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Posted 6/19/2008 6:30 PM (GMT 0)
Hi everyone!

I am really curious---- I was just at my pain dr. and he had me sign a opiod pain contract. He said that he is getting all his patients to sign this and he had been trying to ............acts actually harm the patients in some cases and how they aren't good.
How many of you that see a pain dr. or to to a pain clinic sign these agreements??
And if so, do you know what would happen if you were to break them? I know that you aren't able to go back to that certain doctors practice, but does that mean you can't go anywhere else at all??

The reason why I am hesitant, is because on the contract it states that there is random urine testing to make sure you are using these meds you are given. Well in my case, I have several malabsoprtion issues and there are some days to where I'm actually scared to take my entire dosages of meds (sometimes i split pills in half) because i hate the side effects it brings. On a urine test, it would loook as if I'm selling my drugs, which I am not! But even with my malabsorption problems (i have crohns and UC and everything else) it still might not show in a urine test. I'm really scared.
Does the FDA just not help you once you break these contracts?
I did go over this with him, and he is aware of my other bowel diseases, but I dont want to be seen as some drug seller. Yet, I dont want him prescribing me less incase I might need more in the future....

Just wondering about this, I'm very nervous.
thank you in advance!

(Please stop including links we've asked you about before)

Post Edited By Moderator (Chutz) : 6/19/2008 1:45:16 PM (GMT-6)

Posted 6/19/2008 6:49 PM (GMT 0)
If you already discussed your malabsorption issues with him, then he is aware of them and would take that into consideration when it comes to urine screens. There is also the option of having you do blood levels instead, which should show your meds if you are taking them.
I , personally don't have a contract, never have been asked to sign one either. However, I would, if asked to. I look at them this way, I have nothing to hide, so why not sign the contract? It protects both my care with my doctor, and my doctor as well.
I don't see them as that big a deal. If I had one, and broke it, my doctor would discontinue my meds, as would most others. You can always ask your doctor if you can add an addendum to yours that says that you have discussed the malabsorption issues and what he will do in regard to a urine screen or blood test to help make sure that you are taking your meds.
Sandi
Posted 6/19/2008 8:21 PM (GMT 0)
I will say that to me the pain contracts are for our benefit. My contract states that I can't get pain medication from anywhere else. It also states that they cannot just stop prescribing me medication. They HAVE to taper me down.

I wouldn't worry about the malabsorbtion problems at all - you've discussed this with your doctor already. He's aware of the problem, and it's in your medical records. It's also used to make sure the doctor is covered if it turns out your getting medication from multiple doctors, or if another medication other than what you are prescribed ends up in a tox screen.

Mine also states that as long as I inform any hospital I goto that I have a contract with them - and have that hospital forward and treating information to them - I'm okay as far as an ER visit. (Which was a fear of mine) - So if I go into the ER and they treat me I'm not breaking my contract.

I would just relax on it, as long as you are doing what you are supposed to you should be fine.
Posted 6/19/2008 8:34 PM (GMT 0)

Hi Jenn, I also have always signed a contract with the 2 different pain docs I have been with. They are supposed to benefit both the doc and the patients but I have heard of some that only benefit the doc so I would read yours carefully.  I second the idea that you have your doc add an addendum with the issue of your malabsorbtion.  That way there is no confusion anywhere.  I was happy to sign mine.  I have never been ua tested and I have had surgery numerous times under pain management and I have had no trouble with making sure I am covered properly.  All docs are different and as long as you have open communicationwith yours and follow what he says, you should have no problem. 

Melissa

Posted 6/19/2008 8:56 PM (GMT 0)
Just curious though, what does happen if you break contract? Does this mean you can't see any pain specialist ANYWHERE and the FDA or whomever gets notified? Or does it mean his practice solely? I don't know why I'm so nervous, its just that I'm so sensitive to meds that sometimes I dont take enough like I should and try to use other things to avoid taking drugs, yet I get the amount prescribed just incase i might ever be cancelled by my insurance-god forbid- and i have pills left over. I dont know why I feel like i'm doing something wrong and the more I question them at the office, i think that becomes a red flag. The nurse today even told me that I was the only patient who questioned this contract unlike the others that just signed it without reading it.
I'm just curious to know if it goes on record through pharmacies and drug administrations etc.... if you get discharged from your pain contract. Anyhow, thank you all for your great advice. I will ask for that addendum next visit. I will let my questions to them rest for now for the above reason.
Posted 6/20/2008 3:09 AM (GMT 0)
I have signed a pain contract with my doctor.  It states if I break the rules he will no longer see me in his practice.  I was happy to sign it.  I'm sorry but I can't help you with the FDA information.  Somehow, I can't see that you taking less than the prescribed does would make you look like a drug dealer. 
Posted 6/20/2008 3:11 AM (GMT 0)
I can answer that real quick.... I guess in their eyes they would see it like that because I would be selling unused medication. Meaning, if they urine test me and I dont have it in my system, then where is it, right? I dont know.. I'm just assuming that.

