Perhaps samples of 'good' contracts could be made available on this site.  I believe they will eventually become required of everybody.  I understand why physicians are putting them into place for self-protection as well as ensuring that their patients are duly informed of the potential consequences of the particular medications.  I would add the following suggestions:

* Ensure that all physicians are informed of all of your Rx's.  I earned all of my physician's respect and trust by understanding my conditions and keeping them informed.  I have all of my medications cooridinated by my PCP once it is established that a new Rx is going to be included into my on-going treatment plan. 

* Have all Rx's filled at the same drug store, mail order, etc.  if practical.  However, if it is more cost-effective to have them filled some at the drug store and others at mail order, then at least make sure that the pharmacist is aware of all of the Rxs to avoid any interactions or potential problems.

* Periodically request from insurance company your perscription history.  They should have it available to you at no cost.  Review the list and honestly evaluate how you are doing & if there are changes in your pattern.  This could also be helpful for end-of-year medical deductions when doing taxes.

* Note that insurance companies can, and do, audit your Rx usage.  If they suspect there is a problem (and having a big Rx inventory can trigger an audit), they may require the physician and the patient to validate the Rx history.  Doctors do not like to have to answer to insurance companies paperwork & just getting the letter can tick them off into thinking you're abusing.  That isn't always the case.  Good doctors will work w/their patients.  An audit requires the physician to review all of your perscriptions that you've filled & report back to the insurance company that they are valid or there aren't any discrepancies.  The patient usually is also provided w/the same information to confirm that the Rx were filled by them. 

* Beware of the growing problem of medical identity theft in which persons fraudulently use another person's insurance info/card to receive medical treatment, surgeries, etc. 

* I personally am concerned about having pain mgt Rx filled thru the mail even if it can save $$.  The risk of easily identifiable mail Rx packaging could lead to theft in transit or from your mail box.  Having those Rx filled at a local pharmacy may provide better physical security of the drug until you get it into your own hands.  Report any lost/stolen Rx to the postal service.

*If Rx filled thru the mail, be sure your physician knows this in the event that you experience nonreceipt of your meds. 

* Have a list of all of your Rx, dose, frequency, purpose in your wallet at all times.  My doctor reviewed my list & signed every page.  If you have multiple meds that you can 'choose' from depending upon the level of pain or problem but can not take at the same time, you need to have that identified on the list.  This info is very good to have and can save valuable time in ER's etc. or new physicians   I personally do not hand over my Rx containers to anybody.  I will give them the list, but it is my responsibility to ensure that my meds do not fall into the hands of someone else. 

* Maintain copies of your medical records even if they charge you for them.  It is better to have the records & review the physician notes.  The physical records do belong to the physician but you are entitled by law to obtain copies.  There usually is a charge for this but it could mean a world of difference under any number of possible circumstances, Katrina-like disaster, changing doctors, your physician retires/dies. etc. Having historical records after the law allows the provider to dispose of your records could be essential if you have unusual medical conditions and/or ever have to retrieve them from some archived depository for medical or legal purposes. 

* Continue to build a sense of trust w/your physicians.  Sometimes it takes years to do, but it is well-worth it if the physician is receptive.  When they understand your medical conditions & that you're not doctor shopping for drugs, it is easier to get better care for your pain, etc.  Sometimes we don't have choices about dr that we see, but if you detect a negative shift in their attitude, it could be better for you to fire them instead of the other way around! 

* If you are a risk of Rx theft from your home, establish a secure place (even one of those home safes if possible) where you can lock up your meds.  Only carry smaller quantity w/you of what you need. 

* Do not flash or discuss your meds w/others unless you needs to to avoida temptation.  Many years ago I had a 'friend' visiting my home stole my cat's medication, a drug that is also prescribed to humans.  Another incident occurred during a party.  Someone stole syringes they discovered in the bathroom.   Although difficult to do sometimes, file a police report of stolen medications.  You should let your doctor know that a police report was filed.

* I believe it is essential that you always be your own health care advocate.  You are the only one who has to live in harmony with your own body.  If you have a 'Rx Contract', you can let your physician know the safety measures you're taking such as locking up Rx, carrying smaller qty, Rx list in the wallet, & mail order Rx supplier.  It may cause them to think twice and not jump to a false conculsion that you're abusing or that you've violated the terms of your agreement. 

* One last item to realize  is that insurance companies & the government are automatically suspicious about validity of patient's pain and/or pain management physicians who are prescribing so many pain perscriptions.  The pressure applied to the physicians could lead to reduced quality of care for the patient.  The only time I was ever summoned to my dr's office was after he'd received a ltr from insurance company for audit.  We went over both of our lists & there were no discrepancies in what had been prescribed.  Naturally I was humilitated and very upset about it, but my dr quickly quieted my concern if he had lost confidence in my integrity.  He was very gentle and kind, adding that "the last thing a physician wants to receive is a letter from the insurance company" or "the government".  (Don't you wish all drs are like him?)

* Despite your health problems, let your state representatives & the Congress (Representative and Senators)  know your position on proposed changes in health care or targeted drugs (for example, oxycontin).  Get involved.  If you can access this web site, then you can email and that's the quickest way to communicate w/our legislative leaders. 

My husband has had 3 back surgeries since he was injured in 1998. The first surgery was an 'experimental' surgery in which the dr. lost his license.  Since 1998 he was once on 90 mg. of Oxycontin daily and 30 mg. (up to 3 times a day) of oxycodon for break through pain.  When SSD implimented their 'pharmacy' program, he could no longer afford the oxycontin, so he was switched to methodone.  In the beginning he was taking 220 mg. daily.  When we moved to TN, the dr. there actually upped the dosage.  My husband took himself down to 80 mg. of methodone daily, with oxycodone for break through.  We have moved back to ME (northern sector).  The dr. he was seeing here told my husband not to worry, that if the pain clinic could not write his RX, he could help.  He ran my husband through a series of tests (xrays, mris, etc.). Well, my husband ran out of all of his meds. yesterday (he should have ran out a week ago).  This new dr. he is seeing told him the 'organization' that he works for will not allow him to see pain patients. Now he has no doctor and he is in excruiating pain. So medicare spent all this money on paying for this dr., when the dr. knew from the beginning he could not deliver appropriate medical care? And he is not the only one.  We have sent in ALL of his medical records to drs., make 100 mile trips to their office, only to be told within the first 5 minutes that my husbands condition was to severe for them to deal with.  We have also been told there are certain dr.s that CAN get away with writing RX for opiod therapy because nothing will happen to them???  WHY?