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Opioid Pain Contracts Can Damage Patient Trust, Bioethics Panel Says


A group of physicians and experts on pain policy have published an article arguing that while opioid treatment contracts between patients and their physicians can be useful, they can be harmful for the patient-physician relationship unless presented in the right way, American Medical News reported Dec. 27.

Doctors use the agreements – also known as “pain contracts” – to warn patients not to give away or sell their prescription pills. According to American Medical News, other physicians treating patients for pain have undergone “high-profile prosecutions,” and the contracts are seen as a way to protect physicians from liability. 

Myra Christopher, who co-authored the article in the November 2010 issue of American Journal of Bioethics, said that the contracts can be helpful in letting patients with histories of substance abuse or mental health issues make an informed decision about using opioids, and create an effective plan for care.

“It is not that any of us disagree with the notion that agreements can, in fact, be very helpful in certain circumstances,” Christopher said. “But, what is becoming common practice in many pain specialty clinics is using a preprinted, standardized form that says, 'If we're going to treat or prescribe controlled substances to you, these are the conditions under which we'll do so — and sign this document, and if you fail to do so, then we'll fire you from our practice.' “

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of Americans using opioid pain relievers non-medically grew from 11 million in 2002 to 12.5 million in 2009. All but seven percent of those surveyed by SAMHSA reported getting the drugs from a friend, family member, or dealer, not from their doctor.

Opioid misuse was responsible for 306,000 emergency room visits nationally in 2008 — twice the number in 2004, according to the Centers for Disease Control and Prevention (CDC). The agency also reported that opioids were implicated in 14,000 fatal overdoses in 2006, three times the number reported in 1999. 

Written contracts are consistent with “fundamental ethical principles,” said Perry G. Fine, MD, president of the American Academy of Pain Medicine, as long as their purpose is to support patient health and patients are not forced to sign them.

The American Academy of Pain Medicine, the American Pain Society and the Federation of State Medical Boards have endorsed the use of pain contracts with patients.

The problem, according to Will Rowe, CEO of the American Pain Foundation, is how the agreement is framed for the patient.

“Just think about how it's presented — unless you sign this, you won't get your medications,” he said. “That, to me, is crossing the line. … It's basically a document that says, 'You do this, or I've gotcha.' That's basically interfering with what should be a trusting relationship between the patient and the practitioner.”

2 Responses to this article

  1. Noreen Sullivan / September 9, 2014 at 12:52 pm

    I went to my doctors office today because now that Vicodin is a Class II drug, it is required that I sign a Pain Management Contract. After the nurse went through the contract with me, I felt insulted and humiliated and refused to sign it. I am 73 yrs old and have had chronic neck and back pain for 30 years. I have been taking Vicodin for 10 years. I am not addicted to it. When I can, I reduce the # of pills I take daily. I have on average 3 epidurals on my lower back a year and radio frequency ablations on both side of my neck area every few years. My PC doctor looked at my last MRI and said “You’re a mess”. I became so upset by the PMC today that I started to cry. Random urine tests? Need to pick up written Rxs and be seen by my PC every 3 months? Pill counts? Phill out a daily pain journal? Please! I felt like a drug addict.I refused to sign the contract. I will take 2400 mg of Ibuprofen a day, which will probably kill me,since I am also taking Cymbalta and my pharmacist said that Ibuprofen and Cymbalta can “cause sudden death” or ulcers and other problems, or I will go on other meds like Robaxin with Neurontin. There are many senior citizens like me who take Vicodin for chronic pain. We are not junkies. We are responsible citizens who just want our lives to be somewhat pain free. Why is the FDA so determined to make us feel like badly because we have pain caused by, in my case, severe arthritis.

  2. Avatar of Debby
    Debby / April 6, 2013 at 8:49 pm

    These are not “contracts.” Contracts are worked out between willing parties. This is medical blackmail used to force unwilling parties to sign away their privacy, personal dignity and Fourth Amendment rights.

    No matter how they try to sweet-talk patients, “gotcha” remains the bottom line. Sign on the dotted line or we’ll make sure your agony of pain will continue.

    Unlike what most doctors clearly prefer to assume, patients are smart enough to figure that out.

    I don’t understand why they don’t drop the gibberish and have patients sign a short statement as follows: “I am a drug abuser and a criminal, and I authorize Group Health Cooperative to treat me accordingly.”

    I’m in severe pain and have scheduled a visit with a “pain specialist.” When he shoves that
    “contract” under my nose, I will refuse to sign. I’d rather live with the pain that accede to a frontal assault on my human and civil rights.

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