I think these are a good way of weeding out the abusers.  I had to sign a contract but it did not bother me.  It is for both you and your doctor's safety.  I would rather this be done because I do not want a pile of pills on the streetbecause of drug seekers, the only part that sucks if you loose or get your pills stolen.

Al

I have been living with chronic pain for last 5 years and have been taking opoids for pain the whole time. I feel it is an infringment on my rights. Why do the people who need these drugs have to be treated like criminals, we have a hard enough time in our daily lifes existence to have to be treated this way.

I understand the need for the contracts as it insures that the patient understands the reasonable expectations the doctors have for the patients in their on going care.  However, I have never been approached about the UA's and don't really know what that information would be used for and how it may get 'leaked' into areas of my life that I feel it has no business affecting!  Like I don't understand how insurance companies should now be able to access peoples credit ratings to determine insurance rates.  At what point could someone avail themselves to my UA and determine something about me?  I just don't think I like it.

I know the contract and random UAs don't seem fair for patients who have very real chronic pain, however, because of the widespread drug abuse, the alternative would be to severely restrict the use of opioids for everyone.  Unfortunately the abuse of opioids has become so prevalent, this is the only way found so far to make needed medications available to patients without opening the door to abusers and drug dealers. 

If your doctor does not require a contract and random UAs and someone he prescribed opioids for turns out to be a drug addict, or worse a drug dealer, the doctor can be prosecuted, imprisoned and lose his medical license.  Sadly many doctors have quit prescribing opioids at all for fear of this happening. 

The random UAs are also a safety precaution for patients.  Studies have shown that a significant percentage of patients do not take their medications as prescribed or mix medications that should not be mixed.  This can be extremely dangerous, especially when taking powerful opioids.

I'm sure this information doesn't make the process any less frustrating, but I hope it at least helps you understand why it's necessary.

Karen

I live with chronic pain and had to sign an opiod contract.  As a young, surburban, stay-at-home mom, the drug abuse culture seems far removed from my life.  I resent being lumped together with criminals and drug addicts.  I sincerely wish that I had diabetes or some other chronic disease where the medications required do not bring on the social stigma or the continual semi-suspicion that I feel I'm always under.  Do people with high cholesterol have to take UA's to measure their medication levels to make sure they're not abusing it?  To me, my pain meds mean no more to me than insulin or even Tylenol.  They just enable me to live my life with a reduction of my debilitating symptoms.  The difference between my bottle of Tylenol and my pain meds, is that I lock my pain meds up.  Always.

I think its necessary for some patients. I had a Dr. who accused me of being a addict. I found another Dr. and explained to him everything and he monitored me for a couple of months. Then told me he didn't think I was a addict and we have a fantastic relationship. I think sometimes Dr's. are not so up to date. I feel the older Dr's. have a set mind and don't believe in chronic pain. If you have a history of abusing drugs then YES you should be on a contract & UA's. You also have to have a trusting relationship with your Dr.. You have to be honest and truthful. I know I am not a addict so I guess mandatory UA's and a contract would not offend me.

Wow.  I really hope that some of the people who have answered already come back to read other answers, and maybe they'll see another side to this.

I have a family history of addiction on both sides of my family.  My father was an alcoholic, and on my mother's side, of seven great-uncles, six died in "alcohol-related incidents".  The tendency towards addiction *is* inherited, and I know that.  If my doctor couldn't require a contract and random UA's, he'd have to be nuts to allow me to be on any narcotics on a long-term basis.

Of course, I'm honest, and I told him about my family history.  Not everybody is honest, and he has to be prepared to deal with people who worry that they won't be allowed to take the meds they need because of their family history or whatever.

I'm not sure my family and friends would be able to see the truth if I tried hard enough to hide an addiction/abuse problem from them.  I think my pain psychologist would, she's pretty sharp.   That's another reason I keep seeing her, and cheerfully submit to any random UA request, and any other hoop that's designed to keep me safe from my own genetic predisposition to problems --  I don't want to become an addict.  Without these safeguards in place, what protection do I have?

