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Drug War Chronicle - world’s leading drug policy newsletter

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.

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Politics & Advocacy DEA - ONDCP

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!

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.

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.

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 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?

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.

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...................

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

re

Everyone has different challenges in his life, it's important to know how to pass these moments.drug interactions

friend in agony

Is it ok to use stimulents if you are in a lot of pain ? I'm asking this because i have a friend who is currently having a lot of pain and suffering from post traumatic stress disorder. Can i do something to help him out ? His name is Dave.

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

Just another attempt to make the people's lives harder?

It's not a secret for anyone that there will always be online pharmacies selling pain medications to those in need. Even now, I'm sure that most of such drugs are purchased on the Web rather than in CVS and other ground-based drugstores. I myself buy my pain relievers from this online pharmacy since my doc keeps on telling me that the pains I get resulting from an incorrectly cured fracture are not a reason serious enough to prescribe such meds to me. Guess the government should better invent the way to control those who purchase pain relievers for illegal purposes - not the ones who prescribe them to the people in pain!

re: Pain contracts

I have absolutely no problem with signing a pain contract. I know that I am not only protecting myself, but my doctor as well. He does treat me with opiates. I have fibromyalgia and CFS among other things, and although even opiates cannot bring my pain level down to "0", I am very willing to live with a 4 or 5 on the 1-10 scale. Without these meds I am often at a 10, and after several days at this level it feels like a "20", if there were such a thing. The pain contract feels like a very small price indeed to pay for some relief. I had been treated for my pain for years in WA, but then I moved to AZ and could not find a doctor who would prescibe opiates under any circumstances, despite pleas from my psych doctor that he did so. I finally found the doctor I now have, and swear he is an angel. If I am protecting him by signing this contract, I can be reasonably sure he will be practicing for many years to come. BTW, he is not a 'pain specialist', but a family practice doctor who's specialty is palliative medicine. He treats 'all' of me, not only the pain. I know I am in good hands with him, as he does not blame all my symptoms on FM. but carefully checks each one out, and sends me for the entire battery of tests once each year.

Veteran's Narcotic's Contracts

I had signed a Veteran's Narcotics Contract for many years and had never used illegal drug's in my life, I went to a 35th high school reunion and was partying with friends I hadn't seen in over 30 years, there was some illegal drugs being done in the hotel room over the course of 2 day's, including some smoking of cocaine and marijuana, all I did was dring alcohol, however upon my next visit to the veteran's hospital about three days after I had returned to my city, my urine showed positive for cocaine, I tried to explain the situation to my primary care physician however they took me off all my med's within 5 days, I am told by other veterans that they had similar situation's happen to them, and after reestablishing a period of clean urines they were given back their narcotics, however my primary care physician is declining to put me back on them, he say's after I violated my contract he under no obligation to ever put me back on them, he say's it's totally against veterans policy, I have agreed to go through the SATT program and be tested for clean urines and do what ever it would take to get back their trust, but he say's it no use, I am disabled 100% and really need my medications to live my life somewhat normally, anyone have any situations or remedies or other veterans with any knowledge concerning Veteran policy?
Please help....Buck in Gainesville Florida

buck7583@bellsouth.net

What $hit

Fight for your rights, Theese contracts are a violation of the fourth and fifth ammendmants.
My pal is booted out of pain management for a very low thc level.
I suspect he will die.
We are forgetting the patients. If he dies I know his wife will kill the doctor and I hope she does.
You people not in chronic pain, who are not dying shut up or I will have you discuss this with her.
She is pretty upset.
This is about compassion not some piss test.

THINK B4 U SPEAK!!!!!

I certainly hope none of the things you outlined in your blog come true. Otherwise the cops may be knocking on you and the wife's door..... for premeditated MURDER!

Honest isn't always the best policy, but for me it worked out.

I started to become ill when I was 17 years old, I become progressively sicker with 1 autoimmune disease after the other.

I was once a healthy young man, and now I am lucky If I have enough energy to go out to the doctor. I only leave the house to see doctors.

I am 22 now and after years of suffering I took my pain control into my own hands. There were no doctors in my city to help me and no one would prescribe anything, not even non-narcotic pain relievers.

I decided to self medicated with Methadone which was wrong.

Finally after much time on Methadone (self medication with no doctor) I got into the ONLY pain specialist in my area.

The first thing I was presented with when I entered was a contract which I signed, I didn't know the urine test would follow.

I did the test and I FLUNKED. I tested positive for Methadone even though I had no prescription for any type of narcotic.

