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

Submitted by Phillip Smith on (Issue #457)
Consequences of Prohibition
Politics & Advocacy

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.)

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."

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 content is licensed under a modified Creative Commons Attribution license. Content of a purely educational nature in Drug War Chronicle appear courtesy of DRCNet Foundation, unless otherwise noted.


Anonymous (not verified)

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.

Sat, 10/14/2006 - 2:00pm Permalink
Anonymous (not verified)

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.

Sat, 10/14/2006 - 4:18pm Permalink
Rev. Anonymous (not verified)

In reply to by Anonymous (not verified)

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.

Mon, 05/03/2010 - 4:27pm Permalink
Anonymous (not verified)

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.

Fri, 03/13/2009 - 11:21am Permalink
Anonymous (not verified)

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?

Sun, 10/15/2006 - 2:58pm Permalink
Anonymous (not verified)

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.

Mon, 10/16/2006 - 1:57pm Permalink
borden (not verified)


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 the Drug Reform Coordination Network
Washington, DC

Tue, 10/17/2006 - 11:05pm Permalink
Anonymous (not verified)

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

Wed, 10/18/2006 - 6:04pm Permalink
Anonymous (not verified)

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.

Thu, 10/19/2006 - 11:52am Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

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.

Wed, 07/09/2008 - 2:00pm Permalink
tempname_73827 (not verified)

In reply to by Anonymous (not verified)

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 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!

Tue, 07/30/2013 - 1:08am Permalink
LEAP_Speaker (not verified)

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
Law Enforcement Against Prohibition
[email protected]
Mohave Valley, AZ
LEAP Introduction Video

Sat, 10/21/2006 - 10:40am Permalink
Anonymous (not verified)

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?

Wed, 01/31/2007 - 4:56pm Permalink
Anonymous (not verified)

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

Sat, 02/17/2007 - 7:18pm Permalink
Anonymous (not verified)

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

Sat, 02/17/2007 - 7:34pm Permalink
Anonymous (not verified)

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

Tue, 02/27/2007 - 12:44pm Permalink
Anonymous (not verified)

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

Sat, 04/07/2007 - 10:39am Permalink
hang in there (not verified)

In reply to by Anonymous (not verified)

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: 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.

Mon, 04/11/2011 - 5:21pm Permalink
Anonymous (not verified)

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

Sat, 05/05/2007 - 10:02am Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

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

Sat, 01/03/2009 - 11:16pm Permalink
Anonymous (not verified)

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.


Box holder
Box 32
North Carolina

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

Wed, 10/17/2007 - 11:45am Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

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

Mon, 07/07/2008 - 6:21pm Permalink
buddy (not verified)

In reply to by Anonymous (not verified)

hey bud you should still be proud. there are more people out there that want to help  who are proud of you with out knowing you i am a peace time vet {ft. hood} but i am proud of my time there so you meet a smart a$$ to hell with them you have something to be proud of

Fri, 01/28/2011 - 3:36am Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

Dear Sir,
I am a disabled Vet from a spinal condition. I am no doper but I have used marijuana on occasions when all else fails to relief the pain. I would like to sign your complaint but if you feel I would taint it I fully understand. Let me know your thought if you would please I have had no Pot in my system for over 16 months.
Russell Belcher

Sat, 01/03/2009 - 11:26pm Permalink
Mark Hicks (not verified)

In reply to by Anonymous (not verified)

Not sure what an ADA complaint is but, something needs to be done! I too have had the same problem with the VA.

I've had 3 surgeries on my lower back and have to get my pain meds off people I know with scripts. My pain tolerance is high so it is only needed every so often.  I had 60 pain pills after my surgery in Oct. 09 and in June 2010 I asked for some to keep around (I still had 3) so when I needed them I'd have them.

The problem is I told the mental health staff to shove their medication (All of them - they tried them all) and started smoking pot for my PTSD. It was other vets at the PTSD clinic that told me to stop taking the poison they were "Pushing". They were right. Taking the poison they gave me made me not want to leave the house. Started smoking pot and was back at work in no time. It keeps me from playing Army in my sleep (That really spooks my family) and keeps me from choking the shit out of people who really deserves it.

