some places make you do mandatory drug testing, others don't. It's unfortunately ridiculous. If you are approved for a medical marijuana card it should be okay as everything is still doctor prescribed.

Good luck to you fellow Oregonian!

Dear Anonymous- I live

Dear Anonymous-
I live across the river from you in Vancouver Wa. I'm also on a pain contract for Morphine and they pee test me but that's ok. I hate pot. I had a lady friend a few months ago who died from an opiate overdose. She had the same doctor as me and she loved the pot. She was also getting Morphine. Well, they found THC, pot, in her pee two times and stopped her pain meds. She freaked. She really needed both drugs for pain and was a fully funtioning person that worked a full time job. She ended up buying pain pills off the street. About 3 months ago I called her house just to chat and her roomate got real quiet and said "You didn't know she died?"

I couldn't believe it! She said that she died from withdrawel but we know thats not right. I think she got something from the streets and it killed her. She was in her 40s and a great lady.I think the doctors and clinics need to really look at each case real good before throwing someone off the pain meds cold turkey. Why not at least taper them down for a few months so they don't go running for black market crap. It's a sad thing. The pain meds work but the doctors and clinics are so paranoid of lawsuits that the patient takes a backseat to their own safety. There is no better pain killer then morphine, and taken right, it does the job. Keeping it off the streets is a problem but it can be done.

I think it would be real good if they put caps on the lawsuits. Too many frauds looking for a free lunch and we all pay for it with higher cost and having to pee in a bottle. You might have to make a choice. Good luck.

Can anyone help me please?

Can anyone help me please?....I just moved here to Vancouver, WA from out of state and I'm having a hard time trying to find a doctor or pain management clinic who will keep prescribing my oxycodone rx. I was legitimately diagnosed with chronic pain, but there are so many people out there who abuse the medications that it's hard if not impossible for us who actually need them to get any help.  It's extremely frustrating.  I have a broken hip (2 metal plates and 8 screws) and also a broken vertebrae in my lower back along with a herniated disc.  Since I no longer live where I can pick up my rx from my old doctor he will not send me my rx or call it in since it is a narcotic.  Anyway, I was wondering if anyone knows of a clinic or possible doctor who can help me..?

Thank you to anyone who can help. 

PAIN MANAGMENT CONTRACT

It was not till i signed a pain contract that i finally started 2 get the help i was supposed 2 be getting. I have made numerous trips to the Er and 2 the walk in clinic and of course they treated me like a dope fiend when i was really in pain. Then i finally got to c a surgeon who dismissed that i am a dope fiend that i really am in serios pain in which case they had me sign a pain contract and the doc has me on 10mg of methadone and 5 mg of oxycodone it works and i like life today yes i have to go back for a script everymonth but that is better than nothing. GOOD LUCK PEOPLE

what kinda pain

what kinda pain

DEAR SUFFERING IN OREGON

JUST KEEP YOUR FAITH AND DONT WORRY FOR TODAY ,BECAUSE TODAY YOU CAN NOT DO ANY THING ABOUT IT,AND WORRY ADDS TO YOUR PAIN!! ALSO EVEN THOUGH WE DONT ABUSE MEDICATIONS,OUR BODIES TEND TO GET ADDICTED, SO I RECOMMEND YOU TRY AND WORK A TWELVE STEP PROGRAM,OTHERWISE YOU WILL DRIVE YOUR SELF NUTS-ALSO HAVE YOU EVER THOUGHT ABOUT METHADONE? IT SAVED ME FROM A VERY PAINFULL CONDITION CALLED ENDOMETRIOS. I DR SEARCHED FOR YEARS AND LOST MY TO BE HUSBAND BECAUSE OF PAINPILL ADDICTION,WHICH BY THE WAY WERE TOLD TO TAKE BY MY MEDICAL DR. BEFORE THE PAIN ACTED UP, THEN ONE DAY CUT ME OFF!!!! AFTER THAT AND FIVE SURGERIES I FOUND OUT ABOUT METHADONE AND IT HAS CUT MY PAIN AT LEAST75%-ALTHOUGH IT IS LIKE LIQUID HANDCUFFS--- WISH YOU THE BEST SINCERELY SALT LAKE CITY

V.A Medication

My dad is a 100% service connected vet, he has been on hydrocodone 10mg for the past five years and now they want to take him off of it when nothing else works. He's done everything they have asked of him, submitted to drug test, signed a narcotic aggrement, and jumped through hoopes basically. He is 74 years old and served his country, he did this without asking for the V.A to sign a contract! He is the commander of the American Legion and a proud American. Now when he needs his medication they turn him away, he has some snot nose punk telling him he can't have his medicine, a physician who isn't from this country and could care less about the men and women who fought for this country, it pisses me off to say the least!
SHAME ON YOU V.A! I'm a paramedic and a nurse and I hope i get to take care one of you SOB's one day!

