Have you ever been prescribed an opioid medication for chronic pain due to a chronic illness like fibromyalgia, ME/CFS (myalgic encephalomyelitis / chronic fatigue syndrome) or Lyme disease? If you were only given an opioid prescription once or twice on a short-term basis, then you may not have encountered the pain medication agreement. However, if you are going to be taking any kind of pain medication on a regular basis, chances are you have been or will be asked to sign a pain medication agreement (also called pain management or opioid treatment agreements).
At one time, pain medication agreements were primarily only required by pain clinics and pain management specialists, but with the opioid epidemic featured so prominently in the news, along with the current increase in DEA scrutiny of any doctor who prescribes opioids, more and more general and family practitioners are requiring patients who take any kind of long-term opioid medication to sign them as well.
A pain medication agreement is a contract between doctor and patient that serves to ensure patients are taking opioid medications according to their doctor’s instructions. It also helps protect the doctor legally in case a patient abuses the medication and overdoses.
The Importance of Understanding Opioid Medication Agreements
When you’re asked to sign this agreement, you may feel under pressure. You are in a lot of pain and your doctor is saying that you cannot have any pain medication unless you sign. Although it is fine to go ahead and sign the agreement, it is essential that you fully understand every detail of what you are signing.
Why is understanding every detail so important? Because failing to abide by all of the terms of the contract can have dire consequences. At the very least, violating the agreement means your doctor will probably refuse to prescribe any more opioid medication for you. If you have already been taking opioids regularly, you will likely face going through opioid withdrawal. You might also be dismissed as a patient. Once you have been dismissed for breaking a pain medication agreement, it will be very difficult to find another doctor who will take you on as a patient and virtually impossible to find a doctor who will agree to prescribe any pain medications for you.
10 Things You Need to Know Before You Sign
Although the specifics will vary slightly from doctor to doctor, the following 10 requirements are basic to most pain medication agreements:
- You agree to take the medications at the dosage and frequency prescribed.
You MUST follow the prescription directions exactly. Although it may be tempting, do not take less medication on low-pain days so you will have extra left for high-pain days.
- You agree not to increase, decrease or change in any way how you take the medications without the prior approval of your pain management doctor.
If you feel the dosage prescribed is too low because you’re still in a lot of pain or too high because you feel lightheaded all the time, call your doctor and tell her what you’re experiencing. Do NOT under any circumstances change the dosage on your own. If you are drug tested and found to have too much in your system, it will be assumed you are abusing the drugs. On the other hand, if you have too little of the drug in your system, it will be assumed you are selling or giving your medication to someone else.
- You agree to random drug testing to assure you are only taking the prescribed medications in the prescribed amounts.
While you know you are trustworthy and would not abuse drugs, there is no way for your doctor to know that. Because prescription drug abuse is so prevalent today, physicians have to be extra vigilant. If a doctor is found to be prescribing controlled substances to people who are either abusing them personally or selling them to others, he can lose his medical license and face criminal prosecution.
- You agree to obtain all of your medications at one pharmacy, which you must name, and give your consent for the physician and pharmacist to exchange information about you.
The reason this is included is because abusers sometimes try to obtain prescriptions from multiple doctors and fill them at different pharmacies. Since prescriptions are now entered into computers with interconnected databases, this practice is currently much more difficult to get away with.
- You understand that lost, stolen or destroyed prescriptions and medications will not be replaced under any circumstances.
Some agreements may allow the doctor to use his discretion in the event your medication is stolen and you file a police report, but he is not required to replace the stolen medication. Therefore, it is essential that you safeguard your medications and make sure no one else has access to them. Ideally, all opioid medication should be kept under lock and key.
- You agree to inform your pain management physician of all other medications you are taking.
Although it is important to inform every doctor you see of any medications and supplements you take, it is essential that you do so with the physician who manages your pain and writes your opioid prescriptions.
- You agree to inform your other health care providers of the pain medications you are taking and of the agreement you have signed. This includes dentists and emergency care providers.
It is not unusual for other doctors and dentists to prescribe a short-term opioid for special circumstances, such as oral surgery or an injury requiring emergency room care. However, if you have signed a pain medication agreement, ONLY your pain management physician can prescribe these drugs for you. Other health care providers must contact your pain management doctor if you have a need for additional pain medication.
- You agree not to request any pain medications or controlled substances from other health care providers.
