I notice that a lot of people on this board mention having signed pain contracts, pill counts, etc... Is this typical for pain specialists? I was never asked to sign one. HOnestly the whole concept seems really bizarre to me.
Mark, I have never been asked to sign a contract either. I asked my PM doc why he doesn't require one and he said it is not mandatory. I don't know if he meant in my state, or in general.
I do understand why a doctor would have a patient sign a contract, though. I know that it's their neck on the chopping block, should one of their patients be abusing the meds or a diverter. It is a safeguard for the doctor and they say for the patient, as well. I'm not really sure what benefit the patient is supposed to get, because I've never read one. I'm sure that someone here can fill you in on that aspect.
If my doc required me to sign one, I'd have no problem doing so. I have nothing to hide, and I'd be lost if my doc lost his liscence, because one of his patient's crossed that line.
It's one of those things that is becoming more and more "standard" in PM. No one "requires" Docs to do it per se, but rather, PM Docs have largely adopted the procedure(s) to limit liability and please the DEA. It is my understanding that in many cases, especially with larger practices, the Docs work hand-in-hand with the DEA....Even turn over patients to them where applicable.
As with any field, PM Docs go to seminars and continuing education classes where they learn the most up-to-date procedures and office policies....They in turn adopt them where they see fit. As a fyi, other PM trends are: Post dated scripts, random pill counts, and Rx monitoring (state data base). All are "tools" available by PM Docs to help them manage the difficult field of PM and the abuse that inevitably follows.
As a general rule, contracts and UAs are more common in large PM practices, for the obvious reasons. All it takes is ONE patient to potentially bring down an entire practice. Conversely, smaller Docs....And GP's in particular, almost never have them.
I for one, welcome these tools because I do not want any abusers and / or diverters to infiltrate my Doc's practice. As a CP patient desperately in need of my Doc's services, I cannot afford to have him lose his ability to practice PM. Although bothersome and invasive, I don't mind these policies because it increases my chances of receiving good medical care in the long run. Many addicts and diverters get caught with these new systems....Maybe not right away, but over time when they make a "mistake" somewhere.
I was at pain management for about a month before I signed the contract. I had never heard of it before. I had still had my pain prescription from the surgeon when I started there. After a month I needed a refill. So after my first or second shot I mentioned that I needed the pain meds. I was sitting in the chair after I came out of the anesthesia. So they came in with the prescription and the contract and told me to sign it. They did not explain and did not give me a copy. I was under the impression I had to sign it or no pills. Maybe it depends on where you are going. The place I went was big. They had so many patients it was like a factory. Maybe the only way to keep track was the contracts. Don't get me wrong, I liked them alot but they saw alot of patients.
I forgot to mention that contracts also protect the Doc from litigation or AMA formal complaints in case they dismiss someone....The contact clearly spells out the terms and conditions of receiving narcotics and if the patients doesn't abide by them, they can (and will) be dismissed. This covers the clinic in case a patient claims Doc abandonment.
When patients are dismissed for abuse of their meds or other narcotics, it's protocol for Docs to provide one "ween down" script. In the case of the absence of scripted meds (suspected diversion), however, the patient is simply dismissed.
I think the contract requirement is strictly up to the Doctor and/or the practice. I know that my first experience seeing a pain management doctor at a large teaching hospital didn't include a contract. I was there for almost 5 years. I switched docs to be closer to home about 4 months ago and the new practice requires that everyone signs a contract to include pill counts, urinalysis, etc. Like others have said, having to sign a contract isn't a reflection of the doctor's trust in the patient - it is usually just a matter of the medical professional protecting his/her license and to show the "powers that be" at licensing boards and the DEA that they are requiring accountbility on the part of their patients. Memere (KathyMac) BTW - I haven't been asked to bring in my pills for a count or to produce a specimen for a urinalysis since the first appointment. But I know that they can call me at any time to come in.
I switched docs to be closer to home about 4 months ago and the new practice requires that everyone signs a contract to include pill counts, urinalysis, etc. Like others have said, having to sign a contract isn't a reflection of the doctor's trust in the patient - it is usually just a matter of the medical professional protecting his/her license and to show the "powers that be" at licensing boards and the DEA that they are requiring accountbility on the part of their patients. Memere (KathyMac) BTW - I haven't been asked to bring in my pills for a count or to produce a specimen for a urinalysis since the first appointment. But I know that they can call me at any time to come in.
UAs are usually random and on average, about once per year. It talking with PAs & etc., it's my understanding that pill counts are reserved for suspicious patients, or those who are on "probation."
Your first UA is always an interesting one....At least it was for me. It will humble you, that's for sure. If you can't produce a specimen, they send you to a lab to draw blood....You have 20 minutes to arrive there or you're dismissed.