VA no meds

I recently enrolled in the VA Hospital sytem. I am in shock over their policy on pain medication. Two doctors so far have told me that they were sorrry, knew I was in pain but could not prescibe me narcotics. I have a Medtronic inplant which does nothing for the back pain. I don't take pain pills everyday. I even brought my pharmacy printout and all my medical records with me. Proof that all of last year I only had 70 pills. I can manage the stuff. I just have to have it at times.It is sad that I am being treated like a drug addict.

re: VA MEDS

You are positivly right!!!!!!!!! They treat you like you are a criminal.Iam a 100% and the last time I saw a new primary care doctor at the VA .I was treated like a piece of shit by a foreign doctor and I told them to shove there pain killers up there ass !!!! I have a new doctor who speaks english and is not part of the VA and treats me with total respect for my blood shed for this great country!!! Angry ! Yes especially when there so called motto is" TO CARE FOR THOSE WHO BORNE THE BATTLE ' God bless all my brothers and sisters who have to bear this burden from this agency!!!!

So much for them being 2nd to

So much for them being 2nd to none, because they are 3rd to the one's that are 2nd !!!!

They make you feel like you have to fight for it ever month, which at times puts you in so much pain you want to kill

 yourself

I too am an American Legion

I too am an American Legion commander,and was taking 10/325 for nine years.I too was cut off,by the friends at the v.a.I was also a veterans service officer, and had heard of this new trend in care..They through a piss test did not find enough of the prescribed drug in my sample.I drink (8) or more glasses of water,and a little beer, to help my kidneys and liver when taking this stuff.Also as we all know we have to request by mail,then we receive by mail our medications sometimes having run out days before due to forgetfulness or being busy or just the damn mail.They also wanted for me to sign an updated version of a narcotics agreement,bull ##@$!!&&.When does administrators in these clinics become the deciding vote,on your patient doctor privilege.Now we must be at the mercy of an internal third party worrying about his ass.We need a waiver from the D.E.A.We are not second class citizens.Lastly the v.a. wants me to run and be tested by my local clinic,then if the drug is still not there they want me to go to the nearby v.a. hospital for a confirmatory test.You know the first test will fail as I have been out for some time,and the other test seems ridiculous.In the this time when we veterans are strapped for money we are supposed to be the at the beckon call of the v.a. when their is some administrative policy change.It at first seemed that the v.a. was picking on me and I find this site and hell this has been going on for to many veterans.Stand proud and let's organize and out a damn stop to this nonsense and disrespect.

im right there with you. my

im right there with you. my husband has had 5 spinal surgeries from a helo crash while in service. we just moved to idaho and his doc at the salt lake city utah va cut his meds in half even a NON-narcotic!! the problem is doc just dont care like they used to and like they should. i cant wait for the day that those "doctors" are finally slaped with a lawsuit for refusing treatment as patients they have the right to choose what treatment that works for them these are docs with a God complex if you ask me.

VA Drug Contract Violation

Have been dropped from VA narcotic prescriptions, no questions asked, after having become involved with major dental work that spiraled from a short term pain issue outside the VA program to an unmanageable situation. The VA discontinued treating a proven verified medical condition (being treated for over 2 years) and contacted outside VA physician, instilling terror of a DEA swat team raid, who also stopped treatment for painful neuralgia condition resulting from dental treatment. Would like to appeal the VA cancellation but don't know where to start.

contracts, peeing, blood work = $$$

I am being treated for chronic back pain and also a 4 level cervical fusion. I have been undergoing the URINE screening for years now. Suddenly, they also want blood work in addition to the urine. Why?

I never run out or ask for medication before I need it. I have passed many years of their urine screenings.

I am drawing a line in the sand when it comes to blood work. I hate needles and I get blood work for my low thyroid enough. If they toss me out, fine.

 

Who is watching the doctor? Mine goes out of the country for 3 weeks, every 6 weeks. He does appointments over the phone about 4 times a year. He mails me narcotic pain meds after he hangs up from our phone appointment. He post dates prescriptions because he has nobody, "on call", for when he is vacationing, whereever.

 

I was told by a doctor working on me manually, that I should not be taking neurontin and lyrica as they are the same thing (pretty much) nerve medication. Taking over 1800mg of neurontin is pointless, yet I am on 2400mgs a day.

He changed me from avinza to Kadian and from oxycodone to oxycontin. These were choices HE made after I told him what the "manual" doctor said.  I do not think blood work is necessary and it IS invasive to me. I should have some say as to where I draw the line.

 

So, I have all these hoops to jump through, and I have done it, but who is watching the doctor? 

I have done NOTHING wrong in the 5 or more years I have been getting prescriptions nor have I flunked any urine test. Does anyone else think it is odd to suddenly add blood work and for what reason would this be necessary?

