Patient contracts and a lawyer’s advice to doctors on managing pain patients

http://www.edsinfo.wordpress.com/2016/07/23/for-some-pain-patients-life-without-opioids-is-torture/

http://www.statnews.com/2016/07/15/chronic-pain-opioids-patients/comment-page-1/#comments

As the nation begins responding to the epidemic of overdoses and deaths caused by opioids, some people with chronic pain who have relied on these powerful painkillers for years are finding them harder to get. A survey conducted by the Boston Globe and Inspire, a health care social network of 200 online support groups with 800,000 members, found that nearly two-thirds of respondents reported that getting prescribed opioid medication had become more difficult in the past year…

Under comments:

Mtla
JULY 15, 2016 AT 9:45 PM
Have you read the recent pain contracts required by the DEA of all LTO patients? They are horribly written, riddled with contradictions and typos, and they strip the patient of all rights. It’s assumed you’re a criminal just for claiming to be in chronic pain.

http://deasucks.com/essays/typical-pain-contract.htm

1. I have been informed about the potential for addiction to controlled substances. If this happens, I will follow my doctor’s guidance and participate in an addiction treatment program if prescribed.

4. I AM AWARE THAT I COULD BE CHARGED WITH “DRIVING UNDER THE INFLUENCE” (DUI) AT ANY TIME FOR DRIVING WHEN TAKING CONTROLLED SUBSTANCES.

6. I will adhere to the following rules:
> I will use only one pharmacy to fill my controlled substance pain medications.
> I will accept generic substitutes when available.
> I will not accept prescriptions for controlled substances (pain killers or sedatives) from other doctors without prior approval from MSPMI.
> I will not use illegal drugs and must limit my alcohol use. My doctor will periodically ask for a urine sample to check for illegal drugs, alcohol,and other pain killers.
> If a specific medication does not work for me I will return the unused portion to MSPMI.

10. I agree to submit to a urine and/or blood screen to document appropriate blood levels of prescription analgesics and to detect the use of non prescribed medications at any time.
** I UNDERSTAND THAT I WILL BE DISCHARGED FROM MARQUIS de SADE PAIN MANAGEMENT INC FOR ANY POSITIVE RESULTS FOR ILLEGAL DRUGS, FOR A URINE SAMPLE THAT HAS A TEMPERATURE READING OF BELOW 90 DEGREES, FOR REFUSING TO GIVE A URINE SAMPLE WHEN REQUESTED OR FOR NOT SHOWING UP AT A DESIGNATED OFF SITE LAB IN THE ALLOTTED TIME I AM GIVEN TO ARRIVE THERE.

http://www.thehealthlawfirm.com/resources/health-law-articles-and-documents/Legal-Tips-for-physicians-to-manage-pain-patients.html

Legal Tips for Physicians to Manage Pain Patients
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

I have represented a number of physicians who have been accused of “overprescribing.” Some of these were criminal investigations by local law enforcement authorities, such as a county sheriff’s office. Some were investigations by the Drug Enforcement Administration (DEA). Some were investigations by the state licensing agency (in this case, the Florida Department of Health).

In almost every one of these cases, either the DEA, the Department of Health or the local law enforcement authority used undercover agents posing as patients to make appointments with the physician, agents usually wore a wire device, and gave the physician false information.

In several cases the investigation began when the patient died of a drug overdose (in several of these cases it was unclear whether it was a suicide by the patient or an accidental overdose). In each of these cases, there was an angry, upset family member who blamed the physicians for the patient’s death…

Here are some ideas on how physicians might protect themselves from drug-seeking patients. These are tips I give to physicians I advise on this issue…

(Note: The following tips are not applicable to physicians who treat cancer or hospice patients.) …

6. Patients who are clearly addicted to opiates should be referred a physician specializing in addiction medicine for rehabilitation. Do not accept this patient back until the patient does this.

8. If you are not a certified specialist in pain medicine, refer pain management patients out to one who is.

9. If you get any information that the patient has been “doctor shopping” or obtaining similar medications from more than one physician, immediately terminate the relationship and notify local law enforcement personnel. In many states, “doctor shopping” by patients is now a crime, and the physician is required to report the patient to law enforcement.

11. Require that prior medical records, especially diagnostic reports such as MRI and x-ray reports be received by your office directly from the other physicians or the radiology facility. Forgery of radiology reports and the sale of false reports is notorious among drug seekers.

13. If prescribing opiates for more than a short, chronic episode, require a pain management contract be signed by the patient in which the patient acknowledges your guidelines and requirements.

14. Require a urinalysis test before every visit. Wait and review the report prior to prescribing. An absence of the medications the patient is supposed to be taking is just as informative as the presence of medications you have not prescribed.

17. If the patient demonstrates drug seeking behavior (asking for certain medications by brand name and dosage, becoming angry and upset if the physician doesn’t prescribe what the patient wants, etc.), terminate the patient immediately.

20. Require current x-rays, MRI’s and diagnostic tests. Do not treat based on old x-rays and diagnostic test reports.

21. If you are not board certified in the subspecialty of pain medicine, and you are not part of a large, institutional of pain management clinics, then you should only have a few pain management patients in your practice. The majority of your patients should not be pain management patients.

23. You should consider reducing the amounts of narcotics at each patient visit. Gradually weaning the patient off of addictive medication should be a primary goal of the physician.

24. Be very wary of any patient presenting with no signs or symptoms of pain or who has inconsistent signs and symptoms of pain. These are patients who may be selling the medications or who may be undercover agents seek to entrap you.

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4 thoughts on “Patient contracts and a lawyer’s advice to doctors on managing pain patients

  1. I have a medical cannabis card. Unfortunately, the amount of cannabinoid necessary to control my whole-body arthritis and nerve pain due to spinal collapse is so much that I’m rendered immobile. According to medical cannabis experts, this is not unusual for high level pain. I can’t get opioid pain medicine anymore, because mental illness is one of the CDC’s recent position paper’s exclusion conditions. So I guess I’ll have to spend my SSDI on weed, subsist on tortillas, and watch old Betty Boop cartoons for the rest of my wasted life until I get sick of the whole thing and end it. I’d like to look into starting a registry of pain related suicides. I predict a tsunami of deaths due to untreated pain, beginning pretty soon.

    Liked by 1 person

    • Many in the chronic pain community have been predicting a marked increase in suicides, I guess partly because they hope this will be real evidence of how wrong the opioid war is. After all, you can die from drug addiction, but how many death certificates say the person died from chronic pain? Where’s the proof that the opioid war is directly responsible for killing people (and not saving people)?

      I think you’ll agree that it takes a lot of courage to take your own life. There’s probably a high percentage of religious people who suffer from chronic pain, and most of them would not even consider it. Yes, the suicide rate will continue to increase, just as it has over the last decade or so. But I think most pain patients will suffer in silence, without taking that final step.

      I’m sorry you can’t get painkillers anymore. I haven’t tried, but I’m assuming that I’m in the same boat. And it sucks. Nothing works on pain like painkillers. Go figure. 🙂

      Like

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