In a previous post I tried to explain why I would not sign a contract for pain medication. We had a nice debate about the contract and some folks even suggested I must be a druggie for not signing the contract.
Well it would be quite the opposite if one has any commonsense at all because a druggie will do anything to get their Buzz!
I have not had ANY form of pain medication now for quite some time, yeah I'm stubborn and in pain now, and have been threw the withdrawals of these harsh opiates all because I WILL NOT and I never will sign a contract that the Doctor/Government can invade my private life at their will, and at any time they want.
I found a copy of the standard contract that the Doctors can/will require you to sign, so I ask...... Would YOU sign it, or would you give-up your freedom of private life for a bottle of pills?
The quotes in
red is what I object too.
Medication Contract
I, , _____________have agreed to use the following medications as
part of my treatment for chronic pain.
I understand that these medications may not eliminate
my pain but may reduce it and improve what I am able to do each day.
MEDICATION DOSE DIRECTIONS QUANTITY PER MONTH
I understand the following guidelines for continuing pain treatment under the care of
1. I understand that I have the following responsibilities:
•I will take medications at the dose and frequency prescribed.
•I will not increase or change how I take my medications without the approval of this
health care provider.
•I will arrange for refills at the prescribed interval ONLY during regular office hours. I
will not ask for refills earlier than agreed, after-hours, on holidays or on weekends.
•I will obtain all refills for these medications only at pharmacy
(phone number: ), with full consent for my provider and pharmacist
to exchange information in writing or verbally.
•I will not request any pain medications or controlled substances from other providers
and will inform this provider of all other medications I am taking.
•I will inform my other health care providers that I am taking these pain medications
and of the existence of this contract. In event of an emergency, I will provide this same
information to emergency department providers.
•I will protect my prescriptions and medications. I understand that lost or misplaced
prescriptions will not be replaced.
•I will keep medications only for my own use and will not share them others. I will keep
all medications away from children.
•I agree to participate in any medical, psychological or psychiatric assessments recommended
by my provider.
•I will actively participate in any program designed to improve function, including social,
physical, psychological and daily or work activities.2. I will not use illegal or street drugs or another person’s prescription. If I have an addiction
problem with drugs or alcohol and my provider asks me to enter a program to address this
issue, I agree to follow through. Such programs may include:
•12-step program and securing a sponsor
•Individual counseling
•Inpatient or outpatient treatment
•Other:_____________________If in treatment, I will request that a copy of the program’s initial evaluation and treatment
recommendations be sent to this provider and will not expect refills until that is received. I
will also request written monthly updates be sent to verify my continuing treatment.
3.
I will consent to random drug screening to assure I am only taking prescribed drugs. I
understand that a drug screen is a laboratory test in which a sample of my urine or blood is
checked to see what drugs I have been taking.4. I will keep all my scheduled appointments. If I need to cancel my appointment, I will do so
a minimum of 24 hours before it is scheduled.
5. I understand that this provider may stop prescribing the medications listed if:
•I do not show any improvement in pain or my activity has not improved.
•I develop rapid tolerance or loss of improvement from the treatment.
•I develop significant side effects from the medication.
•My behavior is inconsistent with the responsibilities outlined above, which may also
result in being prevented from receiving further care from this clinic.
Signed: Date:________________
Provider: Date:_________________
Click this link to the actual contract
http://www.ohsu.edu/ahec/pain/med_contractlf.pdf