how else would they find out people are selling meds? they told me today they found 1 person doing so... I'm assuming it was from urine testing.

anyways, thanks~
Posted 6/20/2008 4:06 AM (GMT 0)
Why is that you think that your doctor would go straight to "selling your meds" if you show no/low levels? There's a lot of things that can happen. I have serious bowel diseases and absorption is a problem for me, but I'm not sweating it, if it happens, it happens. I can tell you from professional experience, if they run a tox screen and see some drugs that are not prescribed or illegal that's when you would get in trouble--most drug addicts take a variety of drugs and I believe that is what the doctor's are looking for, the stuff you're not prescribed and taking.

I believe Gramps once wrote that he did a tox screen and it came out negative even though he had been taking his pain meds as prescribed.

I think the funniest thing about drug contracts is that drug addicts would have nooooooo problem signing them, because they would do anything to get the drug--do you think a drug addict would suddenly go, "Well, I guess I'm done using, I signed a CONTRACT." Give me a break.
Posted 6/20/2008 8:24 AM (GMT 0)
I also have a contract and it basically says what the others have said theres does. I also have a malabsorption problem and and didnt show a trace of xanax that I was prescribed in my urine. The Doc simply asked me if I was taking it and then ordered a different test that evidently did find it and all was well.

Alot of clinics use a cheaper, less broad test to detect presence only of particular meds and this is for insurance and patient billing reasons since some of the more extensive tests are also very expensive to use on a monthly basis but generally if the one the use come back not up to par they then go ahead and run the other one and I know of one clinic here where I live that charges the patient for this one since medicaid and many insurance companies will not cover the test,that is your option but otherwise you will be dropped from the clinic.

My contract also states they have to taper me over a 3 day period and refer me to a rehab or treatment center if at which time they conclude I have a problem.

It also states there is no 3 strikes your out rule it is one strike and that is it! If they find one opiate or illegal med that has not been authorized by them and it matters not whether it came from a legit Doc or not,if they dont know about it and say OK your out,no questions,second chances,not even a kiss goodbye!

Now as to try to answer your other question about is it just this clinic that will not prescribe or will they forward the word to the pharmacies? That is tricky for they can and if you are lucky enough to live in one of the 35 states that have a tracking system for opiate drugs they will be inclined to enter that info there and then all pharmacies and the police and other Docs along with whomever else is authorized to access that system will have that knowledge.

I hope this helps some and remember that even if they dont have a tracking system in your state your medical records get forwarded to new Docs as requested and not being able to account for years of treatment somewhere might be harder to pull off.

We are never forced or coerced into signing those contracts but if we want to be a patient in those clinics that require them we read it and sign it and follow its directive for the alternative isnt something we want to have to deal with again.
Posted 6/21/2008 6:45 AM (GMT 0)

You wanted to know if anyone other than the doctor's practice would find out if you were dismissed?

I know that the contract that my PM doctor uses says that they have the right to trade information with your pharmacy, other doctors ( which means your GP, and any doctors you might request that they forward your records to), so the answer to your question would be yes, they would all know. I've been there when they have called other doctors involved with a patient that they have dismissed for not taking their meds or having a dirty screen. And it says clearly in that contract that if you are dismissed, they will only forward your records to another doctor, they will not release them to you.

If your contract has that release about information on it, or something similar then those things could happen to you too.

If you are taking one less a day, that might not be a big deal, but if you are prescribed 6 a day and you are only taking one, then your best option might be to tell your doctor that you don't need so much medication since you are trying to cut back or feeling better than you were.

If they do serum levels or quantatative tests, then they will show what your blood plasma levels are, and if you are below the threshold, then you might be in trouble and accused of diverting if you can not produce the correct amount of meds......

Urine tests don't do quantatative amounts but have a minimal amount that they will detect, and if you fall below that, you will show a negative screen.....which will lead to being dismissed from most PM offices.

Anyway, it may be different at your doctors, so read the contract and if you are not taking a good amount less than you are prescribed a day, you might want to consider asking him to cut back on the amount he is prescribing, rather than take a chance at having a negative urine screen. Or have a discussion with your doctor and tell him that you are taking less meds most days and ask him how he wants to handle it. Either way, it's not worth loosing pain management over if you really need it not to do something the right way.

Sandi

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