If you are seeking a prescription for pain medication in the United States, chances are that you will be asked to sign an opioid or pain contract. More than just a piece of paper, this formal agreement legally binds you to a set of very stringent rules regarding pain medication usage.
It acts as both an educational tool to help you understand the dangers of pain medication, and as a way to protect healthcare providers from potential patients looking to scam doctors (or collude with them) to sell pills. If you violate the rules within a pain contract, you may be blacklisted by your doctor, and will most likely no longer receive any medication from them.
In turn, you’ll also have a much harder time finding a doctor willing to take you on as a patient. These heavy repercussions can even be triggered unintentionally, and it’s very important to fully understand what your pain contract implies before you sign it, as well as what your options for alternatives to opioids are.
What Is a Pain Contract?
Pain contracts are a relatively recent development, coinciding with the rise in opioid overdose deaths (leading to today’s opioid epidemic). The epidemic can be traced back to the 1990s, when a few unscrupulous doctors and several key figures in the pharmaceutical industry put profit over patient safety.
Due to these scandals and growing deaths in subsequent years, it has become standard practice to ask patients to sign a pain contract when they require a prescription for opioids. Opioids, which include medications derived from opium as well as any synthetic variants, are largely used to treat different levels of pain. Common ones include:
These drugs help the brain manage and reduce pain signals but are also dangerous if used improperly or taken recreationally. Too much at once can cause an overdose, triggering respiratory depression that leads to death. Misuse and other factors help contribute to opioid addiction.
Supporters of the pain management contract argue that it helps succinctly inform patients of the dangers and risks associated with opioid medication, ensuring that they take their medication very seriously and avoid any legal trouble associated with opioid use. Detractors argue that these contracts are inflexible and violate patient privacy and do more harm than good.
These contracts are not set in stone, and rules for how they should be written and what they should and shouldn’t cover differ from state to state. Individual doctors typically have their own versions of a pain management contract, which means that caution must be exercised whenever you speak with a doctor about a new prescription.
While there are pros and cons to be considered, patients who need the medication to deal with intractable pain or debilitating chronic pain have very few alternatives. As such, it’s important to understand in detail what a pain contract entails.
Don’t Take Too Little, Don’t Take Too Much
While pain contracts differ minimally from state to state and doctor to doctor, there are a few general hallmarks that remain the same across most providers. One of them is that there is little to no flexibility in how pain medication is to be used.
This means that when a doctor prescribes a dosage and schedule for your pain medication, you are required to follow it to the letter – you cannot save medication on low-pain days for high-pain days, because the doctor will then suspect that you are selling your medication (if you aren’t using as much as you should be) or misusing it (if you’re using more than directed).
Prepare for Drug Testing
How and when you’re using your medication may be closely monitored through follow-up questions and mandatory drug testing. Refusing to drug test may be a violation of your pain contract, and if there’s anything that shows up in your drug test that is out of the ordinary, your doctor can refuse to treat you again.
Avoid Getting Medicated Elsewhere
Roughly over half of the states in the United States keep databases for physicians to monitor the use and prescription of pain medication, and dissuade patients from “doctor shopping”, which is the practice of seeing multiple healthcare providers to amass a larger stock of drugs for sale or misuse.
Any signs that you have been using or buying prescription pain medication from other doctors may get you blacklisted. It’s important to note that this only applies for otherwise illegal medication. You can buy over-the-counter drugs and non-prescription medication from multiple providers, from physicians to drug stores.
Alternatively, there have been instances where patients have been unwillingly treated with prescription medication in urgent care clinics or even emergency rooms, leading them to void their contract involuntarily because their urine test subsequently showed levels of a different opioid pain medication, or abnormally high levels. In at least one case, the physician did not continue serving their patient even after context was given for the results of the urine test.
Don’t Let Your Medication Get Stolen
If you report to your doctor that your medication was stolen and ask for a refill, they may be obliged to refuse. Similarly, some pain contracts explicitly forbid you from losing your medication or having it stolen, as it might imply that you sold it. In such cases, physicians are trying to ensure that they distance themselves from a potentially fraudulent patient.
Some Doctors Are For Them, Some Doctors are Against Them
Not all states require or recommend a pain contract or opioid treatment agreement, although most do. In states where a pain contract is necessary, you may find doctors who use them begrudgingly as well as doctors who find them to be beneficial in informing patients of their responsibilities during treatment.
Some experts find that pain contracts prioritize the provider’s protection. Others find them to be helpful for talking to patients about the treatment process and highlight the very real dangers of opioids.
If you find yourself needing pain medication, understand that the terms of your pain contract agreement may be different from doctor to doctor, and that thoroughly reading and understanding exactly what you can and cannot do is important.