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A signed contract in exchange for pain medicine?

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by Plagueis Plagueis (New Member) New Member

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Leslie, dear friend, you are really hopelessly naive! Do you really think that a doctor is going to risk his or her license and freedom for a patient? :lol2:

well...i know there are many 'dh's' for physicians, but there are a handful who would look the other way, in the name of compassion and mercy for terminal pts.

you would especially hope to find these qualities in palliative care drs.

the only other thing i'd suggest, is try to find another dr/team for this pt.

there are many resources out there, and not all drs use contracts.

palliative care is supposed to be about holistic comfort.

terminal pts should all be exempted from the terms and conditions of said contracts.:twocents:

leslie

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all_over_again has 5 years experience.

3,220 Visitors; 113 Posts

Doctors are under tremendous pressure when it comes to pain relief for their patients. The majority of them want to help, I really believe that, but their options are so limited.

As a nurse and person formerly dependent on pain meds, I have a fairly good grasp on the dilemma. I think everyone will be better served when addiction is seen as a public health problem instead of a human short-coming or moral issue. Only then can we get on with the business of getting our patients and ourselves the help we all need.

The most frustrating thing for me is that this is 2011 and we still don't have much in the way of effective pain medication that doesn't cause tolerance and dependency issues.

Yes, there but for the grace of God I go.

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azhiker96 has 10 years experience as a BSN, RN and specializes in PACU.

1 Article; 42,061 Visitors; 1,118 Posts

Leslie, dear friend, you are really hopelessly naive! Do you really think that a doctor is going to risk his or her license and freedom for a patient? :lol2: My family and I learned this the hard way when Grammy's oncologist let her die in agonizing pain, all supervised by home health nurses via hospice, rather than help her get some freakin' grass. I do understand where he was coming from, but it all sure opened my eyes about just which side doctors are on. And it is not the side of the patient. Understandably.

Kooky, I'm sorry you had such a poor experience with hospice. Please don't let that one experience color your view of all doctors or of hospice. There are many good doctors who do write orders to effectively control pain and other symptoms.

My wife works in hospice and has no problem adjusting narcotics to control her patient's pain. She had one young man who was bed bound with pain but was able to get him back on his feet with 50mg methadone TID. Ironically, she went into hospice because of one doctor who would not write for narcotics for his cancer patients because he didn't want them to get addicted. His attitude is wrong on so many levels I don't even want to get started on it.

I work in PACU with a lot of great docs. Most of them willingly give me orders that allow me to control my patients' pain, even among my addict population which are sometimes a challenge.

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643 Visitors; 6 Posts

Swampcat, I too have a friend who had CF and he smoked/ingested mj to help with appetite and generalized pain. His docs were not happy:rolleyes: and almost took hm off the transplant list (thank the gods they did not, and he got his new parts in Jan),:D but he had to fight for every bit of it. He also grew his own and got busted, but essentially said...."look, I have CF, I am going to die...soon,,, so what can you really do to me to make me NOT use MJ? These are my choices....."

The DA let him out of it....:jester: I am sorry your friend has such trouble with the issue. I used to work addiction units and I can understand the use of contracts, but all it is doing is keeping the honest people honest, as my father used to say. The real addicts? They will find a way.

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needshaldol specializes in Pain management, Med/Surg.

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OK here is how it is. I worked for 15 years in a high tech pain clinic and the anesthesiologists gave out enough pain meds to kill all of us here. People in pain have high thresholds for narcotics. We always got a contract signed but I never ever remember it being enforced. As for the patient who does not get enough pain control.........patient needs to go to a pain specialist as they are not afraid to give out the goods. As for the "weed" issue, how unfortunate that it is difficult to obtain. There is marinol that is legal. As for hospice..........if hospice is not controlling the pain, this person needs to change their hospice care. My mom had hospice and they almost killed her with medications. After a week of them thinking she had a stroke, and the poor woman was basically in a coma, I threw away 1/2 the meds and mom came around. That was over a year ago, and she is walking about and fine. Thus, I am not a fan of hospice, at least the one that she got.:twocents:

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deege58 has 26 years experience and specializes in Labor and Delivery.

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I have severe pain issues due to being an old broken nurse. My neck and lower back have mild herniations and arthritis. I finally had to go for pain management so that i can work. The place i go to not only makes you sign a contract stating that you will not get pain meds from any other source, but they drug test you prior to giving you your first script. They also let you know that they have the right to do random pill counts and drug tests. They work with you to make sure your pain is controlled, but they know what goes on in the real world. I believe it's an excellent system, protecting both the patient and them. We often hear of doctors getting in trouble for giving out narcotics too freely. With this system they can avoid that.

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tyvin is a BSN, RN and specializes in Hospice / Psych / RNAC.

17,667 Visitors; 1,620 Posts

The contract is fine in it's place with non-hospice but it's true; patients are made to feel like criminals. I really don't think that having the doctor have so much control that they can request you to bring in your bottle to make sure you aren't gobbling or selling is out there.

If the patient keeps coming in early for refills then cut them off but this control issue with random bottle checks reeks of well...........

Also I feel sorry for the docs. They are hounded by the feds and are afraid to prescribe anything to anybody; hence the pain clinics. It's a mess.

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deege58 has 26 years experience and specializes in Labor and Delivery.

3,343 Visitors; 65 Posts

Now of course, there is the other side.. before the pain management clinic where the ortho wouldnt write me for anything but an antiinflamatory. I was actually in tears from pain and he wouldnt write for a narcotic, and that was after reviewing my xrays. I had to live through another whole week for pain releif. It was a nightmare..I switched orthos immediately!!

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linearthinker has 25 years experience as a DNP, RN and specializes in FNP.

12,084 Visitors; 1,688 Posts

If you don't like existing laws re controlled substances, you should be writing your congressman, not blaming providers for declining to participate in illegal activity. I don't think MJ ought to be illegal, but it is, and I'd not look the other way if a patient were breaking the contract. I worked too hard to get here. Making and enforcing law is not my job, but I am bound to follow it.

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classicdame is a MSN, EdD and specializes in Hospital Education Coordinator.

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I feel if her physical condition has changed then the contract is no longer valid. Dying and dying in agony are two different things.

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needshaldol specializes in Pain management, Med/Surg.

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ClassicDame

The contract is between doc and patient and is an understanding so that there is trust. The patient is not to take more than ordered and the patient knows that a refill will not be given early. If the patient needs more pain medication then the contract remains the same; the doc adds more or different meds to the care. If someone is dying in agony, then that person is with the wrong pain care doc. He/she ought to change jobs fast.

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1 Article; 18,807 Visitors; 2,334 Posts

Yes leslie, she has. It's illegal and that is that. Her doctors don't care about anything other than the legality of it. Therefore if she is caught with it in her system she loses all pain meds.

She doesn't smoke it, she ingests it mostly or will vaporize it

Marinol is an FDA approved drug and would provide all of the same "benefits" she gets from injesting mj.

http://reference.medscape.com/drug/marinol-thc-dronabinol-342047

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