Migraines, Pain, and Narcotics Contracts

What to Do if You're Terminated

by Megan Oltman

Migraineurs and other chronic pain patients who use narcotics (opioids) are often asked to sign narcotics contracts, or treatment agreements, with their doctors. These contracts establish the rules for the doctor’s prescribing narcotic pain medications. They require that the patient submit to random or scheduled drug testing to determine if they are taking the proper amount of the drug and that they are not taking any other pain medications or illicit drugs.  If patients fail the test, these contracts allow the doctor to terminate care.

Who do these contracts protect?

Doctors can get into big trouble for over-prescribing controlled substances, or helping people with addiction or substance abuse issues get them. These contracts are an attempt to limit doctor’s exposure to prosecution for misuse of controlled narcotics. Research shows that it’s not usually chronic pain patients who abuse narcotics. Pain medication is widely under-prescribed, and pain undertreated. Do these contracts help patients at all? There is certainly a danger to narcotic medications, and strictly controlling the prescriptions may help some patients to avoid problems.  I don’t think the contract's main purpose is to protect patients, however. They do protect doctors, who are risking their professional standing if they prescribe narcotics without having a contract in place.  Patients need doctors who are willing to treat them, so narcotics contracts may be a necessary evil.  

Typically, the contracts require patients to:

  • have all of their pain medications prescribed by this doctor alone..
  • take the pain medication as directed, at the intervals directed, without variation
  • be subject to some type of drug testing, whether regular or random, to determine if they are taking the prescribed medication(s) as prescribed, and that they aren't using other medications or illicit drugs

Patients who are told they have violated their narcotics contract may be in a difficult position. If they take narcotic pain medication regularly, they may face withdrawal when their care is terminated.  We frequently get questions from people who have been terminated without a referral to another treating physician, or without any help in getting ongoing care.  What can you do if this happens to you?

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