In many cases, pain specialists don't know their patients for years and years before they start prescribing narcotics, so they can't go by a long history of knowing a person and knowing that this person wouldn't abuse their meds.  And even if they could, how hard is it, really, to hide a problem from someone you see three or four times a year (before you become a chronic pain patient)?  My father hid his drinking problem for years. 

And one of the ways you could be "misusing" your medications would be by selling them on the open market.  You could certainly hide any signs of that!

So, would it be fair to ask your doctor to stake his reputation -- hey, his entire career, income, and future -- on his ability to determine if each and every patient is really and truly using their medications properly?  I don't think so, and I don't think it would be fair to even ask.  

Think of it this way.  They have to make ONE rule that applies to their entire practice, in order to be fair.  The only safe rule for your doctor is that *every* patient signs the agreement, and gets tested occasionally.  Any other rule would be professional suicide, and in the case of a pain management doctor, that would also leave hundreds of other patients high and dry, completely screwed, looking for another doctor -- one who would probably require the agreement and the random UA, after seeing your last doctor go under.

Oh... and for the person who asked about the people on other meds having to take blood tests... Yes.  I am also diabetic, and also on cholesterol meds.  I have to have blood tests done every three months, to be sure I'm not only taking my meds, but also eating right and exercising according to what "they" think I should be doing.  And if they think I'm not, I get The Royal Lecture.  It's been quite a hassle to find a doctor who understands that (1) they don't put you on morphine or fentanyl just because it "hurts a little bit" to walk, and (2) if your fentanyl patches flap off in the shower, it's a good bet you can't swim with them on, either.  It's not just chronic pain patients who get "the attitude".  And, BTW, no, you don't wish you had diabetes.  You might wish you had that instead, but they're not mutually exclusive.   And you wanna talk social stigma?  I'm regularly accused of causing my own diabetes, because I'm large.  (I was much smaller when my diabetes was diagnosed, but that's another story.)  At least for my meds, I only get it in the pharmacy; for my size I get crap everywhere -- parking lots, supermarkets, you name it.

When I was in Florida I had to sign a contract.  It didn't really bother me.  It was basically "requiring" me to be responsible for my actions when taking narcotics and guidelines for getting help if needed.  I don't know if it was a universal form or just one this doctor used but like I said it wasn't troublesome.

As far as fair, I don't know.  I am big on the right to determine my course, however, I think my doctor has the right to ask me to sign something if it will keep the insurance company and "drug lords" off of his back.  I sincerely doubt that these would hold up in a court of law.  They aren't witnessed and notarized, and as a patient needing pain meds a good attorney could argue coersion. It would also depend on what exactly I was being asked to agree to.

Hi Carol

Interesting question!

I actually was glad when my doctor & I made my contract up.  He sat with me and explained every part of it, what was expected of me and what he would take care of, he told me that he really thought it was silly that every pain patient had to be put on contract, as he knew that I was not going to ever become a problem, but these contracts were created to help protect us both and make sure we both know and abide by the rules.  Everyone else had to have one to refill their meds too and it would be especially helpful when he was on vacation and one of his colleges would have to refill my meds without seeing me them selves and would avoid a hassle for us both.

He also added that although it stated that he could do a UA at anytime, he really did not ever forsee that I would need one. 

It's been five years now and he's never asked for urine, I've never used one tablet more than he & my pain doctor have told me too, never ran out of meds early, unless they were the ones who changed my rx first and the only time my contract has come into play has been when he's out of town, onvacation or not in the office and I've never had any trouble getting my rx promptly with out question every 28 days as agreed.

With the way the world is today, I can only imagine how doctors have to be under constant scrutiny in acessing each patient they see that comes in for pain meds.  Pain is the number one cause of a patient to see their doctor and I just don't mind playing by the rules in order to continue with my medications.

I do although understand how some people could feel it violates their rights.  And I also know that some patients may use some home alternative Herbal remidies to help them to control their pain the best they can and really don't have any problem with them doing what is best for them. We all are so different in what works and what does not work and I don't think my heart could ever harshly judge a person who needs some extra help, but their doctor may now feel the same way, so I guess we have to make a choice and follow the rules, as I have.

