The Tyranny of Pain Mgmt Contracts

Pain Management Contracts

– To receive opioids from a pain management clinic, you are required to sign away your personal rights and privacy in extremely restrictive and coerced contracts.

How would you feel if you entered a doctor’s office with distressing pain, only to be treated like a lying drug addict, presented with a completely one-sided legal contract, and be expected to sign away important personal rights just to get a medication you need?

Perhaps you just can’t understand just what it feels like to read such a contract when you are a person 100% dependent on opioids to live somewhat decently. It is demeaning, infuriating, and even scary to be treated like an addict without any provocation.  

I have done nothing to deserve this treatment. I have no history of abuse at all, so why should I have to sign such a contract for my medication?

The contract is a direct accusation that any patient will behave dishonestly and immorally in order to get more opioids than they really need. It’s like being called a liar and a cheat right to my face.

Control

These 5 to 10-page contracts are designed to give a pain doctor full control over a patient’s medication. They allow screening for all drugs at all times and set forth pages of conditions for a patient to receive their medication.  

The slightest infraction of the rules or any deviance at all (which is detected during constant screening) allows the doctor to immediately stop opioid therapy, refuse further treatment, and report the patient to the authorities.

The contracts are 100% one-sided. There is no concern that stopping a patient’s opioids abruptly could send a person into terrible withdrawals while they try to find another provider.

However, finding another doctor to prescribe opioids may now be impossible because the contract-break will be added to the patient’s record, warning that this is a “drug seeker” or “addict” so that no other doctors will prescribe them medication either.

These contracts give pain doctors almost complete control over how much pain a patient must tolerate from day to day, not just now, but also reaching far into the future.

With a single stroke of the pen, a negative notation from a single doctor (or nurse, or other healthcare provider) can prevent a patient from getting opioids from any other doctor.

Fear, anger, suspicion

Considering the risk of triggering these draconian measures for what could be a clerical or laboratory error, it’s no surprise that patients are wary of these contracts.

The first reaction is anger: anger at being essentially accused of being an out-of-control addict that needs these tight controls.

Then comes suspicion because the contract is so one-sided. With its detailed list of prohibitions, it seems the doctor is very reluctant to treat at all and is just looking for ways to terminate opioid therapy.

You don’t get treated like a drug addict for any other prescribed medication. This blatant discrimination is extremely painful to those of us dependent on medication. I would feel no differently if the contract were for the antidepressants I also depend on.

Relationship

These pain contracts can do irreparable harm to the relationship between patient and doctor. The contracts express such an utter lack of trust and such a low opinion of the patient that I would never be as comfortable and open with that doctor afterward. The exception is when a doctor is forced by their management to make you sign a contract, as mine was.

By demanding we agree to these contracts, doctors are immediately setting up an adversary relationship and putting themselves in the position of being our parole officers.

If there was some logical reason for a doctor to present me with this contract I might feel differently, but I have been using opioids for over 20 years and have never had a problem, so this is just a total insult.

I find it similar to being asked to sign a prenup before the wedding, which, in my mind, nullifies the trust necessary for a good marriage. This may be somewhat justified in cases where there’s a gross discrepancy in value… and right there is the problem.

The contracts, both pre-nup and for opioids are putting one party in complete power over their value, but at least pre-nups provide some protection for both sides.

I will always be forced to live under the care of a doctor, and this contract tells me right away that it’s not going to be a good relationship.

I know you’re probably wondering: if I didn’t do anything wrong, why would I mind being monitored? But this is like asking why you would mind me putting a camera in your living room if you’re not doing anything wrong.

Such intense monitoring is a gross intrusion without provocation. Even the police need a warrant to invade your privacy like this.

I’m being asked  to sign over my rights to privacy in ways that are completely unrelated to my care, which is for pain, not addiction.

13 thoughts on “The Tyranny of Pain Mgmt Contracts

    1. Zyp Czyk Post author

      Wow, thanks, David! I’m proud to have written an article you can fully endorse.

      Having had to sign such a contract myself made feel furious and trapped – I had no real choice but to sign. I felt betrayed by my doc, even though it was her clinic, not she, that had made these new policies.

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      1. david becker

        Even though I am not in pain it infuriates me how they can do that to you and so many others. And the article was very well done. You have superior writing skills and are doing a great service for people in pain. You have covered a lot of ground and I admire your efforts. I would find it interesting if you would write about a theory on why pain care is riddled with so many challenges.
        I think you will find my upcoming book- Pain Care In America: Cant Get it Right, interesting and i do propose some theories to explain the many problems in pain care- and some solutions.

