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#278986 - 09/13/17 11:23 AM Pain Contracts?  
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WhiteCell Online
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Whidbey Island WA
I went to my new Rheum in Seattle 2nd visit yesterday. I had requested 10 norco for about 6 months for those days. She has a blanket "contract". After I read it I was shocked. The patient agees to "unannounced urine tests...." and it went on. I pointed out that I have always had trusting relationships with my doctors and use the medication infrequently to no avail. She became defensive and when I told her that it clearly was unlawful and outrageous she supported her position that the entire medical center was using this. I stressed the key thing about a relationship is the bond between doctor and patient. She however was not impressed.

Is this typical for these type of contracts? It remains on my mind this morning that the desire to counteract opiod related deaths has put regular patients in the cross hairs and that the bond between doctor and patient comes 2nd if not at all.

I'm glad I made her very uncomfortable. Perhaps she will think about it and return her practice to the patient first. I was actually chuckling when I left the office at how outrageous the "contract' is.


Starting at 18 yrs old > Reiter's Syndrome. Diagnosed 2001 Ank Spon.
Started Remicade 2002 - 5mg/kg every 7 weeks.

Right Eye Glaucoma- Trabeculectomy/lens replacement 2006.
DSEK Cornea Transplant 2009.
Ahmed Shunt 2016.
DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. 2004. Cured by RF ablation 2008.

ICU RN - Seattle, WA

~Grasp The Challenge and Succeed~
#278987 - 09/13/17 11:51 AM Re: Pain Contracts? [Re: WhiteCell]  
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Ken Delano Offline
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That's a first for me.


AS/PsA DX in 1988

Retired on disability
in 2005 at age 44
#278988 - 09/13/17 12:01 PM Re: Pain Contracts? [Re: WhiteCell]  
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onlywhenilaugh Offline
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I think this is becoming more common. My sister recently encountered a similar situation. She rarely uses pain meds, but her pain is so bad that at times she is unable to walk without pain meds. She is 70yo and cannot even get her groceries or make it to her dr appts at times without pain meds. She has a long term relationship with her dr and the dr knows she rarely uses pain meds. She was irate when she left because they would not refill her prescription without a urine test. They said they would call her to come in for a unannounced urine test before they would refill her script and sent her home without anything for pain. She would prefer to take nsaids but is unable to because she is on a blood thinner for A-fib. It is extremely difficult for her to make unannounced appointments because of her pain levels and transportation issues. I think that in trying to address the opioid epidemic they are causing great obstacles for those who truly need the meds and use them responsibly, while those who wish to abuse them are still going to find them.


Age 61. AS dx'd at age 57
HLA-B27+,iritis/uveitis periodically since 1970, diabetic
Meds. naproxen and muscle relaxer(as needed)
#278991 - 09/13/17 12:26 PM Re: Pain Contracts? [Re: WhiteCell]  
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Thesnakejakw Offline
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Originally Posted By: WhiteCell
I went to my new Rheum in Seattle 2nd visit yesterday. I had requested 10 norco for about 6 months for those days. She has a blanket "contract". After I read it I was shocked. The patient agees to "unannounced urine tests...." and it went on. I pointed out that I have always had trusting relationships with my doctors and use the medication infrequently to no avail. She became defensive and when I told her that it clearly was unlawful and outrageous she supported her position that the entire medical center was using this. I stressed the key thing about a relationship is the bond between doctor and patient. She however was not impressed.

Is this typical for these type of contracts? It remains on my mind this morning that the desire to counteract opiod related deaths has put regular patients in the cross hairs and that the bond between doctor and patient comes 2nd if not at all.

I'm glad I made her very uncomfortable. Perhaps she will think about it and return her practice to the patient first. I was actually chuckling when I left the office at how outrageous the "contract' is.




With the rise of people selling their meds or overdosing many doctors implicate contracts as a way to help protect their license from being taken away from the d.e.a. each state medical board has their own regulations , but yes indeed they can drug test you but it's not as crazy as it sounds they do one urine test on day of signing of contract to make sure you are not taking any illegal drugs and you are taking your drugs as prescribed . I was given a month and a half of prescriptions before being told if I was going to use narcotic or opiod therapy I would need to sign a contract I did and understood they can randomly urine test me as I have nothing to hide . It's also helpful for the pharmacy you go to so they don't judge you when picking up your pain meds and they will be able to see you have a pain contract on file .I have seen doctors being fired from urgent care or hospitals for prescribing to many pain meds, and as they can't initiate a contract they are targeted more by the government especially if these so called drugs were killing patients . Sometimes to build trust with doctors you also have to realize the risk they take when they put their name on your prescription bottle and you end up over dosing the next day with bottles of beer on the table and your pill bottle empty if your old they are still going to do it to see your drug levels or if someone else is taking their meds without knowing. And in my case especially I am almost 24 years old I am 6"2 and every time I go into a urgent care or emergency room they think I'm trying to score pills so I just tell them my prescriptions so I don't run into problems as I have in past you can also be red flagged as a drug seeker or doctor shopper if you don't have a contract for all your pain meds

Last edited by Thesnakejakw; 09/13/17 12:36 PM.

