Contracts

[mellie4]

I've seen contracts referenced a few times while I've been reading.  I'm just wondering if most people who see a pain management doctor sign contracts and what that includes?  They've never talked about a contract where I go.

[Sarajmt]

Hi BP:  Mellie's thinking on putting teens on long term narcotic use mirrors my own.  This was a weight room injury resulting in a deep muscle bruise.  The pmp had him excused from all weight bearing exercises on his knees.  He just needed to get the swelling down and some rest.

I would do anything to help my children.  If their condition required long term narcotic use, so be it.  However, not until all avenues have been explored.  Simply put, he is not mature enough to use these responsibly.  All my children have at one point or another had to use narcotic pain relief.  Short term, no problem.  Long term, they're going to have to really need it.  And then I would.

[TrayCee]

They ABSOLUTELY the in place to protect the,   NOT the patient

[mellie4]

Thanks, Tuck.  I have no intention of asking why they don't use contracts :)  The less constraints the better as far as I'm concerned.

But it does seem very unfair to me that a patient can be just dropped with no resources.  That bothers me.  I'm sure there are often times a patient should be dropped.  But if it's a patient who previously has had no issues and a test is wrong, or they lose a prescription or something, it seems very unfair to me that they are just totally dropped.  That leaves them where?  Going into withdrawals most likely and with no one to help them deal with their pain.  That seems like bad medicine to me.

And I know anyone prescribing narcotics has to be very careful to protect themselves, but the patient needs protection, too.  For far too long, chronic pain patients were not able to get their needs met.  Even terminally ill cancer patients have been known to be undermedicated.  There is no reason for anyone to suffer pain in this day and age.

I can't imagine being dumped as a patient.  My nurse practitioner is the one I deal with on a regular basis at the pain clinic.  She is very open to listening and talking.  She's been great.  I'm able to tell her my fears of tolerance, dependence and addiction, and she does her best to make me understand the difference.  She's also open to listening to me about anything new I come up with.  And she knows I discuss my treatments with a friend who is also a nurse practitioner in orthopedics/rheumatology in another state.  (I love having this friend because I know she loves me and has an interest in me and what's best.)

And if things didn't work out with my pain management clinic, I'm fortunate to have a wonderful PCP.  She is the best.

[Tuckamore]

Those contracts are made for the protection of the physician and clinic. They are not designed to protect you as a patient.

For example I have never heard of one saying, "If for some reason you fail a Urine of Blood Drug Screen you will have the opportunity to defend yourself, offer explanations and/or retake the test. It will be taken into consideration that Drug screens are not 100% accurate." I doubt there are any such statements in a contract that protects you.

I am prescribed my medications through my PCP. That is the way my state practices. I have not had to sign a contract.

I wouldn't ask why your clinic does not use contracts. I would just feel fortunate that you are not subject to the errors that can occur with testing or contracts.  

Peace,
~Tuck

[mellie4]

Thanks for the link.  That was very interesting to read.  I'm not sure why my clinic doesn't do it.  

Has anyone encountered any problems due to signing a contract?  It seems straightforward enough, but I'm wondering if anyone has ever run into an unforeseen problem with it and how you handled it.

[TrayCee]

the above link is a PM example

[TrayCee]

I also signed a contract at my PM DR.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829426/bin/11606_2006_84_Fig1_HTML.jpg

[mellie4]

I'd be pretty nervous having any of my kids on narcotics for anything other than a short-term need.  Narcotics are just too addictive and teenagers and young adults are often not responsible enough to understand the consequences and responsibilities of being on these kinds of medications.  (My daughter did take Percocet for a few days when she got four impacted wisdom teeth out.  It was great as she was in a lot of pain, but we weened down very quickly to just ibuprofen.)

[BP88]

I honestly don't agree with the whole mentality of people being too young for pain medication.  Regardless of age we all feel chronic pain and it hurts us all the same.  I could understand if he was five or something but a teenager is not too young to need pain medication.  These medications whether it be marijuana or opiates originate in the ground and should be available to all living beings if needed without going through a bunch of red tape.

[Sarajmt]

States do differ in their regulations.  Perhaps that's it.  I don't know.  My doctor saw my son (17) because of a knee problem.  football player hurt in the weight room.  He'd been through pt but was still hurting.  She did an injection and voltaren gel but no drugs.  He even had to sign a contract.  Btw, I would not have agreed to him going on pain meds like we do.  Way too young.  I just took him in for the injection.

[mellie4]

I wonder why my pain clinic doesn't do that?

[Sarajmt]

Mellie:  I've signed one for both doctors whom I've seen.  My present doctor wanted to make sure there was nothing in my system when I first saw her.  The doctors have to protect themselves in today's environment.

For the most part, I think they all probably say the same thing.

[pmartin1664]

Ya  Mellie, every state is different. In fact it's not the state that orders thee contracts, it is most always the indiv. dr's  offices or Pain Clinics that might require them. They are really only a liability safeguard for the medicine writer, so that they do not become embroiled in any law suit should you shop around for Dctors to write scripts, thus having numerus opiates in your system, and while high, lets say, driving a car into a loaded school bus. Those kind of stories! It is suppose to serve as a safeguard for Doctor and patient, however we know some folks on these medications take them for one purpose. Pain is not one of them!  But in the chance these people do get caught, whether by Phar. alert, or through one Doctor to another, then they are OUT. That person will find it difficult but not impossible to find another reputable doctor to assist them in their endeavors. Take Care, Pmartin

[BP88]

I had to sign a contract for my opioid med prescription.  It's basically a list of rules and guidelines you have to follow in order to keep your pain meds.  Such as no doctor shopping, no abusing illicit drugs, no taking drugs you're not prescribed, etc