Treatment Agreements: What You Need to Know Before Signing
By Karen Lee Richards
If you go to a pain clinic or pain management specialist, you will almost certainly be required to sign a treatment agreement in order to be treated. Even if your family physician or other specialist is handling your pain management, if you are being prescribed controlled substances (e.g., hydrocodone, oxycodone, alprazolam, etc.) on a regular basis, you may be asked to sign a treatment agreement.
When you’re asked to sign this agreement you may be so desperate for pain relief, you’d be willing to sign anything – even without reading it carefully or understanding it completely. However, if you don’t understand and abide by every point in that agreement, you could find yourself without pain medication, facing withdrawal, and unable to find another doctor who will prescribe it for you.
It Happened To Them
Following are some examples of people who found themselves in this situation (names have been changed):
• Brenda felt like the dosage of oxycodone her pain specialist had prescribed was too strong because she was feeling “high” and had difficulty functioning. Thinking she was doing a good thing, she took less medication. At her next appointment, she was given a drug test, which showed that she did not have the prescribed amount of oxycodone in her system.
• Frank had some dental work done and the oral surgeon gave him a prescription for hydrocodone. When Frank took it to the pharmacy, the pharmacist refused to fill it and immediately contacted his pain clinic.
• Vivian’s husband hurt his back over the weekend. She couldn’t stand to see him in so much pain, so she gave him some of her oxycodone to help ease his pain until he could get to the doctor on Monday. This caused her prescription to run short, so she cut her dosage in half the last few days of the month. When she went in to get her refill prescription, she was given a drug test, which revealed she only had half the amount of oxycodone in her system that she should have.
• Kevin was having a really bad day and his fentanyl patches just weren’t giving him enough pain relief to allow him to get his work done. He had some oxycodone left over from before he started seeing the pain specialist so he took it to help with the breakthrough pain. His doctor’s office called and asked him to come in a couple of days early for his appointment. When he arrived, he was given a drug test, which showed the oxycodone in his system.
These were all well-meaning people who had no intention of abusing drugs, but in each of these cases, the patient was immediately dismissed by his or her doctor/clinic. Because they had been dismissed for failing a drug test, no other doctor was willing to prescribe any kind of opioid pain medication for them.
How can you avoid finding yourself in a similar circumstance? By reading every word of the agreement before you sign it, asking questions about anything you may be unclear on, then following the agreement to the letter.
Treatment agreements will vary some from doctor to doctor, but there are some basic requirements that are included in most. When you sign the agreement, you:
• Agree to take the medications at the dosage and frequency prescribed. It’s essential you follow the prescription directions exactly. Don’t take more or less than the prescribed amount every day. Don’t try to take less on good days so you’ll have more left for bad days.
• Agree not to increase, decrease or change in any way how you take the medications without the prior approval of your pain management doctor. If you feel the dosage prescribed is too little because you’re still having a lot of pain, or too much because you feel spacey all the time, call your doctor a tell him what you’re experiencing. Do not under any circumstances change the dosage on your own. If you’re tested and found to have too much in your system, they’ll assume you’re abusing the drugs. If you have too little in your system, they’ll assume you’re selling or giving them to someone else.
• Agree to random drug testing to assure you’re only taking the prescribed medications in the prescribed amounts. Although you know you’re trustworthy and wouldn’t abuse drugs, there’s no way for the doctor to know that. Because there is so much drug abuse today, physicians have to be extra vigilant. If they are found to be prescribing controlled substances to people who are either abusing them personally or selling them to others, they face losing their medical license and criminal prosecution.
• Agree to obtain all of your medications at one pharmacy, which you must name, and give your consent for the physician and pharmacist to exchange information about you. This is because abusers sometimes try to obtain prescriptions from multiple doctors and fill them at different pharmacies. With all prescriptions being fed into computers now, interconnected databases make this much more difficult to get away with.
• Understand that lost, stolen or destroyed prescriptions and medications will not be replaced under any circumstances. It’s essential that you keep track of your medications and make sure no one else has access to them.
• Agree to inform your pain management physician of all other medications you are taking.
• Agree to inform your other health care providers of the pain medications you are taking and of the agreement you have signed. This includes emergency care providers.
• Agree not to request any pain medications or controlled substances from other health care providers.
• Agree not to use illegal drugs, street drugs, or another person’s prescription.
• Agree to keep all your scheduled appointments. Your agreement may require 24-hours notice to cancel an appointment and/or have a maximum number of appointments you can reschedule and still continue to be treated. Canceling an appointment at the last minute isn’t fair to the doctor, who doesn’t have time to fill that slot with another patient. But, perhaps more importantly, they don’t want you cancel appointments because you’ve been using your medications improperly and are afraid you wouldn’t pass a drug test.
In addition to the above, you may be required to agree to participate in any medical or psychological assessments recommended by the doctor, or to participate in any program designed to improve your function, whether it be physical, social, psychological, daily activities or work activities. You may also have to agree that, if you have or develop an alcohol or drug addiction problem, you will follow through with any addiction program you’re asked to enter.
Finally, you’ll be told that your pain management physician may stop prescribing medications if you:
• Don’t show any improvement.
• Develop a rapid tolerance for the treatment.
• Develop significant side effects from the medication.
• Fail to abide by the terms of the agreement.
That final point – failing to abide by the terms of the agreement – is also likely to result in the doctor refusing to provide any more care for you at all.
Harsh But Necessary
I know some of these things seem harsh and unfair to honest people who are in severe pain and simply looking for some relief so they can function and live a decent life. They are unfair. But as my Mother always told me, “Life’s not fair.” Because there are so many people out there who do abuse drugs and who have become experts at cheating the system, those of us who need stronger medications to control our very real pain, are forced to abide by these highly regulated restrictions in order to receive the treatment we need.
We tend to get angry and blame the doctors for making it so difficult to get our medications and for making us feel like we’re suspected of being drug abusers; but the fact is, doctors are mandated by their states and the Federal government to play by these rules. If any question should arise about a physician prescribing controlled substances for a particular patient, that doctor has to be able to provide proof that every care was taken to ensure the patient was taking the drugs properly.
Also, it’s virtually impossible for a doctor to be absolutely sure whether a patient is genuinely in pain or just seeking drugs. Studies have shown that most physicians are not able to discern true pain patients from drug seekers with any reliable degree of consistency. Unfortunately, abusers are often very good at faking it, and there are no lab test that can accurately identify pain levels, so doctors are forced to do the best they can, utilizing tools like treatment agreements and random drug testing to make sure they’re not contributing to someone’s addiction problem.
I wish I had an easier solution for you, but until someone comes up with a better way, our best option is to make sure we understand the treatment agreement before we sign it, then do our best to strictly abide by the agreement.
© Karen Lee Richards 2009
Last Updated 6/3/09