 

Thanks.....

ADHD Meds

I didn't know that Adderall was a narcotic. I would guess that the new policies are part of the general outfreakage of the DEA regarding opiates.

At the "behavioral" appointment, the only thing I could recommend is probably what you already know: be calm, rational, and non-antagonistic; explain your situation honestly so they can see that you're stable.

Good luck.

Picture of pills

The picture above does NOT show Oxycontin (TM), the continuous release oxycodone from Purdue Pharma. None of the Oxycontin (TM) pills are caplets like the ones at the bottom, and none are reddish brown like those at the right. The white ones could be 10 mg., but they look a little too big.

It really looks like the white ones are aspirin, the reddish brown ones are ibuprofen, and the caplets I don't know.

If you need pictures of the real thing to illustrate your articles, try one of the many pill identification sites on the Internet, but please don't use fakes or substitutes.

pill pics

The top pills look similar to the 5 mg oxycodone I take and the pinkish pills are identical to the 20 mg oxycodone CR (12 hour control release) I take for bedtime.

Adderall

Adderall is not medically a narcotic, it is a stimulant... but it's another medicine that's being demonized by overzealous drug police, Amphetamine. Although, like opiods, it has abuse potential it has been a useful medicine for nearly 100 years.

adhd meds and pain contract

I was diagnosed with adhd in 2007. My dr. rx'd methelyn e.r which is cheaper than the concerta my kid takes. In nov of last year she required a contact and a drug test. I agreed but felt intruded on. She was the one who has been prescribing my meds; adhd meds, cholesterol, migrain and advair for asthma. She didn't require a drug test for my daughter or my husband who is onl tylenol w/codein for periphreal neurapathy. We were with Kaiser perm. for 10 years prior to 2007 and they never required a contract or drug test. I have nothing to hide, the problem is the drug test cost me 150.00
I understand wanting things documented but if I have to go in every 3 months just to get the stupid peice of paper, I think a contract and a drug test is way out of line. I'm pretty sure my dr is not a proponent of adhd meds but as the article stated, there is now a little hositility between me and my dr.

Medication Contracts/Picture of Pills

God forbid anyone should feel good after taking medication. The whole policy is disgusting and, unfortunately, typical.

And what's with the complaint about pill identification? Are you some employee of Purdue? Or are you just obsessed by pill identification?

Picture of Pills

I am not an employee of Purdue, but a lot of people find pills that are unlabelled and if they experiment with them the results could be harmful. No, not with aspirin or ibuprofen, usually. And maybe I am a little obsessed with the correct identification of pills. If you don't think this is a problem, call Poison Control and ask them about the number of people who call to find out what they or a friend have taken when they start to have problems like convulsing, etc.

borden's picture

the now infamous picture

Friends,

When putting together this issue of the Chronicle I found this picture of what I believed to be Oxycontin pills on the DEA web site. I believed it to be Oxycontin because it appeared alongside a discussion of Oxycontin.

Looking back at the web page, I realized that I had looked too quickly and that the paragraph in fact discussed other pain pills as well, though less prominently. Rather than research the matter I have decided to take the word of our anonymous participant that in fact the pills are not Oxycontin.

There is now a different picture on the site which is definitely Oxycontin.

David Borden, Executive Director
StoptheDrugWar.org: the Drug Reform Coordination Network
Washington, DC
http://stopthedrugwar.org

the infamous picture

Thank you, David! I am the one who posted the original comments about your earlier picture. I know something about Oxycontin because I take them. By the way, Purdue stopped making the 160mg at the request of the DEA a couple of years ago.

--John Zelnicker
zman4254(AT)comcast.net

Pain Management Doctors

I went to pain management doctors for 5 years and I did take several medications such as oxycontin,liquid morphine,sleeping pills, muscle relaxers,and many more medications at the same time and was I walking around like a zombie. I also had thoughts of ending my life due to these medications. I used marijuana so I wouldn't have these thoughts and it worked, also I used it to stop the spasms and nausea right away instead of waiting for the medications to take affect. Well they took a test and dropped me as a patient and I'm glad they did. I now am thinking very clearly since I don't take all those medications. I also found out my pain level went down. When I told one of my doctors this his reply was after taking pain medications for a long length of time it sometimes will reverse and cause more pain than I had. Now at times I might need to take pain medication for a day or two but I will never go back to pain management doctors again. I have seen two other pain management doctors since and when I ask them about marijuana for medical use one understood me and the other wished he could find out what was in marijuana that helps so many people. I wish someone would tell me to go to a drug rehab or a group for addiction but when I did go to a psychologist he told me if I could not admit I had a drug problem with marijuana I couldn't see a drug counselor. Yes I would like to talk to them just to see there side of this issue but I guess that won't happen. Anyway it's funny that every doctor I have talked to about this issue agrees with me and the only ones that don't are pain management doctors. I hope one day the doctors can be doctors instead of police doctors.