The doctor asked me how the drug made me feel when I used it, I stopped him explained I had been self-medication for pain control and not to get "high". The doctor paused for a while...he then reviewed my case and told me he would find a sensibile solution for this problem and that it was wrong for me to self-medicate but that someone should have intervened a long long time ago to help me with my pain issues and illness.

I walked out of that appointment with medication for the first time since I became ill, and for once, I realized someone understood me and didn't jump to conclusions and throw me out for being "dishonest" or a "drug seeker".

Not many of these good people exist but there are some doctors who will believe you and treat you with dignity and not rush to judgment and who will not label you something you are not.

This doctor took the time and used compassion to realize that I had no other choice but to medicate or to suffer even more than I already do now. When people are suffering from pain or illness they will self-medicate themselves...who can blame them?

Good luck to all of you who are looking for help with your pain. It took me over 4 years to get to this point but now I know I will be treated like a human being and it feels GREAT. That's all I ever wanted......nothing more, nothing less.

It is painful to be in pain.

That is a very encouraging story. I have had such a struggle looking for the solution to my chronic pain. I believe every pain sufferer can sympathize with you and Michael Krawitz.

I suffer from acute chronic pain on nearly a daily bases but I have always wanted to live a normal lifestyle. Since birth I have dealt with disability and chronic illness and until recently, had no one who was willing to listen to my difficulties. At age five I was diagnosed as having an un-identified form of Cerebral Palsy. To this day I still cannot pick up a pin a write on a piece of paper quite right.

I am unable to work and have been legally disabled for eight years now. I receive a small amount of SSI, not enough to live on, so I go to College to make ends meet. Normally I live in destitute caused by the chronic pain. People look down on me because I am impoverished.

I was a relatively healthy teenager and attempted to join the army but could not due to chronic ear infections. It pretty much started when I was seventeen, some peculiar adult onset ear condition and it has deprived me of that which so many others take for granted. I have been to hundreds of doctors who say they cannot fix it, half of them could not even figure it out.
Just recently a pain specialist diagnosed me as having gloscopherngial neuralgia.
Which makes sense because my grandfather is dying from a rare and relatively un-classified neurological disorder, similar to pseudo-Parkinson’s disease...

One of my previous physicians had discharged me from their clinic for not wanting to go to a pain clinic, where I had already been. I did not particularly relish the idea of traveling hundreds of miles while being in constant pain and leaving unfinished work to be done. I did not ever refuse, I just said I did not want to go, that I have done it before, and this regiment that I have been on over the last year-and-a-half is working great. I disagreed, but did not refuse. Biggest error I have ever made.

They had me on a 130 mg of Oxycontin and Percocet a day and then just told me to get lost. They did not slowly reduce my dose nor did they send me to any other doctors and I had been going to this clinic for well over a year. I was making straight As in college and was able to take trips to visit aging family members.

So I was basically just kicked out the door for no apparent reason. This drastically altered my lifestyle, and not for the better. But I figure business is business, once a doctor makes their decision, there’s nothing else to be said.

There is nothing personal, right? It is after everything, just business.

Well that is what I figured until I got another primary doctor.
My last physician agreed to a pain therapy regiment but I had to sign a contract of course. I submitted to the drug tests after having taking 8-12 Percocets a day for pain along with Valium, and Zoloft, 5 drug test were done on me total, at the same clinic, 3 of them during the same day.

Urine Drug test#1 :Negative(Same day)
Urine Drug test#2: Negative(Same day)
Blood Test#1: (Same day) Positive but for Methadone and nothing else. Methadone and NOTHING else.
Urine Drug test#3: Opiates and nothing else.
Urine Drug test#4: Opiates and methadone.

I realize that Methadone tests are a separate test for the urine but for goodness sake, the blood test took weeks to get back and when it did it was a GM-CS test and should have revealed the right medications in my system. The same day I got the blood-test results, they said they did a final urine test on me but without first telling me the results of my blood-test.

I was cut off of my medications because they said I was not supposed to be taking the methadone and I was not taking the methadone. They did not believe me. They said I could be selling them. Makes sense from an objective standpoint. I voluntarily went to Detoxify at the hospital twelve hours after. The hospital naturally did a drug screen on me and I came up positive for opiates and benzodiazepines just as I should have. Thus the prescribed Percocet and Valium. But the hospital did not find any methadone on their test. They found what I had been taking the whole time.