They don't know how close some of them have come to pushing me over the line of sanity. Having been assaulted by a drill sgt. and suffering a fractured neck and nothing was done to him has been brewing in me for 30 years. Now I'm in the fight of my life for disability after working though the pain for 30 years - Lets just say they should be glad I'm smoking pot.

The people at the VA can't be too smart in the first place - Who else but a dumb-ass would knowingly, continuously piss-off a bunch of guys who have been taught buy the best, to kill people and break things. They really don't used their heads! They better hope we all smoke pot!

If I can help with your complaint I'd be glad to.

Fri, 10/08/2010 - 6:00pm Permalink
Anonymous (not verified)


Thu, 02/12/2009 - 9:06am Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

I live in Bangor,PA and see a pain management doctor in East Stoudsburg. He is currently prescribing me 30mg oxycodone, 10mg cyclobenzaprine, 300mg gabapentin and 800mg iburophen. They do random urine tests but as long as you take the meds you are suppose to there are no problems. Let me know if you want to know where to go for help. If you send me your email I will send you the name of the clinic.

Sat, 05/02/2009 - 10:33pm Permalink
Anonym (not verified)

In reply to by Anonymous (not verified)

Saw your post. I run an adventure kayaking biz here in Hbg, hurt my back severely in an accident several years ago. Need a pain doc as mine left the area, can you help?

Sun, 04/25/2010 - 6:50pm Permalink
Anonymous (not verified)

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

[email protected]

Tue, 01/15/2008 - 11:28am Permalink
Anonymous (not verified)

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

Mon, 03/10/2008 - 4:58pm Permalink
Anonymous (not verified)

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.

Thu, 07/10/2008 - 5:36am Permalink
Anonymous (not verified)

I signed a narcotic contract with a doctor about a year ago and recently at an office visit she told me she didnt think I was benefiting at all from the narcotics and took me off of them and put me on multiple non narcotic meds. I tried the new meds for about a week and they did not help the pain got so bad i ended up going into the er, the next morning i called my doctor to explain the new combination of meds was not helping me at all I did not even ask her to put me back on the narcotics she simply had her nurse call me back a very rudely told me "absolutly not she will no longer prescribe the narcotics to you" then she proceded to tell me "if a different provider feels comfortable doing this for you, you can go ahead and try that" so I did set up an appointment with another provider who did put me back on the narcotic. now a couple of weeks later I get a letter from the first doctor I spoke of telling me I never complied with any other referalls she had given me besides wanting the pain medication and that she has recently been informed that I am getting narcotics from a different health care facility therefor she will know longer provide narcotics for me ( which I thought was already established befor I went to a different doctor) and she will no longer see me. OK fine but now what I am worried about is what does this do for my permanent record - which by the way I did contact my current/new provider and told her I do not want the narcotics any more and asked her if we could come up with a different solution. like I said i have a concern about how this will effect me I am currently a student studying in the health care field I do not need a drug seeker label I feel as though my reputation is being slandered but i will admit i didnt follow through with all the things I should have I just wanted the pain to go away i feel as if im to busy and have to many other things i need to take care of or do instead of things such as physical therapy. does any one know how this horrible misunderstanding and neglect from myself is going to affect me. (I feel like Im in trouble or something)???????

Sat, 10/25/2008 - 4:31am Permalink
Anonymous (not verified)

there is no permanent record other than the notes and records of doctors that you have seen. Just dont mention the doctors that you have seen that have bad records on you

Mon, 11/24/2008 - 8:55am Permalink
lemara (not verified)

In reply to by Anonymous (not verified)

I'm wondering about the records thing because while at my PCP he was able to pull up every time I had been at 2 different emergency rooms and exactly what they perscribed and what treatment I received. With medical records being made digital I'm worried that excluding a doctor who has bad info about you could back fire.
What do you think?