I'm curious to read what others think of this and I thank you for asking this question.

Take Care, I hope your feeling alright too

Betty 

i've never had to sign a contract,but had to have a random ua.of course it was ok,i've nothing to hide.it is a good way to find out about those who abuse their meds which makes it bad for the rest of who really need them!not really thrilled about it all,but i don't blame the docs for doing it.

When I am in pain, anything that facilitates being able to take something to help me be comfortable, I will agree with.   Do I think I should have to?  NO!!!!!!!!!!  If this is prescribed by a legitimate doctor and is recorded in my file, pain medication should be my choice and my doctor's.

Is a contract fair?  In a perfect world the answer would be no. However, we do not live in a perfect world do we.  Living with cronic pain from RA, my pain meds are a life line for me.  If this is what is necessary to allow me those meds then that is what is necessary.

I had no trouble with signing a contract.  My Doctor and I see each other once a month and the subject of how much pain meds I have taken is always talked about.  The bottom line is my Doctor is doing this for my protection.  It has been one of my fears that I would become addicted to the meds.

I had to sign a narcotic contract for my severe pain caused by fibromyalgia.  i dont think that they are fair at all.  i lost my meds for a time because i had no way to get to my doctors office on short notice for u/a and pill count.  i have a ride program that i have to give 3 day notice to, to get rides to the doctors office for apointments.  the only way to get a ride is to have a apointment and the doctor does not set apointments for ua and counts so i have no way to get there at all.  i live 45 minutes from my doctors office.   i dont think it should go agianst a person when they do not have there own transportation and doctors are not willing to work with you and want to see you the day they call for ua's or counts.  i do understand the contracts need to be there for the people that are abusing the meds, but what about us who need the meds and they make it hard for us.  i have been on pain meds for 8 years and it hasnt been easy.  i feel the contracts should be different for those on long term care then short term. 

I had to sign a narcotic contract for my severe pain caused by fibromyalgia.  i dont think that they are fair at all.  i lost my meds for a time because i had no way to get to my doctors office on short notice for u/a and pill count.  i have a ride program that i have to give 3 day notice to, to get rides to the doctors office for apointments.  the only way to get a ride is to have a apointment and the doctor does not set apointments for ua and counts so i have no way to get there at all.  i live 45 minutes from my doctors office.   i dont think it should go agianst a person when they do not have there own transportation and doctors are not willing to work with you and want to see you the day they call for ua's or counts.  i do understand the contracts need to be there for the people that are abusing the meds, but what about us who need the meds and they make it hard for us.  i have been on pain meds for 8 years and it hasnt been easy.  i feel the contracts should be different for those on long term care then short term. 

IF, and that's a BIG IF, I could find a doctor who would prescribe Lortab 10 for my daily use - jest one or possibly two on rare days, I would not mind in the least in signing a contract and having a random UA.  I am an addict, only as far as needing possibly 2 lortabs a day.  I accept that.  We are all addicts to the extent that we NEED meds to have any quality of life!  I don't think that it is against my rights; I'm the one asking the MD for help. 

The problem is the DEA.  I live in southern Utah and the MD's here are seemingly terrified of the DEA. My husband is a retired Nurse Practitioner who had a DEA number and he has told me of so many MD's who are afraid to prescribe what patients legitimately NEED, unless they happen to be terminally ill.

My husband suffers from chronic back pain due to an accident.  He knows (see above) that nothing can be done except to take the "edge" off of the pain.  As for me, I have awakened with tension headaches daily for over 40 years; sometimes I also endure a migraine, although they are lessening with age.

The situation is terribly frustrating for us.  The DEA needs to STOP and realize that there are LEGITIMATE uses for pain meds; and, if using random UA's would help the situation, I am all for it.

No, it is so not fair!  Chronic pain has already been proven over and over again to be UNDERTREATED.  It affects every aspect of a person's life. (Their jobs, their relationships, their family life, etc.)  Only the person suffering really knows how severe the pain is.  