Marijuana while at times may

Marijuana while at times may be helpful, it can bring on panic attacks and muscle pain when using it. It is very helpful for nausea. When used in moderation anything can be helpful. I know of someone with genetic neuropathy and they give this person neurontin and lyrica which totally zone them out, and I can't stand being around this person when they are like this but when they are using their pain medication and off the anti-seizure meds they actually have a life. I think that if Drs. prescribed pain meds for people that needed them, they wouldn't have to go to the Dr. and therefore the healthcare industry would suffer. The government is very sneaky at what they control. I was prescribed prozac for anxiety at one time and damn near committed suicide, I was so amped up but yet you can get that crap at the drop of a hat. It's all relative what hurts, who you are, how you use it, if the FDA approves it and I know how this agency works. They do not do proper inspections at medical assembly plants, they don't even really know what to look for, it's amazing.

Pain Drs.

I to went to a pain clinic.  I was happy because i was being given the right amount of medication that really helped me cope with the pain.  I have had 3 failed back surgeries.  With the medication i am able to more fully function, and well just do normal things most healthy people take for granted.  I on occasion would smoke some weed, but not too often as i was subject to random drug testing.  I also got booted out on my ass from the clinic.  It was just like screw you, we don't give a crap if you r in pain..you marijuana smoking freak!  I finally found a family doc that was giving me some meds, alot less than was on at the pain clinic, but i was just thankful he was giving me enough to sort of cope with the pain.  I was actually going to complain to the Dr. because he just without my knowledge lowered my hydrocodone to almost nothing, and i really needed a higher dosage!  Today i was at his office and he telling me he wants me to stop taking the hydrocodone because he thinks that my stomach is not emptying the food because of the narcotics.  I am amazed he came to this conclusion as i have been on pain meds for quite a few years, and all of a sudden it is like i am healed.  Now i figure, well i quit smoking weed back in Dec when i got busted from the pain clinic and it is the end of July now..hell i am starting to smoke pot again because it is all i have!

Pain medication contract

I am a clinical psychologist with chronic pain. Over a period of years, my physician and I have developed a regimen of several medications that works for me - most of the time I can work, participate in volunteer activities, and care for my family. I live in fear of losing my physician because of the difficulty in finding another who understands the difference between a chronic pain patient and a drug addict.

I had a patient whose pain treatment provider left (actually was run off to practice in another country because of willingness to prescribe pain medicines). She was a middle-aged woman with a documented history of medically-related pain and absolutely nothing that would indicate a potential for drug abuse. The first time she went to a new physician, she left in tears. He had a medication contract with the humiliating conditions listed in this article. In the presence of her granddaughter, among other things,he berated her because she had taken xanax briefly in the past and told her she would be dead in five years if she continued to take oxycontin. She was devastated. Fortunately, she did find a practitioner with some knowledge and compassion. Sometimes I wonder if some people become interested in treating pain patients because they enjoy the power it gives them over such helpless individuals.

Tomorrow I will be going to

Tomorrow I will be going to my pain management appt. Last time I overheard them telling a vet that he could not receive his meds unless he took and passed a drug test. Hearing this I had a panic attack and was sent home. I smoke and know that I will not pass a drug test. I am not even trying to get narcotics, just ultram. I have two slipped disks in my back and can barely move. Injections made them worse and now they want to drug test me to give me my pills!!!!! This is ridiculus!!!! I am still not sure whether or not to just cancel my appt and go to my regular dr. and explain the truth about why I smoke. I suffer from depression, anxiety, insomnia, among things and smoking eases all of these things without having to medicate with antidepresents. I feel like a criminal for something that about 80% of the population does. I am not a drug addict and do not use any other drugs. I am simply trying to cope with pain and be able to lead a normal life without having back surgery. Any advice would be so great right now! What should I do?

dude ive been with the va

dude ive been with the va for years got cut off of pain medication and am in pain all the time I have severe arthritus bone spurs buldging and herniation. I was cut off cold turkey. My advise smoke weed dont get on narcotics. They will make you dependent on them no matter how low a dose if taken for long periods and ultram should be classed a narcotic because it does the same thing as opium which is what all narcotic pain meds are made from. Pick the lesser of 2 evils