Le Mara

Mon, 08/17/2009 - 1:56pm Permalink
Anonymous (not verified)

Please help. Im in really bad pain due to neuropathy. I spent 1 year in the hospital with 6 surgeries, a colostomy,complications,then mersa suegery then more complications then after the dust cleared I ended up with a fistula and neuropathy. I have bad cramps and burning sensation on my ankles. I walk with a cane because I cant move my right ankle up or down,the nerves are totally shot. Only a person with severe neuropathy knows how painful it can be. I used to be a pro soccer player and know I cant even walk. I know what its like to feel pain because of lifting weights,running and pushing myself to the extremes to perfect my soccer craft so what Im trying to say is that IM not a girl man or a wus complaining about unjustified pain. I havewas on liquid dilauted in the hospital sometimes up to 8mg so I have built a tolerance to pain meds, and it seems like only opiates or oxydose oral solution has worked for me but after having surgeries and a pain doctor in Arizona I moved to Dalla and I cant find a doctor to treat me and give me the opiates I need to relieve my pain,My PCP prescribed me my oxydose but not nearly as much as I needed and told me she would only do so until I found a pain management doctor and after doing so for a year she dropped me. I had and been having a big problem finding a pain doctor who accepts my insurance Medicade Evercare and when I finally did he treated me like a drug seeker and would not prescribe the opiates that I was on for a year but offered non opiates and said he would not prescribe me what I was on as if I was taking it to get hi. I told him that if I wanted to get hi I would do cocain (Im no a drug user) and not oxydose oral solution which tastes like crap and makes me sleepy. Since then Im out of meds and feel like pulling all the hair out of my head or am starting to entertain the thought of commiting suicide due to the unbearable pain.How can I find a doctor to give me strong medication that I know a least for now works on me even though these past few years I have built a tolerance to it. My family thinks Im an addict but they dont understand that I need the meds for my pain and not to get hi. Most if not all doctors I have me are shit and treat you as a guilty drug seeker until you prove otherwise. What can I Do. I bring my medical records to meetings with new doctors but up to this point no luck finding a compasionat (sp) doctor willing to take care of me. I dont know what to do. Sorry for the misspelled words Im writing fast and in pain.

Mon, 11/24/2008 - 9:22am Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)


Thu, 02/12/2009 - 8:54am Permalink
Anonymous (not verified)

First, I do not suffer chronic pain, so for those of you who feel I have no credibility to comment on this article, I will save you the additional pain of continuing to read this comment.

My opinion is that Doctors are NOTusing pain/opioid agreements 1) to trample on the rights of those with chronic pain 2) because they don't care about their patients, or 3) because they enjoy masochism. My *wild* guess is that Doctors are using these agreements (contracts) to minimize liability.

Based on the comments I have read, I can understand why many of those on this forum have no love for doctors. Having said that, it seems like a far stretch to blame them for using these agreements. Does a compassionate doctor = someone that does not care about losing their practice, career, and source of income due to a lawsuit? If someone can prove that no doctor has ever been sued for prescribing narcotics to someone who, unbeknownst to the prescribing physician, was also taking illegal drugs, ultimately leading to injury, then you've got a point. Otherwise, doesn't it make sense to try and understand the reason doctors are using these agreements? Maybe its just more fun to bitch.

Compassion = Compassion
Prescribing powerful pain narcotics to someone that the doctor 1) knows is taking other potentially dangerous medications/drugs or 2) doesn't care whether they are or not = stupid, not compassionate.

Our litigious society is likely more to blame than the Doctors. It is the fault of Doctors that act like drug dealers and get caught; it is the fault of addicts that flummox Doctors into prescribing pain meds, then sue them when they get injured - everyone else suffers (literally) due to the poor judgment of the shallow end of the gene pool. I guess you would have to pay an exorbitant med mal insurance policy premium to begin to understand why Doctors are trying to protect their asses.

Certainly, if you explain this away by simply demonizing those in the health care industry (of which I am not a part of), assuming they have ill will against all those with pain, then who cares about trying to understand why they have taken the actions discussed in this forum?