I agree with Ex word to word, couldn't say better.
I am glad they are suggesting a contracts to people, it may work both ways.
Some people may not even know what can happen if you don't take meds as prescribed. Random blood work, counting pills, etc. can prevent over dose, addictions...
All of you make good points and thanks for the interesting info. I realize I'm in a very small minority on this opinion, but the whole contract/urine test thing seems really messed up to me. Actually, I've always felt that the government shouldn't be in the business of, in general, regulating what people do with their bodies. Personally, I choose not to do any illegal drugs, always comply with my prescriptions, etc... but at the same time I don't really blame addicts/diverters for hoops CPers go through. I do, however, blame the DEA as well as politicians who think that addiction is a legal problem rather than a medical one. A friend told me that many states keep a database in which they record every time you fill a controlled substance prescription. I find that really creepy. Can you imagine the outcry if the government kept a database everytime someone filled a prescription for cancer meds? The cruel irony is that those of suffering from CP are in no position to take any sort of principled stance, because as others in this thread have pointed out, we can't afford to lose access to our doctors!!
Actually, I've always felt that the government shouldn't be in the business of, in general, regulating what people do with their bodies. Personally, I choose not to do any illegal drugs, always comply with my prescriptions, etc... but at the same time I don't really blame addicts/diverters for hoops CPers go through. I do, however, blame the DEA as well as politicians who think that addiction is a legal problem rather than a medical one.
I would agree. If someone wants to abuse themselves....As long as they aren't hurting anyone else, I could really care less what they do to themselves. In the grand scheme of things, pain meds aren't that much different from a number of other things readily available to consumers today (in terms of health issues...Far too many to mention).
However, we have to play with the cards we're dealt, and we're in an era of more gov't regulation, not less. No question to me that the dispensing of narcotics has become a "political" issue, not a medical one.
Furthermore, modern medical research has proven that some current unaccessable (illegal) meds do in fact work very well in controlling pain, and are even less addicting in nature. However, I don't foresee anything changing due to political correctiveness, so it's non-debatable and a waste of energy to discuss.
As I've posted before, our country is very hypocritical in it's regulation of substances. For example, I just don't believe that alcohol and tobacco aren't as harmful....Maybe more so.....Than some controlled substances. It all goes back to when these categories were established / regulated. At the time, our leaders didn't have the information available today, yet no one (politically) wants to grab the bull by the horns and change things....Either de-criminalization, or criminalization (tobacco for example).
There is an ABC store in the same shopping complex as my grocery store.....The people I see filter in and out of the establishment are for the most part, much worse off looking than the average person I see in my Doc's waiting room. Think about that for a bit! Additionally, alcohol is supposedly so dangerous that we don't allow those under 21 to acquire it, yet those same people can go to war and die for our country. Explain how that makes sense?
A friend told me that many states keep a database in which they record every time you fill a controlled substance prescription. I find that really creepy.
Yes, it's true....And expanding. Why? Because again, it's a political issue.
Even worse....In some states, they only use the database in certain parts of the state....Not the entire state. Not to be crass, but if that isn't "political" or "sterotypical", I'm not sure what is! I understand the politicians rationale of only monitoring poor or working class parts of a particular state (the call it profiling), but how is it fair that two people (in the same state) with relatively the same background, job, income, & etc are treated so differently....One is monitored by the state and the other is not....All due to simple geography.
To be honest, I think we're heading towards a system of a national database where Docs and pharmacists will be able to access your med file via the internet in real time. As much as I think all of this isn't right, if that's what it takes to weed out the abusers / diverters, then so be it. As I mentioned in a previous post, one could do away with most of these issues / components if it just became mandatory to do blood tests @ each appt.....Rationale: If you follow the rules and only take what's prescribed, we'll give you all that you need, but those who don't, aren't retained in a PM program and must be dismissed. This would virtually eliminate the guesswork and cynicism by Docs. They would KNOW who's legit.
This is definitely an interesting and very debatable topic! I'm just concerned that in general, getting access to meds seems to be harder all the time. Sorry if I came across crass.....But, I'm very passionate about this topic because like most of us, I LIVE IT.
Fascinating post executor. You have an interesting point which I never thought of -- if we were all required to do blood tests at every appt, it would essentially make the government regs pointless (since the blood tests would tell you who was doctor shopping, diverting, taking too much, etc...). If doing so could actually remove some of the other restrictions, I could get behind that.
Thanks for the feedback....The idea is certainly something to think about. I think in the bigger picture, it all boils down to the patient / Doc relationship....It may be utopia on my part, but if we can somehow eliminate the potential skepticism by Docs, things would certainly improve a lot.