PAIN AND DRUG TEST

I hav gone n worked with my pcp for 20yrs. I hav documented back injuries n went to pain management for a new injury-a tear in my disc n ins did not cover Umh which I know do not always work but was willing to try but couldn't afford. Ay that point my pcp told me "dont go to pain mngmt he would take care of me n prescribed 10mg percocet, I told him at the time I did not want a med that would cause me to b viewed as a drug attack or criminal n he said don't worry. Recently I called 4 a refil n requested my dose b lowered so I would not become tolerant n need a dose increase the next time I get hurt or hav a flare up, I wad given med wit letter requiring me to go to painngmt, a different one than I previously went to, I went thinkin doc needed to weed out pts who did not hav documented pain, called pcp after 4 script, rene to get it b4 grabbing grandson from bus n was handed pee cup in front of pts, one I knew n had cared for in the hospital, I had peed b4 leavin house which is 5 mins from office,was embarrassed, n didn't hav 2 pee, I was yelled at to sit n wait to pee or no script, I had to get grandson, could not wait n again was yelled at in waitin room "no pills unless I pee" it is quite possible some of my patients were in waitin room n I was appauled n had to leave. Worried bout my pain I called, asked my doc to call in something less restrictive so I didn't hav to n treated like a druggie criminal n he will not speak to me and has left me to cold turkey n b in pain. I am very upset, a 20 yr relationship n he will not even speak to me. I hav a choice between surgery or meds n I choose meds, but do not want to submit to urine test n b treated that way. However now absolutely no meds for my back. I care for 2 grandsons n work as a RN, perhaps it is better to not work at all or live my life. I just don't get it n am continuing to call my pcp cus I don't eve- know if I hav a doctor at this point. Unbelievable!!!

What's up with these "pain contracts"?

I don’t see pain contracts as a bad thing; they can protect both the physician and the patient. Most states have pain guidelines, not pain laws like California.

I worked years as a cop fighting the war on drugs for many years. When I became a pain patient, I was treated like a drug seeker. I’ve had to fight for almost 20 years for the only medication that works, opioids, these are schedule I drugs and tightly controlled. Pain contracts, when used properly; protect both the doctor and the patient. Doctors should use a check list to make sure they follow the medical board guidelines in their state.

My current doctor is no exception. I studied two years of Medical Board actions against physicians here in Arizona. What I found was physicians failing to document some of the basic things. I designed pain forms for Arizona physicians; these forms assure they meet the pain guidelines of, Substantive Policy Statement 7, on the Use of Controlled Substances for the Treatment of Chronic Pain.

The forms included New Pain Patient Questionnaire & Pain Assessment, a personal history, pain history, medical history, psychiatric history, social history, drug abuse history, and pain diagram. None of these things are bad, they document the patient is a pain patient, and give the physicians a base line.

The Interval Report Form is filled out each visit; it documents the patient’s pain level, side effects, and any new problems. It prevents the physicians from writing “patient doing well” on visits where they refill medications. The medical board called this type of answer as a “canned” response.

An Opioid Treatment Agreement, this says the patient will only receive pain medication from one physician, and use one pharmacy. It also advises the patient of the risks and benefits of opioids. Patients who take opioid medications can potentially develop problems; this simply protects the physician and the patient.

I didn’t include drug testing; I feel a physician needs probable cause to do drug testing on a pain patient, or any patient. I feel doctors need to believe their patients, and believe in their patients. If they live in constant fear patients are lying to them, they need to find another job.

E. Jay Fleming
Speaker
Law Enforcement Against Prohibition
LEAPSpeaker@Softhome.net
Mohave Valley, AZ
www.leap.cc
LEAP Introduction Video http://www.leap.cc/audiovideo/LEAPpromo.htm

pain contracts

I, too, am a 100% disabled Vietnam vet w/gunshot wounds, diabetes from agent orange and severe diabetic neuropathy. V.A. had me on over 1,000 5mg. pills of Oxycodone per month since Des Moines, Iowa V.A. doesn't order/stock Oxycodone over 5mg's. My dr. consulted with the pain mgmt. team & they insisted I go on Oxycodone SA (Oxycontin) 20 mg. @ 240 mg. per day & sign a pain contract. I immiediatly refused since I want nothing to do with Oxycontin or pain agreement contracts. They said if I refused they would eventually take me off all narcotic pain meds and give me very high doses of the non-narcotic drug gabapentin even though I was told by my primary dr. I would be on some kind of narcotic pain meds for the forseeable future. I had to sign the contract or no narcotic meds. I signed "under duress" just to get treatment. Is it legal for them to do this? What remedies do I have? How can I learn more about the lawsuit or help? PLEASE CONTACT ME @

Kevin Anderson
717 17th. Street #6
Des Moines, Iowa 50314 (515)-282-2055

pain

its sad that people who are really in pain have to suffer like my husband you have to smoke pot or you will be in worse pain doctors think they are gods they are not there has to be help somewere what do you have to do move to a different country?

taking 240mg ofoxycontin

i 've been taking oxycotin for 4 year aprox,starting from20mg to 240mg and i need help because onebody knows wont to do.i'm only 37 years old

taking 240mg of oxycontin

I am the 37 year old whos been on OXYCONTIN 4 years . i have been in andf out of hospital for past 5 years .need to stop taking so many drugs,i also take 150mg AMITRIPTYLINE and i feel like a drugy and feel as i have no life, i just wont to sleep all day and not wake up ,,, j w from england

Oxycontin

To anonymous 37 year old taking Oxycontin:

I work in pain management and one of the main factors you need to realize is that there is a very distinct difference between someone who is dependent upon taking pain medications so they can function normally, allowing them to live their life with little or no pain. An addict is defined as someone who abuses pain medications or other drugs to get high.