Wed, 12/03/2008 - 4:07pm Permalink
Anonymous (not verified)

I am a disabled veterans who broke his back in 1977 and had to have a L4-S1 Fusion. Since that time and after working in communications for over 20 years climbing telephone poles, towers etc. In 1986 I was diagnosed with pseudoarthrosis, crack in the fusion is what it amounts to. Now I have a whole sheet of secondary symptoms caused by the injections and pushing my back way beyond it's limits. I started having steroid injections sometimes 6 in a month, that should be a years worth by the way. Anyway in 2001 I was totally disabled from all the damage done to my back. In that 7 year time frame I have been discharged from 3 clinics because they said my dose of opiates was to high and it may bring the DEA down on them. The highest does of anything I been on during that 7 years was 400mg of morphine a day. The other reason these jackass doctors let me go is that I refused to have anymore injections done in my lower back. The last injections I had was in 2005 because that jerk doctor threatened to let me go if I didn't at least give them a try. Like the other 15 years worth I had them didn't count. I let him give me 6 to the tune of $3500, 5 months later he let me go sighting he was affraid the DEA might bust him for having me on to higher dose of meds, 400 mg Morphine every 24 hours. The lower end of my spine looks like a damn jig saw puzzle. The majority of the time these doctors that do get busted and loose their license is because they don't keep their records in order.
Don't preach on something you know very little about.

Sun, 12/07/2008 - 2:13am Permalink
Anonymous (not verified)


Thu, 02/12/2009 - 8:30am Permalink
Anonymous (not verified)

I don't know if this subject has been broached here or not.( I can't find it) but does anyone know where I can find NY state policy on drug test by Dr's for patients who are taking narcotics ? This seems inherently wrong to me and against my civil rights. I just found out about this and am appalled .

Fri, 03/13/2009 - 10:54pm Permalink
Anonymous (not verified)

Instead of just whining on website's, let's get together and complain.I'll join in anything legal to fight contracts for medicine I need.

Not to mention it's a violation of the constitution and quite frankly it's none of the doctor's business what I do when I leave there.
I have nothing to hide, I only take what is given by my doctor.
I'm insulted by the insinuation that I am buying and using illegal drugs by being forced to take a urine test,

Sun, 03/22/2009 - 12:38pm Permalink
lemara (not verified)

First of all, having moved to TN 2 years ago, I have no insurance (unemployed). While living in CA I was receiving treatment including pain management. Having insurance through my employer of course made everything easier. In 2000 I had a diskectomy L4/L5 after the disc actually ruptured. Anyway, it took awhile to get through the right channels but once accepted into the pain management treatment evrything was great and I was never asked to submit to any tests let alone a urine test.
Having NO treatment for almost 2 years and due to the severe pain, employment was not an option. I have worked in IT for more than 10 years- as a certified Network Engineer. The point being I could be a contributing member to society (paying taxes etc.) if able to find relief from the severe sciatica pain.
OK- so out of desperation I pulled my 401K and used it to pay for a PCP ($178.00 per visit), an MRI ($800.00), a Neurosurgeon consult ($280.00) etc. Finally, I was referred to a pain management clinic for injections ($2000.00 each) and the PCP agreed to write a script for 7.5 Vicodin 4 times a day ($100.00 per month). So, now I am finally set up for 3 refills before having to see the PCP again. WHEW! THEN- they asked for a urine test which completely threw me for a loop. I have only had to take one of those once before for a job with Sitel in a call center for $9.00 an hour, here in TN. The job sucked by the way and was a far cry from my not only my skill set but also pay range. I passed the test for Sitel. But, I had smoked MJ a couple days before this appointment- because the PCP had left me without meds for 5 days until the appointment. I failed and have been TERMINATED from not only the meds through the PCP but also the injections. I was given no explanation or any chance to explain myself. I very rarely smoke MJ.
With the treatment I was receiving I felt so much better I began my job search again. Now- I'm back on the couch and half broke on top of it.
Does anyone know how to get a second chance or how to approach a new PCP? People here in TN say that I am blacklisted and will not be able to find any PCP to accept me into a pain management program- period.