Diagnosed 4+ months ago with as causes chest pain and severe back pain . Medications : methotrexate .6 per week in divided doses, Prednisone tapering off 2 5mg daily, folic acid mg daily, dicloymine for stomach pain and cramping , ranitidine 150mg twice daily and Prilosec 20mg extended release once daily , Carispodol (Soma) 350mg 5 times daily , oxycodone 10mg every 4 hours as needed
#278993 - 09/13/17 01:17 PM Re: Pain Contracts? [Re: WhiteCell]  
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Winston Online
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This practice of random drug testing is becoming the norm at pain clinics. The DEA is going after pain doctors, and the doctors view the tests as one way to protect themselves from a potential criminal prosecution. The tests are not going away. In fact, I'll be surprised if most states don't pass legislation mandating them. I work in criminal justice, and I predict that opioids will be reserved for end-of-life and post-surgical patients in hospital and hospice settings within a few years. I predict some opioids will be banned outright, e.g., fentanyl.

Last edited by Winston; 09/13/17 01:19 PM.
#278996 - 09/13/17 06:54 PM Re: Pain Contracts? [Re: WhiteCell]  
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Cake Offline
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This has become the new normal.

I've been on such a contract for many years. I've been on pain meds for over 15 years and the contracts started 5-7 years ago.

My rheumatologist has prescribed morphine for me for many years. Once the laws started changing, that is when he asked me to sign the pain contract. Then I started having to do a urine screen once a year, and now I do one at each appointment. I can also be called in randomly, but that has never happened as he trusts me and I have never failed a single tox screen.

He doesn't want to do all this extra monitoring. He is very compassionate and knows that many patients with rheumatic diseases also require pain medication in addition to DMARDs, etc. But he has to take these extra measures so that if he gets investigated, he has documentation about his patient's medication use.

#278997 - 09/13/17 08:29 PM Re: Pain Contracts? [Re: WhiteCell]  
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WhiteCell Online
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Whidbey Island WA
Thank you for the replies.

The entry of law enforcement into an area for which they are not trained is profoundly dark and disturbing. It is also fracturing to the doctor patient relationship which is a trusting one. Like trying to do surgery with a hammer.

Thanks for the heads up. It is a profoundly disturbing trend in patient care and I can assure you Winston that your predictions will never come to pass.


Starting at 18 yrs old > Reiter's Syndrome. Diagnosed 2001 Ank Spon.
Started Remicade 2002 - 5mg/kg every 7 weeks.

Right Eye Glaucoma- Trabeculectomy/lens replacement 2006.
DSEK Cornea Transplant 2009.
Ahmed Shunt 2016.
DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. 2004. Cured by RF ablation 2008.

ICU RN - Seattle, WA

~Grasp The Challenge and Succeed~
#278998 - 09/13/17 08:31 PM Re: Pain Contracts? [Re: onlywhenilaugh]  
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WhiteCell Online
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WhiteCell  Online
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Whidbey Island WA
When this happened in women's health abortions were done in the back rooms. One cannot treat pain by scaring people into compliance. So 1984.

Looks like I'm going to be writing some letters on this. It is unethical and creates harm to patients increasing their pain and stress.

Stupid controlling people. More and more of them every day.


Starting at 18 yrs old > Reiter's Syndrome. Diagnosed 2001 Ank Spon.
Started Remicade 2002 - 5mg/kg every 7 weeks.

Right Eye Glaucoma- Trabeculectomy/lens replacement 2006.
DSEK Cornea Transplant 2009.
Ahmed Shunt 2016.
DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. 2004. Cured by RF ablation 2008.

ICU RN - Seattle, WA

~Grasp The Challenge and Succeed~
#278999 - 09/13/17 09:53 PM Re: Pain Contracts? [Re: WhiteCell]  
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SouthernMoss Online
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WC, you're lucky your rheumy will even prescribe your norco. My rheumy will not prescribe any narcotics. Period. No exceptions. From what I have read, there are many other rheum's who have taken the same stance. They just don't want to deal with the regulations and the fear of lawsuits.

I don't need norco, but my husband does (he has severe OA). He sees the same rheumy I do, but he gets his norco from our family doctor. He has a wonderful relationship with our family doctor and has not had to sign a contract so far. But it's probably coming...


Ginny - 57 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis
unicompartmental knee replacement June 2014
MTX, Humira, Cyclobenzaprine, plus Indomethacin ER as needed
Supplements: Folic Acid, Vitamin A, Vitamin D, Calcium, Fish Oil, Melatonin, Culturelle probiotic
#279002 - 09/13/17 10:24 PM Re: Pain Contracts? [Re: WhiteCell]  
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WhiteCell Online
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WhiteCell  Online
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Whidbey Island WA
She won't. I met her new to me in Seattle in Juneand went in yesterday for my 2nd appointment and she refused if I would not sign the contract. I impressed upon her my history of successful relationships with doctors, and she was defensive and distant.

I am going to change shortly not necessarily to a Rheum which will prescribe Norco but one who wants a relationship with me, the person not a set of circumstances pressing her to control large groups of people.


Starting at 18 yrs old > Reiter's Syndrome. Diagnosed 2001 Ank Spon.
Started Remicade 2002 - 5mg/kg every 7 weeks.

Right Eye Glaucoma- Trabeculectomy/lens replacement 2006.
DSEK Cornea Transplant 2009.
Ahmed Shunt 2016.
DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. 2004. Cured by RF ablation 2008.

ICU RN - Seattle, WA

~Grasp The Challenge and Succeed~
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