If you are in fact in chronic pain and need narcotic medication to function normally then you should not feel drugged up, unable to sleep or function normally. You need to tell your physician that the Oxycontin is making you feel all of these things, because there are many other combinations of pain medications that can help you with less side effects, eventually allowing you to feel normal and live your life, going back to work, school, etc.

If you are not in pain and do not need narcotic medication then you obviously have a problem and should speak with an addiction specialist or someone who can help you taper off from the oxycontin.

I hope this helps and good luck

I lied to my nurse and been dropped with a ua and as a patient

I have had a failed back surgery, i have been taking pain meds for 3 years. someone had stolen my pain meds, so a family member was kind enough to give me some of hers,
I went to my appt. and since(nurse PA) she had given me my pain meds two days early the month before she was going to write the day for 4 days and i wasnt going to ask my family member for more, so for the PA to give me them 2 days early i had to submit to a UA. My pain meds are Avinza 60mg,Norco 10/250 mg. the family members that i took were percocet. when i went back to my appt 3 weeks later my ua showed morphine and oxycodone. i knew when she called me in it had to do with sometnig of my UA, I asked my family members what to do and they said dont tell her nothing. so i didnt tell her, so she redid the UA. And swear i havent had any percocet for 3 weeks, now they sent me a letter saying there discharging me, just like that ,i am in chronic pain i have submitted to every test they wanted to do, now they send me alist of drug rehabs, I dont know what to do, i am so depressed and i wont go to rehab, i feel like i have been let down. i know i shouldnt have lied and that is my mistake.

DONT KNOW WHAT TO DO

She was a new nurse PA, first time i ever saw her she dropped the ua ( never had a ua in three years)and about the contract,You are sighning so many papers i dont ever remember what it said or how long ago it was. they should go over the contract with there patient every office visit so no mistakes happen.
I am writting to you because you work in these places and is there anyway to get my pain meds back or am i just a number? Just another patient to dispose of.

So, I think you said you had

So, I think you said you had no pills left so you borrowed some from a friend or relative right? Well, oops! You forgot that you found a few laying around a few days ago and took em. They should give you one chance on that test also. Just say you did take a couple but thats it and they were yours. You found them in a drawer. There's no way they should kick you off when they found no other drugs in you except the ones they know about. I'd go over someones head-talk to your doctor directly and start complaing about the pain-call them every hour!

You said you took percocet

Sorry, But that's what sunk your boat. there was a drug in your system you were not prescribed. The Avinza if I'm correct is Morphine which is what showed on the UA and the other you said you were on was Norco which is Hydrocodone and it metabilizes into Hydromorphone. I know this because a doctor accused me of taking Dilaudid which is Hydromorphone. But the short of it is the Oxycodone in your system which you had not been prescribed is why they booted you out.
That's just my opinion and I been going around this circle jerk drug war for the past 6 years and have been through 7 doctors which is another long list of stories. All boils down to the damn government getting into the medical profession and we the pain patients are paying a hefty price.

Pain Meds

Since your in the field of medicine maybe you can help me. My doctor recently sold his practice. I did not have a contract with my old doctor. As it would be I spent a night at a relatives house. This stay was not planned. I did not take any meds with me. So although not legal she gave me one of her pain pills and said it is the same as mine. 2 days later when I wnt to the new doctor he had me sign a pain contract. At the same visit he gave me a urine test. He found her medicine in my system. Was I under contract already. Since I did not sign it until that same day. Is it legal against me?

anonymous 37 year old

thank you for the comments, i know i am in chronic pain and i take oxycontin for hip surgery witch went wrong ,i have had surgery four times in the past six years because of the pain i am in , the last one was in 2006 and has not worked .i just wont my life back to what it was before the surgerys.i just donot wont to be on so many drugs thanks

New Agreement

I am a 38 year old male with a herniated L4/L5 disk with chronic sciatic running down the back of the leg. Because I am in sales, I am constantly on the road behind the wheel of a car in order to see clients. Sometimes hours away. By the time I get home, I fell like a bent pretzel unable to stand up straight.

Late 2006, I saw a pain management doctor for the first time. He agreed, after a MRI review, to provide narcotics, injections in the muscle above the sciatic nerve in my butt and suggested I start physical therapy which I promply did. Therapy did not provide the results I was looking for so I have turned to alternative methods such as chiropracters but still see a pain management specialist for pain meds and injections as the injects do provide some relief.