Looking for advice if there is any out there!
Le Mara

Mon, 08/17/2009 - 1:44pm Permalink
Anonymous (not verified)

I was recently cut off of my methadone for having morphine in my urine. I was referred to a new clinic by my regular doctor, do you think that someone else will fill the narcotics for me even if my doctor is tapering me off of them while I wait to get it to see someone else. I have thirteen inches of metal in my back and a failed huge spinal fusion. I made a huge mistake to take a pill tht wasnt prescribed for me, I will think twice nextime. Do you think that I am done for good with the narcotics? I am currently taking 20mg after 30mg last week and 10mg next week, when I will be going to a new doc... Please help me!!!

Fri, 09/04/2009 - 9:56pm Permalink
Anonymous (not verified)

All the visits I had with my primary doc have been rush, rush, rush.The VA overbooks the appointment time to see as many vets as possible. So I'm a 30-year Active Duty Vet and he never served this country, I can get past that. But when they rush rush rush through a pain management contract, still have time to make sure there is a nurse witness, do not discuss any Chain of Custody measures, Protected Personal Information (PII), what institute is testing the specimen, and what method of testing is being used, it leaves alot of trust in the sytem to provide the results you are already sure of, considering the consequences that will surely follow -- you can count on it.

I'm of the opinion (as a federal agent now) that there should be at the very least, at the very least, some inkling of "probable cause" by the doctor when they make the vet submit to the contract if he wants to receive his medical benefits for serving our country. There's no parameters established fin the contract or probable cause either. There's alot to risk and alot to give, for getting so little information and hoping everything works out OK. Somebody smart needs to look at this entire process. Betcha there's a HIPA violation around the corner too, or just wait until the next theft of a VA laptop or database with PII stored. It's another way to be a victim, or to lose your hard earned benefits if you are a vet. KILROY WAS HERE.

Thu, 02/11/2010 - 2:57pm Permalink
Anonymous husband (not verified)

Who proffits from the sale of all these extra ua tests?
Do they have lobyists pushing these policies?
My wife had acl and meniscus surgeries but was told she still needs a knee replacement
Her orthopedic surgeon said if she was 10 tears older he would tell her to retire
So she is supposed to wait untill it is "unbearable" and then he will operate
Meanwhile, her "clinic" will not increase her pain meds post op because she signed a "contract" to reduce them
She "applied" to be a new patient at another facility
They said she broke her "contract" with the "clinic" and could not be rx'd pain meds as a new patient
If she gets hit by a bus, will the ER admit her?
She is a saint, but will she get into heaven?
Where will this end?
Who is the customer?
Who is being paid to do what?
Who is serving who?
Demand satisfaction!

Fri, 02/26/2010 - 5:47am Permalink
Ayzle (not verified)

My doctor is very tight with meds and i have to beg for pain relieve. Even though i Have Rheumatoid arthritis,peripheal neuropathy,heart disease,thyroid disease and to many diseases to mentions i get 3 vicondin a day and nerurotin 3 times a day that is it any more and he says it will cause me to be an addict. When someone is in terrible pain and has to live everyday with it they should get relief.Life should not be one of torture..Thanks,Ayzle

Tue, 03/16/2010 - 12:38am Permalink
Allan H. 'Bym'… (not verified)