As stated before, only the physician who is managing your pain treatment can prescribe opioids or other controlled substances for you.
- You agree not to use illegal drugs, street drugs, or another person’s prescription. Some agreements also require that you not use alcohol.
If you live in a state that has legalized medical marijuana, ask your doctor about how this applies. Since marijuana is still considered to be illegal for all purposes on a federal level, this could possibly present a problem.
- You agree to keep all of your scheduled appointments.
Your agreement may have rules about canceling appointments. It may require 24-hours notice to cancel an appointment and/or have a maximum number of appointments you can reschedule and still continue to be treated. The main reason for including this stipulation is to prevent you from canceling an appointment because you have been using your medications improperly and are afraid you would not pass a drug test.
In addition to these basics, you may also be required to agree that you will participate in any medical or psychological assessments recommended by the doctor, or take part in any program designed to improve your function––whether it be physical, social, psychological, daily activities or work activities. You may also have to agree that if you have or should develop a drug or alcohol addiction problem, you will follow through with any addiction program you are asked to enter.
Finally, you will likely be told that your physician may stop prescribing pain medications if you:
- Show little or no improvement.
- Quickly develop a tolerance for the treatment.
- Experience significant side effects from the medication.
- Fail to abide by the terms of the agreement.
In addition to no longer being prescribed opioids, that final point––failing to abide by the terms of the agreement––may also result in your dismissal as a patient.
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True Stories: Honest Mistakes Have Severe Consequences
Lest you still have any doubts as to the seriousness of pain medication agreements, here are four examples of actual situations in which well-meaning patients, with no intention of abusing drugs, violated their agreements and found themselves unable to get a prescription for opioid medication from any doctor. Needless to say, they all faced horrible opioid withdrawal and long-term chronic pain with no options for relief. (The names have been changed to protect their privacy.)
- Kathleen had some dental work done and the oral surgeon gave her a prescription for hydrocodone with acetaminophen. When she took it to the pharmacy, the pharmacist refused to fill it and immediately contacted her pain management doctor.
- Deborah’s husband hurt his back over the weekend. She couldn’t stand to see him suffering so much so she gave him some of her hydrocodone/acetaminophen to help ease his pain until he could see his doctor on Monday. Because this caused her prescription to run short, she cut her dosage in half the last few days of the month. When she went in to get her refill prescription, she was given a drug test, which revealed she only had half the amount of hydrocodone in her system that she should have.
- Michele felt like the dosage of oxycodone her pain specialist had prescribed was too strong because she was feeling “high” and had difficulty functioning. Thinking she was doing a good thing, she took less medication. At her next appointment, she was given a drug test, which showed that she did not have the prescribed amount of oxycodone in her system.
- Mitch was having a really bad day and his fentanyl pain patches just weren’t giving him enough pain relief to allow him to get his work done. He had some oxycodone left over from before he started seeing the pain specialist so he took it to help with the breakthrough pain. His doctor’s office called and asked him to come in a couple of days early for his appointment; when he arrived, he was given a drug test which detected the oxycodone in his system.
How can you avoid finding yourself in a similar situation? By carefully reading every word of the agreement before you sign it, asking questions about anything that is not clear to you, then following it to the letter.
Your doctor should give you a copy of the agreement you signed, but if not, be sure to ask for a copy. Then even if you read the agreement while in his office, read it again at home when you have plenty of time and are not feeling pressured. If you have any questions, either call the office or ask at your next visit.
While the fairness, effectiveness and even legality of the pain medication agreement continues to be debated, the fact is that if your doctor requires you to sign an agreement before prescribing the medication you need for pain relief, you don’t have much choice in the matter. Until or unless changes are made, you are responsible to make sure you understand and abide by the agreement.
This article, originally published on January 31, 2017, was updated on June 5, 2019.
Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) in 1997 and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE magazine. After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, then worked for eight years as the Chronic Pain Health Guide for The HealthCentral Network before coming to ProHealth. To learn more about Karen, see “Meet Karen Lee Richards.”
Sample Patient Agreement Forms. National Institute on Drug Abuse. Retrieved January 2, 2016.
Agreement on Controlled Substances Therapy for Chronic Pain Treatment. American Academy of Pain Medicine. 2013.
Opioid Treatment Agreements or ‘Contracts’: Proceed with Caution. PAINS Project. Center for Practical Bioethics. Issue 4; Spring 2014.