After 3 visits in three months, 3 shots and a slew of dicussions, for the first time, the doctor insisted that he take a urine sample from me and that I sign their pain agreement. I was thrown for a loop. Not only had I never used narcotic before but never anything considered illigal. I questioned the need for the agreement and sample. His reply was "it protects me and you". I don't see it protecting me at all. In fact, it limits my ability to seek relief for chronic pain if he fails to provide what I believe is inadequate pain relief.

My wife suffers from MS and has debilitating pain from time to time. I told the doctor honestly that, when I am very bad, after driving hours, I sometimes take some of her Percocet instead of the perscribed Vicoden as it is far stronger and provides a higher level of pain relief. He told me never to do that and that under the agreement, I could be let go as a patient if I did this once again. I am being honest yet I am being prosecuted for that honesty which is the crux of these agreements.

My PCP can provide me with stronger medication if I needed them since she understands that I am the primary bread winner for our family and understands the level of pain I am in, in addition to my wife's level of discomfort. However, signing this agreement restricts me from doing this. If the pain doctor refuses to increase the medication, I am stuck unless I leave the pain practice and walk away from injections that may help. My PCP will not make me sign an agreement - we have a typical patient-doctor relationship that has worked for years.

I have never been ill or very sick til this problem and I am not at a stage where I am totally disabled. However, these agreements are too limiting, provides no structure or discussion around what is best for the patient and chastises those that go outside the agreement for help.

My hope is, in the future, that these agreements will not be so rigid and can be worked out together between the doctor and patient. I understand the need for some level of understanding between patient and doctor. I don't see, however, a contract being one of them.

anonymous 37 year old

i m in a lot of pain today , days like today i feel like ending my life, the pian killers i am taking are no longer working as i've been taking them for years . i thing my life is shittt at the mommet.no body nos how i feel,iwork 30hours a week in a hospital as a nurse ,i work on orthopaedics the job his the only thing that keeps me going at the momment every day gets harder and harder ,the pian hospital changed my appointment until the end of july,which does not help.I DID NOT wont to get up today, i can not live like this any longer, nobody knows how i feel.I can not see the futuer at the momment.I JUST WONT TO CURIL UP AND DIE...................

Please hang in there. It

Please hang in there. It doesn't seem like it but it will get better. I have been where you are many, many times and have also considered killing myself because it gets so bad. The Lord is watching over you, keep your faith and you will have bad times along with good times, just remember when it gets bad, have even more faith than when its good. I know what you are going through trust me. The best advise I can give is to find others like your self that are going through horrible pain. Please check out this website: mdjunction.com Just reading how these people help each other live in pain day to day is inspiring. Best of wishes, remember you are not alone in this, I Literally feel your pain.

pain management and random urine drug screening

I am a 31 year old Registered Nurse and chronic pain patient. I have been out of work and receiving chronic pain management (oxycontin currently) (many other long acting narcotic over the past 7 years). I have been a patient of the same pain clinic for approx. 7 years and just last month I was told I needed to take a urine drug test. The test was ill explained after I requested what they would be looking for. I was told they were checking to see how the drugs prescribed by my doctor were metabolizing in order to determine appropriate use and maximum pain benefit. Being an R.N. and an occassional pot user for my pain, muscle spasms I submitted to the test. I didn't realize nor was I asked or informed about the screening of any potential narcotic or illicit drugs. I never signed anything and my pain contract which I signed many years ago may be used against me as my defense against not being given informed consent. I was humiliated at the way in which my marijuana use was interrogated by my physician. I now have to submit to every 2 week urine testing , have to resign consent for narcotic treatment and now will only be given 2 weeks worth of medication vs my normal monthly dose. I feel like a child being given detention!!!!
I am most upset about the lack of informed consent I was given especially after I specifically asked what they were testing for. I had no idea what drugs both prescription and illicit that would be tested for. I feel BETRAYED!!!
While I am not ashamed of my medical use of marijuana I do feel embarrassed about how the presence of THC in my urine is being handled. Being a medical professional myself (although not currently working due to severe disability after a work related back injury) I am upset about the medical communities disregard and lack of information and empathy toward patients who are using marijuana for medical conditions. I am also concerned about how workers comp. will view these results and if they will deny my claim and refuse to continue to pay for treatment. Anyone going through the comp. system knows how they thrive off of refusing or delaying treatment. Secondly, I am worried about my ability to work as an R.N. in the future. I know my medical records are supposed to be confidential but I already feel STIGMATIZED!
I can't even imagine how I would have been treated if they found cocaine or another drug which I consider to be of higher importance. I was just wondering if anyone has any thoughts on my issue of lack of informed consent ( I never signed anything that day other than initialing something that said this was in fact my urine) as well as the lack of explaining what exactly they were testing for. I was also never given the choice about taking the test. I feel I should have been explained whether this is mandatory CT state law or just a policy within the doctors office. Either way I should have been informed as to my right to refuse and what the consequences would have been.
Thanks for listening!!

