pain contracts

[ohmeowzer RN]

my mother started with a new Dr. she is 75 and has very severe osteoarthritis ... i was a little miffed when he had her sign a pain contract. he said medicare requires a pain contract ... for pain meds to be given over a long period of time .. i have never heard of that for medicare . i have been a nurse for 25 years and can't see why he would have a 75 year old woman sign that. does medicare require this or is this just his policy ? my mom never drinks or has never taken any type of drugs legal or illegal.. she was in the convent in the roaring 60's when the hippies were wild. i think chronic pain management in the US is very poor... my mom looked at the contract and was appalled.. her last Dr never had her sign anything like that... any thoughts on pain contracts? .. and does ,medicare really require them or was this his excuse? she was only getting a refill on her lortab 10 she's been on for 5 years for her arithitis... and he tried her on oxycodone without a pain contact and she could not take it .. to much .. she went back to her old med lortab ... anyway in Jan we are going back to her old dr... anyway thank you for your input .. i appreciate all of you !!

[MunoRN, RN]

well you are right.. ive been a nurse for 25 years ,, thats fine if he wants her to sign it. but don't fib to your patients about it being a requirement... he is history in Jan ...we are heading back to her former Doc...

I agree it wasn't good form for him to explain his universal requirement of narcotic contracts as being due to a rule he couldn't control. It's understandable for him to try and remove any accusatory or judgmental tone when having patients sign narcotic contracts, which is probably why he fibbed.

In the grand scheme of things though I don't think his fib was horrible enough to fire him. I think any Doc who is willing to risk losing clientele to try and support a more responsible system for giving out narcotics deserves to stay in business. If you'd prefer someone who gives you whatever you want, no questions asked, then there are plenty of those; they're called pill mills, but I don't really think those represent the type of medicine we should be supporting with our business.

[Lahryn04]

He probably requires them from all of his patients so that he can say he requires them from all of his patients. Otherwise, you get someone that "should" have a contract and they get offended by it, like you and your mom. If you don't plan on abusing the meds prescribed, then there shouldn't be a problem.

Totally agree with ya on this one! Doctors have to protect themselves as well and even if this is not required, it certainly is a good idea. Why were you so offended by it? And why are you switching docs? Because of only this? Was your mother the only one that had to sign this? Probably not... I doubt the doctor meant for it to be offensive either. What is the problem if she doesn't intend to abuse this medication? I might have missed something but just don't understand why its a problem to sign a pain contract, required our not.

[TonieRN]

We do pain contracts here along with random drug screens. Anyone on schedule 2s. Office policy. Prescription drug abuse is too high. We are not only screening for "extras" but also for that they test positive for what they should. Patients roll a dice when they come in monthly to get refills. They roll a "1"...they get a UDS. Protects us and them. With elderly patients, you have the risk that others may be taking their scripts or having them go to multiple docs to obtain....meds then being diverted by family members or other caregivers...or even them. Actually not fair to say just "elderly"....see it in all age groups....just the reality of today.

[TonieRN]

I would not take offense...i would be thankful that the doc is being diligent in pain management. Best for ALL.

[Esme12, ASN, BSN, RN]

The contract is for the MD and it is NOT a medicare requirement.....what a line. Like that makes it "justified". I dislike it when I'm lied to. Pain contracts have become common and they are for the MD's protection as they are begining to be questioned and prosecuted for prescribing long term narcotics. Some MD's have stopped filling pain prescriptions all together and refering patients to pain control clinics. But, adding another MD and co-pay to the long list I already have really gets under my skin and they all make you "come in" to get your scripts and for me being unable to walk well irks me!!! I think ir's easy money added with the co-pay/office charge. "Hi, you're here for you script? $40.00 co-pay here's your script.....NEXT" Soon I will have a specialist for every day of the month and will have to sacrifice feeding my family to pay them......

[Butterfliesnroses]

I don't think the thought should offend people. Really it protects the MD. If he was just asking young people I would think that would be prejudice of him. I work LTC and I've seen my fair share of people that abuse drugs. It isn't just the 20-somethings that are the drug abusers. I did clinicals at a clinic and the MD had pain contracts for every patient that was on narcotic pain meds.

[TonieRN]

This is NOT "easy money"...prescription drug abuse has sky rocketed. If a patient has nothing to worry about then they will not have problem signing a pain med contract and giving a UDS if requested. They will recognize that this is in the best interest for ALL involved. We are having drug overdoses coming in on a regular basis....and deaths....prescriptions drugs as the culprit. No, it will not eliminate the problem, but may help identify elder abuse if a UDS on an older pt comes up negative when they should be positive.....also makes sure they...meaning patients in general...know pain treatment is taken seriously. Also lets patients know that their doctors recognize the potential abuse for meds and want what is best for the patients.

[I_OYVEY]

It is not the contract that is offensive it is the doctor that is offensive for lying. The only thing wrong with the contract is the lie behind it. The doctor could have simply said it is now my policy to require this contract for pain medication, etc., etc. end of story. The patient can take it or leave it. A lie is a lie, regardless of the reason.

[~Mi Vida Loca~RN, ASN, RN]

The contract is for the MD and it is NOT a medicare requirement.....what a line. Like that makes it "justified". I dislike it when I'm lied to. Pain contracts have become common and they are for the MD's protection as they are begining to be questioned and prosecuted for prescribing long term narcotics. Some MD's have stopped filling pain prescriptions all together and refering patients to pain control clinics. But, adding another MD and co-pay to the long list I already have really gets under my skin and they all make you "come in" to get your scripts and for me being unable to walk well irks me!!! I think ir's easy money added with the co-pay/office charge. "Hi, you're here for you script? $40.00 co-pay here's your script.....NEXT" Soon I will have a specialist for every day of the month and will have to sacrifice feeding my family to pay them......

You have to pay to pick up your prescription???

[bagladyrn, RN]

I really don't see the doctor's "lie" as a big issue. The more important thing is whether your mother is getting improved pain relief. If having these signed contracts and/or random drug screens makes the doctor more able or more comfortable in prescribing controlled substances over extended periods then I am all for it.

My mother (age 81) has been going to a pain management specialist for several years now, with a signed contract. The treatment has taken her from being unable to walk the aisles at Walmart to being able to spend several hours trekking up and down the streets in Virginia City, NV (mostly vertical). Her reaction to being asked for a urine sample for drug screen was more one of amusement - with conjectures as to what they think is REALLY going on at bingo night at the retirement community!