I have Rheumatoid Arthritis. I've tried "DMARDS", (like Arava,) and my Rheumatologist had to take me off due to the extreme side effects.  I'm on prednisone, Naproxen, and  Tylenol. I haven't taken narcotics in months because I hate them!  However, I have them for when I get a terrible "flare". (My hands swell up, get red, stiff and I physically cannot move my fingers or my wrists. I can't function when it gets like that.)  When I get a "flare", the pain is literally unbearable, and I sit and cry from it. Other times, my feet hurt so bad that I can't walk. I could go on and on. Suffice it to say that I choose not to take narcotics. Others don't have the pain tolerance level that I have. Everybody's make-up is different so we cannot imagine the pain others may feel!

Sincerely,

Rosella Koeller

rosekoeller@yahoo.com

Considering there are safety and professional credibility issues involved, I would  have to say yes, a mandatory UA is in line for anyone who is prescribed or uses Class Two Substances.   In fact, I think all controlled substances should be monitored this way, as it may lead to catching some of the abusers who either take too much, or distribute the amount they do not consume.

Remember, people, prescriptions defer all responsibility back to the prescribing doctor, and it is their livlihood that is toyed with in abuse cases.

I presently take prescriptions for class two drugs myself, and I want to know if I am doing it right, creating complications by consuming other drugs on top of them, and I want to build a bond of trust between myself and my doctor.  I feel like we should be able to trust our doctor, and vice-versa.

I'm inclined to disagree with any sort of mandatory tests.  Who will use this information?  Who has acess to this information?  What are the consequenses if the tests are false-positive? If I were to be denied my meds for having a false-positive UA, what would I need to do to correct it and what would I do in the mean time for my pain management?  Lots of things can go wrong with UA's.

That being said, if my doctor wouldn't precribe me meds without one, then I would discuss these things with him and only him.  I guess I feel that my doctor has the right to ask me to take a test and I have the right to take the test or refuse and find another doctor.

I'm torn.  Yes, it has the potential to weed out the abusers, but it also has the potential to make life even harder on those of us in chronic pain, who use our meds responsibly.

I've read some of the contracts.  They have their good points, but some of the 'rules' are...a little harsh I guess.

Honestly, ever since I've begun treatment for my fibro, I've worried that I may run across a doctor that requires the use of a contract.  Not becaus eI abuse my drugs, but because I am afraid that sometimes they punish responsible users for mistakes.  What if you are travelling and your meds are lost or stolen? What if (like someone on another support group) your house is broken into and your meds stolen?  The lady on the message board had a very, very hard time replacing the meds.  Even with a police report, and she didn't even have a contract.

Hmm..I don't know...I'm still undecided.  But leaning toward no, this is a violation of our right.  We have a right to have access to the medicines we need.  We have a right NOT to be in pain.

It is nothing less than a violation of your rights. Personally I would consider civil action against any "doctor" who required such nonsense.

This is a TEST question right?

This doesn't REALLY happen does it?

This is quite the joke.

Some one tell me who this "Expert" thinks she is or who she is talking to.

These "contracts" are against the law. No one can be conditionally medically treated.

I'll treat your pain if you sign that you won't sue me for killing you with side effects...

This is a violation of your rights, the doctors code of ethics and the law.

Treatment is witheld by a doctor unless you sign a forced contract. Tell me EXPERT, which court is it that even considers these contracts legal and binding.

You cannot be forced to enter any contract, such action would automatically make it null and void.

I am stunned that this is even considered. Where's the ACLU?

You know...I figure if you have an RX for a drug and are RESPONSIBLE taking them...I wouldn't have a problem with it.   I have my PCP "control" ALL drugs, therefore, I can't mix/over do with MY drugs.  That's just me, of course!

I live with chronic pain from lymphedema, fibromyalgia, back problems, major TMJ and deterioration of the joint, lupus, arthritis, and more.  I don't take strong meds unless it's unbearable and there are quite a few of those days.  It amazes me how doctors are so fast to hand out some medications like antibiotics, and now we have a serious overuse of them that they don't work properly against infections anymore.  But on the other hand for pain, they blow you off. 