R.N. w/ chronic pain

Random drug screens unfair

I read your post about being unfairly labeled as a drug offender. Worse yet is you being a nurse yourself if I understood your post correctly, complete disreguard for your career or what it may do to it.
Although I am not in the medical profession the same thing happeneded to me at the Veteraans Administration Hospital and yes it added a stigma to my medical records that hangs with me today 6 years later. They seem unfazed that I have had about 15 clean urine samples since that time, it's once a sinner always a sinner to them.
I have since had to go outside the Veterans Admin to get my pain treatment and I have been caught a couple of time with pot in my system I received only a stern warning that I should refrain from that as long as it is illegal.
The DEA is the cause of all this requiring doctors to take urine samples and do pill counts to insure we are not deverting our drugs. The true reason is the sorry ass DEA and their drug war is not worth a shit never has been never will be so they have to go after ducks in a barrel so to speak they can get them not other way.
Good luck in your battle but I'm affraid we are fighting a system that is way larger than we are. God Bless.
Russell Belcher
Disabled Veteran
Shafted by the VA

ADA Complaint

The Veterans Administration have no business requiring Disabled Veterans to sign "agreements" which are coercive. I am presently drafting an ADA complaint that attacks not the symptom, which is the Pain Maintenance Agreement, but the problem itself, which is the flawed policy of the VA in using this form.
I had my meds, as well as everyone else in the entire VA clinic, yanked by someone in North Carolina's Prescription Monitoring Program because they noted a discrepency on the VA forms, regularly submitted to the pharmacy. Almost running out of pain meds is very dangerous, and to have it occur at the hands of disinterested non-care related strangers is abhorrent.
I have the ADA complaint peface prepared, and it would be nice to have a group of Veterans who are similarly incensed as signatories.
One final thing...if you are a doper, steer clear. I do not want this action tainted by unworthy protestations.

VA COMPLAINT

Box holder
Box 32
Havelock
North Carolina
28532

Your privacy is guaranteed, your name will not be disseminated beyond this complaint.

ADA Complaint

I am also a disabled veteran who is going thru the same thing with the VA in Martinsburg WV. I was injured during active duty in which I took a 20 foot fall and landed on the right side of my body. After being Honorable Medically Discharged I went to the VA. I had and still have chronic pain in the back and extremities. After realizing that the VA wasn't doing anything to help me I went outside the VA and to my surprise I was allowed to walk around for 15 years with a broken back!!! No wonder I was in pain and to think the VA was sure that I was just there to get pain meds for no reason.

I had a fusion done of the L1 to S1 with screws and pins to boot. I still require 2 other surgeries and maybe more. My spine had slipped over 9mm. I now have permanent nerve damage due to the oversight and neglect of the VA not to mention that I am now 100% disabled and am trying to increase my benefits with the VA from 50%.

Long story short, due to the nature of my injuries and the fact that the surgery wasn't a complete success I was fired from my job last November and lost my insurance and was forced to return to the VA as I am unable to afford the pain medication which I so desperately need. Right off the bat the VA denied my Soma which is the only muscle relaxer that works for me!!! For 2 months I received my pain meds without issue and at full dose, but last week I was asked to take a urinalysis which I thought nothing of. I smoke marijuana to help me sleep and with my muscle spasms. I never signed a pain contract with the VA and now am being denied the full doses in which I have been taking for a year and a half now. The medicines are 100 mg Time release morphine every 8 hours, oxycodone 30 mg every 4-6 hours for the spiking pain, Neurontin 800mg 3 times a day, and the non existent Soma was 350mg 3 times a day.

I was utterly destroyed inside when the doctor came back and said to me that "We don't prescribe narcotics to people who use elicit drugs. I was sent to the Chief Medical Officer of the VA who red me the riot act and after much negotiation he only gave me 2 weeks of my meds and reduced my oxycodone by 10 mg's and increased the time to dose too every 6 hours. I was told that they never received my records from the other pain management doctor and basically called me a lier.(Why did they give meds for 2 months excluding the Soma???) I am being told that if I don't have the records in hand by the next visit and that if my urine doesn't show a decrease in marijuana that they will drop me. I still haven't signed a pain contract with the VA. WTF is going on!!!!!

I have contacted my old docter and have an appointment with him tomorrow and hopefully we can pick back up where we left off.

I will sign your petition. Also up until my latest visit with the VA I was proud to be an American who defended this country during the first Gulf War, but now I feel betrayed and mislead.

RR2 Box 720
Harpers Ferry, WV. 25425

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