So I approached my former physicians office about this and they said they would not accept the hospital drug screen as evidence. Apparently I have quite the reputation in this little town and I am not sure what to do about it. I went off of the medications for two weeks, at least, and the pain was so severe I had to withdraw from an entire semester. Also after two weeks of being totally clean, my pulse and blood pressure would not stabilize. Once I started taking the pain meds again, my vitals stabilized after a week or two, and once the pain was under control my pulse went back to normal and I did not have to take the pulse and blood pressure medicine anymore.

Discipline assists control the effects of the pain somewhat. One of the benefits of having a Christian school education is acquiring discipline.

I do so feel sympathy for the doctors who might and do get taken advantage of. Yet still after this last debacle, I cannot rid the feeling that I was lied to just to get rid of me and not one person at that clinic was concerned with what was going to happen to me. They were not concerned whether I lived or died. It is true too, because I got an infection and a high fever, had nowhere else to turn to, and called that clinic and they said and I quote "Don't you get it? We dont want you to come back here! Now stop bothering us!"

So I did. Went out of town, sick, very sick, and found a clinic that would treat me.

This really happened.

Doctor’s definitely need more slack in order to properly fulfil their patients needs.

I am still in school, barely, but hanging in there nevertheless and will graduate college with my degree by 2010 or so. I have never sold a single pill to anyone in my entire lifetime. I do not drink, I avoid caffeine and rarely leave my bedroom, let alone leave my house and go prowling the streets at night to find some hapless bystander to sell my own much needed prescription pills to.

Now I do get a small amount of medicine a day but have to go on a four hour trip to the pain clinic to acquire it every month. The DEA’s crusade is destroying quality of lifestyle in the health system.
If doctors and patients have to have pain-drug contracts, they need to afford the patient the benefit-of-the-doubt and allow for, at least, a slight amount of unforseen circumstances. People should not be punished for making errors, the errors should be corrected, not flaunted and crushed against the patients and doctors. Sick and injured patients have a tough time of it as it is without having to endure neglect and humiliation.

The war on drugs is becoming a war against the average everyday, law abiding American citizen who unintentionally gets caught in the crossfire. Metaphorically speaking.

By any means necessary, I welcome your feedback and input Dear Reader...
snailrg@msn.com

I was called for a pill caount

My primary care doctor at the Va hospital in Togus, Maine called me to come in to count my opiate pills. I said I had no transportation but could be in on Monday, 3 days away. The nurse told me that the Contract that I had signed states that I must come in within 24 hours if asked for a pill count. The nurse told me to borrow a neighbors car. Keep in mind that I have taken 2- 750mg vicodin and I explained this to her. She says drive.... and the bottle that my vicodini is in states that I do not drive. HMMMMM! Who actually backs these contracts. Will the doctors boss take his side? This is so frigging frustrating. I have to call my doctor every month to reorder my prescription. Yes I take more then he prescribes me. I am a 325lb 36yo man with major back problems. I have had the surgeries, the injections and so on. The only thing that works for me is the opiates. And yes, I am addicted. I am addicted just like that ant anxiety crap they prescribe me but you do not see you mental health doctor make you sign a contract for Klonopin. Klonopin is more abused than opiates. I have been taking opiates for 4 years and not once has my doctor increased my dosage even while knowing that I need an increase for my pain. WTF

Life is very hard?

... I have problem with my back, knee, and neck.... I just can't take Lortab and OC Because I just end up with ADDICT and my liver and kidney are about to DESTROYED! So I go to Clinic and take Methadone... Understand... I am DA with UNDER SSD and Medicare and Medicaid and Well care insurance.... However, the clinic will not ACCPECT my all kind of insurance... and ALL MY INSURANCE was told that they will PAY for my methadone rx so I only pay 1.05 for one full month of methadone... But Clinic make me pay 430 dollar every monthly... So How can I solving problem and get this work out? So Clinic told me they accpect insurance for Suboxane... But.. My insurance will not cover it since I am DA with pain problem... So I need something to help me with pain too.. (sorry for my English grammar since English isn't my first language... I am use American Sign Language.) JLearH@aol.com

start a legal movement

to stop this nonsense.

We are patients, not criminals and should not be treated as such..

What we do outside of the doctor's office is quite frankly none of their business..

If you are selling your meds or buying illegal drugs it is a matter for law enforcement, not your doctor.

Let them do their job for cripes sakes.

I will be happy to sign anything that is legal to stop this.

patients

patients are not crimanls and neither are drugs. the drugs are made for the purpose of support not to be taken as a diet which we most do and later on fell pray for this. sowe shld avoid this .

your kid matters

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