NO! I don't think signing a contract or mandatory UA's are appropriate.  It's BS as far as I'm concerned.  It's a violation of my rights and privacy, and it's not fair. It's never been fair to punish all for the people who abuse anything.  It never was in grade school and it's childish.  People in serious pain need help.  Some pain is temporary thank goodness but others are chronic and people need to be able to function and have some quality to their lifestyle.   My medication is the only way I can function.  I think the way to go is pain patches but they are not strong enough.   If someone can make a morphine patch or even hydocodone patches that actually work when you put it on the spot, that would be great.  Not that I would use it, but I think pot should be legal for those who are in need, the chemo patients, chronic pain patients.  Anything that helps you get through the day, and if you can take meds and work, the more power to you.

I agree with Tinabudde... I am 49 years old... have never in my life abused drugs or alcohol. I am now in a situation where I am waiting for neck surgery on two disks... I am waiting on back surgery (possibly) for two disks... and I have Lymphedema, arthritis and numerous other problems with shoulders, neck, wrists, stomach, legs, Knees, feet and ankles.. did I leave any part of my body out??? just include it... because it hurts also.... chronic pain is a nice way of saying that I hurt 24/7 and even then the pills only dull the pain.. for someone to tell me that the medication my doctor gives me is subject to UA's is ridiculas... I have enough problems then to have to deal with peeing in a little cup... If as some say the meds could be a bad mixture then I say the doctor and the pharmacy should be aware of that.. way before a random drug test should show it.. as that might be tooo late.. and to say that if I go and sell my drugs to someone then it is the doctor who is liable.. that is just plain ridicuals.. if that is the case then someone needs to change that law.. that does not make it right for me to have to take random tests... I should be the one to be liable not the doctor if I and I alone abuse my drugs.... If the doctor does not know his patient well enough to know if he is a drug seller or abuser then the doctor should do more research but not take it out on me.... because I have a long term doctor who knows me and knows I am not going to abuse my drugs.... or sell them... and Tina is right about the cancer patients who if needed should be allowed to smoke pot... I myself had a 33 year old friend who died from ovairian cancer... she was told by her doctor that she did not have anything wrong with her to go home and forget about the tumor they found on her.. but a year later it was found out to be terminal cancer... it was horrible as she had three children but.. she ended up having to smoke pot for the pain and it was the only thing that helped her pain and her to be able to eat... I am convinced it prolonged her life in a good way... so I am now a firm believer in pot for cancer patients... everyone needs to work on finding help for patients with chronic pain and illnesses instead of worry about how much drug they use.. find a cure.. I will be happy to give up the drugs that my doctor gave me..

I do not think we should have to have random UA's!  There are many of us that live with chronic pain daily and get NO help for it, we are told that we just have to live with it or are sent to have a pain study done.  Some doctors have told me I am not in pain that I am just chasing pills. How do they know if I am in pain or not??  They touch my foot or legs and Im in tears because it hurts so bad...yet these same doctors hand out pain pills to others like they are candy??  There are so many days I cant hardly stand to get out of bed to go to the bathroom because I hurt so bad.  Wonder if they could deal with the pain???  NO!!!!
Yes there are those that abuse pain pills, I know a few of them and it is the doctors that give them out to these people like they are candy without making them go in for a pain study.  How about we UA all the doctor's and the people that come up with these stupid rules about trying to make it mandatory to have to do a UA in order to get help with the pain and see what kind of DRUGS they are taking???

This is BS and against my rights and if I had to take a random UA just to get help with the pain then that is just wrong....You ALL know for a fact that if it were the people making these stupid laws or the doctors that had chronic pain they sure would be doing something for it....but not us humans!!!!  No we are to suffer or do UA's.......How pathetic!!!

My name is Anne, and I suffer from bilateral secondary lymphedema in my legs, my lower stomach and up the right side of the trunk of my body. I also have osteo-arthritis of both knees. The right knee is 95% bone on bone, and the left knee is approx. 50% bone on bone.

I as well as many of you see a pain specialist to try to get some relief. And yes, I also had to sign an agreement or contract with them. It did mention UA's, but as of yet I have never had to provide one. I thought it was awfully strange that I had to sign a contract with a doctor to have him give me medications.