Today I was asked/'forced' to sign a pain contract. I've been on oxycontin (90mg/day) for the past 5 years after a sudden DVT, severe diabetes and rheumatoid arthritis. My old doctor of twenty+ years was diagnosed with end-stage cancer and left his practice leaving me to find another primary care doctor. After 3-1/2 months of intense searching and being called 'drug addict' and thrown out of doctors offices I located another Internal Medicine primary care physician. She is an excellent doctor! 2 months ago the DEA came and yanked her controlled substance license (leaving her standard med license intact!) Again, I' found myself on the street and looking! I'm about as transperent as glass. I have one pharmacy and I only get my oxy from one doctor! Today, on my 2nd 'interview' with the new doctor, I was introduced to this draconian contract that I had to sign or I wouldn't get my refill on my pain meds. I have to pee into a cup (monitored) and bring ALL my other meds to the office next month for them to COUNT MY PILLS, narcotic or not! I was told that if I even tested positive for alcohol that they would refuse my refills! They denied me a supplemental amount of oxy for any 'breakthrough' pain and told me if I ran out of meds or lost them that I could not get them replaced. I worked for the government for over 30 years and have never once been subjected to a pee test! Besides that, I have severe glaucoma and retinopathy so I'm almost blind...I don't drive, can hardly even walk and am hooked up to oxygen 24/7. Why no alcohol? (I don't drink anyway 'cause it reacts poorly with my meds) but I'm not allowed to drink! Which is legal the last time I looked! I do occasionally enjoy abit of marijuana as it eases my tension and allows me to sleep but peeing into a cup??? My pain dose hasn't changed in over 5 years! and still they treat me like I'm a drug addict! My new (soon to be old) doctor claimed that she could lose her license to practice medicine if she 'allowed' me to smoke the random joint! That is an outright LIE!!! In SE Ct. if you mention Pain Management the doctors get this frightened look in their eyes and most slam the door in your face! I wrote a scathing letter to the DEA about this crap. When they finally did respond it was to wash their culpable hands with, "Go to the ER" They just don't get it. The tighter the noose the larger the black market. Prohibition didn't work. I live in a box...I see people only when I venture forth to a doctors office, about 1xmonth. How am I hurting anyone by smoking pot once in a while? I'm on the fast track out of here but they seemed intent on regulating my bowel movements! wtf? There is not a legitimate Pain Management Center for 50 miles in any direction from New London. I barely subsist on disability pay and cannot walk. I have no car. Now they insist on counting my pills! I'll be damned. It's better off to be dead than to be a puppet. I have the insulin and about 30 minutes...death doesn't scare me, living in pain does. Screaming, crying, breathtaking pain...and they're worried about their damned medical license and big brothers regulatory dildo. I'm glad I know just where I stand in the evolutionary process of modern America. The War on Drugs isn't brought on by altruism, it's brought on by greed and big pharma. Why?

Wed, 03/17/2010 - 5:18pm Permalink
Moondragon99 (not verified)

They call it healthcare but what they provide is far from it. I have been going to the va for a service connected injury, 50%. I suffer with pain 24/7, I have had my dosave increased once from 5mg to 10mg of methadone and I take 5mg of oxycodone for break tbrough pain. The dose does nothing to relieve any pain I have. I requested to be weaned off methadone because the withdrawal is horrible if they are late sending my Rx. They put me on tramadol 50mg, it's like taking nothing. I'm in so much pain I think suicide would be more humane and I did atempt to take my life and failed. I took what I thought would do the job & my husband found me & took me to the hospital. I was in no real danger, the ER doc said I have built a tolerence to the medication. They worked when I first started taking them 10 years ago but now they have no affect at my present dose and barely any at a higher dose. I still had pain on a scale of 7 out of the 1-10 they use to determine your pain level. I can't go on living with this pain so I figure I have two choices, ask for a med change & higher dose or go to an out side doctor for my treatment if they refuse. I'm lucky my husband has good insurance and I feel for those Veterans that don't and have to put up with their crap. I have stayed with the va because of the ease of having my medical records available for when I go for reevaluations of my disability, but I can work it out if I have to with an outside doctor. The va acts all bewildered when when asked why the suicide rate is so high for Veterans. They don't care as long as they can collect that paycheck and make it to retirement, they have cushy jobs and no compassion or conscience. You can't fight them so what are our chances for better care? It may ly in making the public more aware of our plight by having demonstrations with signs letting them know whats going on. But one person won't make a difference, to take down a bully it takes a community just like union members on a strike. I wish you all much luck in your future in pain control.

Thu, 07/22/2010 - 5:13am Permalink
vicky (not verified)

the pain contract I was made to sign left me feeling like I was a common drug street addict signed under derest it was either or I have fibromyalgia and it hurts I only have Lortabs thats all I have troble sleeping the pain is bad at night now I am afraid to take them so now I am here in pain and don"t know what to do I get so tired of doctors looking at me like I just want drugs what comes next??

Fri, 07/23/2010 - 12:24am Permalink

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