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Pain Contracts, Screening and Prescription Drug Databases

Preventing Overuse of Prescription Pain Drugs by Drug Dependent Patients

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Updated October 17, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

If you believe you need pain relief in the form of a prescription pain drug like narcotics or opioids, you should be aware of the steps being taken by doctors, individual states and provinces to determine which patients do need pain drugs, how they manage the taking of those drugs, and whether or not they're becoming abusers of those drugs:

1. Pain Contracts

Some doctors now require patients to sign pain contracts. These contracts must be read and agreed to by the patient, or the doctor will not prescribe the pain-relieving drugs they need.

The contract lays out the important points a patient must agree to, including statements like:

  • I will not attempt to obtain drugs from any other source.
  • I will not sell the drugs you prescribe for me.
  • I will safeguard my prescription so it won't get stolen.
  • I will agree to undergo screening tests to measure whether I am abusing pain drugs during the time I take them.
  • I agree not to try to refill the prescription too early (meaning, the patient is taking too much of the drug too fast).
  • .... and other points.

A final statement says that if they violate any of the points, the doctor will stop prescribing the meds for them, or will dismiss them from their practice. It's one reason patients may be blackballed or blacklisted.

Find a sample pain contract here (from the NIH website).

The use of these pain contracts is a point of contention among doctors, as they feel that asking patients to sign such a contract violates doctor-patient trust. Those who use them anyway may appear to feel a bit embarrassed about asking their patients to sign these agreements, but they do use them because they feel their patients need to know the problems that may develop through use of the drugs, and to protect themselves from legal problems.

Some doctors tell their patients that the government requires these contracts, but to date, no state, provincial or federal government is requiring pain contracts. They're local to a specific doctor's office or hospital.

The list also lays out violations doctors and emergency room personnel know to look for in drug-seeking patients. These patients will be turned away if they show up requesting pain drugs.

2. Urine Tests

One way a doctor can tell if his or her patient has either taken too much of an opioid drug, or has been compounding the drug with other substances—including other drugs, marijuana or alcohol—is to administer a urine test.

If the urine test reflects only the drug that has been prescribed by the doctor, in an acceptable amount, then the patient has a better chance of continuing to work with her doctor, to receive the medication she needs, to undergo another therapy to slowly stop taking the drug, or to relieve her pain in another way.

On the other hand, if other substances—or too much of the prescribed medication—is found in a patient's urine, the doctor may dismiss the patient, or simply refuse to write a new pain drug prescription.

There are stories about patients who have gone to the emergency room for problems which may or may not reflect the pain meds they take, who are then prescribed new pain relievers in the ER. They learn later that their regular doctor, who has been helping them with pain over time will, as described above, learn about the additional drugs from a urine test, then refuse to treat them further.

3. Statewide Databases

More than three dozen states and seven provinces in Canada have established databases to help track opioid and narcotic drug prescriptions.

These databases track doctors' prescription-writing, pharmacy prescription-dispensing, and patients' prescription filling.

When a patient sees his doctor, and the possibility exists for writing him a pain relieving drug prescription, then the doctor will be able to access the database to be sure that patient is not attempting to "doctor shop:" amassing more prescription drugs than he is legally or medically entitled to, or which can be of danger to him if he overdoses.

Discussions are underway to make sharing this information possible across state lines so patients cannot go doctor shopping in other states.

While many patients are upset that such a database violates their privacy, there are actually important reasons to support the use of this kind of tool:

  • Doctors will be able to more confidently prescribe drugs for appropriate patients, at appropriate times, with less fear that they can get in legal trouble.

  • When emergency room personnel can access such a database, patients who go to the ER will be less likely to be prescribed drugs that can conflict with the pain drugs they already take. Or, those same patients will be less likely to be dismissed by their regular doctors if they've been to the ER for some other reason (see urine testing above.)

  • Many patients continue to take pain relieving drugs when they think they are dependent on them, even when they are not. Patients who are capable of being weaned off these drugs will be compelled to do so, even when they think it's impossible. Doctors will have more complete information about their patients' pain drug history, including prescriptions written by other doctors, prior to their relationship with the patient.

Medscape maintains a list of which states are using what kinds of tools to control narcotic and opioid drug abuse.

As time goes on, the laws may be tightened even further, and it may become more difficult for patients to obtain the drugs they want and need for controlling their pain.

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