I don't like the idea of signing the contract, but if I want to be somewhat comfortable, that is what I am going to do. I feel if they are going to make us sign this contract, they should make available all types of treatments to us, for example, medical marijuana.

I understand that doctors do this to protect them and us. I am not sure when all of this started, meaning signing contacts, but I am sure this would have never been implemented if some people out there didn't abuse the medications they were given.

If you have nothing to hide, why do you feel contracts, pill counts and UAs are an infringement on your rights?  Do you submit to labwork to make sure you're doing well on your meds?  So, how is a UA different?  There can be multiple reasons for them, not only to make sure you're taking your meds, not abusing them and not selling them on the street.  They can help patients at times. 

I willingly signed a contract.  In over 2 years at my pain clinic, I've had 2 UAs, the first being first visit protocol. The second one was at my year mark. I found it is normal to do them at that time for ALL patients. I am actually glad I had mine as it showed something interesting.  My doc knew I wasn't selling my meds.  But, it showed much less in my system than was expected given my dose of meds.  Come to find out, it was because in calculating the dose from pill form to elixir form a HUGE mistake was made.  Lortab 7.5/500 elixir is based on a 15 ml dose not a 5 ml dose like most elixirs.  My dose was being shorted by 1/3.  So without the UA, we'd likely not have found that out. 

I figure that I've nothing at all to hide, it's not me being singled out but a policy of my pain clinic and the contract is common sense items for my clinic anyway.  Plus, it protects both my doctor and me. 

And to the person who stated we're all addicts because we need pain meds for quality of life or to have a life....you're wrong.  Would you tell a person who needs insulin that they are an addict?  They need their meds for their quality of life.  That's called physical dependence not addicton.  Addiction carries a psychological component to it.  I've seen one way of putting it that addicts use pain meds to escape their lives, those in chronic pain use pain meds to HAVE a life.  It's attitudes like yours stating we're all addicts that cause the media and others to give us all kinds of hassle.  Using a medication to treat a medical problem is NOT addiction.  You may lable yourself an addict but please do not lable the rest of us who aren't addicts as addicts simply for our pain med use.  It's sad when even those in pain do not get this simple distinction.  I take blood pressure medications daily and suffer withdrawal effects if I don't take them...am I addicted to blood pressure meds?

Mandatory testing...the problem is in the attitude.

many chronic illnesses have regular testing to check on progression of illness, response to drug therapy, compliance with therapy etc.  it is a diagnostic tool that providers use to ensure that they and the pateint are on the right track and to determine if changes need to take place in the therapy or follow up or referral to a specialist.

for chronic pain patients it is used as a tool/weapon to accuse, to belittle, to label, and has no therapeutic value in the way that it is used...it is arbitrary and not at all random as they would have you believe.  Ask them for their policy of how they randomize...they should have a policy that states how pateints are picked...is it every third pt on every third thursday? or everyone with a name that starts with H....or whatever...that is random....

I went to a pain conference recently and I found a company that has the right attitude.  they have devised a therapeutic diagnostic tool that is useful to the physician and every patient show have it done on a regular basis...Not random. 

the information that is provided from the UA is valuable information and reported in a very professional and respectful manner.  it is a test just like a CBC, a Chemistry profile, a liver function test or a renal/kidney function test.  there is no labeling.  it is a tool that providers can use to begin a conversation with a patient about the results...just like all the other tests I mentioned.

some day we may have a lab test to determine the existence of pain and how well you are responding to the therapy prescribed.  but for now we have to settle for a UA.

it is all in the attitude....

I resent the contract...

I resent the "random" UA

I resent the label....drug user/addict or at least the implication

I resent being questioned whether my pain is real

I resent having to call a provider to get them to "do the math" because they think 30 pills ought to last 2 weeks (and the RX says take 2 tabs every 4 hours) the math says that 2 every 4 = 12 tabs per day = 2.5 days.... 

when chronic pain is treated like any other disease that will be a blue ribbon day...

compassion, respect and justice is what we need....

to become an advocate go to www.painfoundation.org and is sign on as an American pain foundation advocate...

join the voices of others ---  75 milliion voices can not be silenced!!