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  1. Connie Posigian, PT, OMPT

    I’ve been reading a little about Hellen Keller, and how much she advocated for the rights, education & proper treatment for those who are blind or otherwise ‘disadvantaged.’ She was a founder of the ACLU!

    Do you think the ACLU would be interested advocating for our rights to pain treatment? We can start a movement: The Pain Suffrage.

    Current modern medicine tends to treat similar complaints (what you are seeking treatment for) with a broad approach, as opposed to individualized care. By dictating treatment instead of education & choices, health care practitioners take away freedom, but freedom & self-efficacy are the building blocks for any self management. To take away a person’s power, and then tell them to find a way to manage on their own is not helpful.

    (Views, statements & philosophy are my own;)~

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    1. david becker

      Connie- i admire your openness to exploring more about pain care. I had hoped some of the civil rights organizations would take up the cause of people in pain- but even Human Rights Watch- who has written about pain care will not do more. I understand some have asked other civil rights orgs to take up the cause- without success. People in pain are orphaned with regard to being part of civil rights or disability studies,etc. I am starting a plan to see if people in pain will unite with animal rights organizations- but so far they dont seem interested.
      Its clear people in pain have not been very good advocates- though some are quite capable and tireless in their efforts. Most people in pain are overconformed to the status quo and have no divergent or independent thought. They dislike me criticizing their inactivism and claim its cruel of me to tell them to stand up for their rights They want someone else to do that, of course. They are too busy dealing with their pain and say they have no time to advocate. Biut if each person in pain gave $5 to a pain care orgaization every year- or made two phone calls a year to their legislators or medical organizations to improve pain care- I think pain care would improve. But they wont do that, of course. They prefer to see me as the insensitive bad guy and leave it at that.
      I can say this for I am often one of the few signing on petitions to improve pain care- and one of two people calling for the NPS to have lowering the prevalence of pain as a goal. Organizations like the CPATF vision was old and limited- and like Helen said- its a terrible thing to see and have no vision. In addition, they crried favor with medical organizations. they became professionalized lay experts and sided with pain specialists- who betrayed their trust(and i told them that they would 6 years ago-before the APS was shut down). They wont consider suggestions- and so i say they have become as lost as our pain care system is. But my dont they come on strong with the self righteous attitudes. Once they are questioned- then they simmer down- for a while. So pain care is bad in America not just because of providers and government but because of the passivity of people in pain. Instead of schismogenesis- they suffered from Stockholm syndrome- they became like their oppressors and stuck in a reinforcement loop. They want more money for research but dont believe we need better research. They want more freedom but dont see that new laws are needed to create new rights. They want a plan to change pain care but dont wish to obtain plannng skills. So by and large the pain community is as lost as their providers.
      Pain care in America is an American Tragedy and reminds me of Kafkas the Trial and Metamorphosis and Waiting for Godot. We need to exorcise and humanize pain care-and too many in America are unwilling to make th effort.

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  2. Terri

    I’ve signed 3-4 pain medication contracts, as well have taken 3 UA ‘s that covered most if not all drugs. It even how much measured how much opiates were in my system. I accepted it as the price I had to pay to get my pain meds. However, without warning, this month my primary doctor prescribed only 2 pills a day instead of 3. It was a 10 day supply. I don’t believe she thinks I’m doing anything wrong. It’s not like I’m going out on the streets and buy illegal drugs, so I will just suffer and wish I were dead. I would never do that as I have a son.

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    1. Zyp Czyk Post author

      I’m so sorry that this is happening to you – even if our docs know we’re doing well on opioids, these changes may be forced on them by the clinic or hospital where they work or perhaps even their insurance.

      Still, it seems to me that most of the medical profession has been too silent even as they are forced to deny relief to suffering people. I say forced because they could be fired if they don’t prescribe much less, and then how would they be able to pay back their hefty 6-figure student loans?

      I predict a backlash against this “cruel & unusual punishment” of pain patients who need the drugs, as they are lumped together with drug abusers who don’t need the drugs.

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  3. Terri

    I usually was prescribed a 30 day supply. I live 25 miles away from my provider, and it takes my doctor up to a week to prescribe it after I order it.

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  4. Angela M. Oddone LCSW, Resiliency Strategies LLC

    Actually, I don’t have an issue with signing a contract if my doctor’s prescribing a controlled substance because I know how my doctor and pharmacist both are also being monitored. What I do have a problem with is needing to sign releases so doctors who specialize in EDS related medical conditions can rule out psychiatric diagnoses. I realized I have to receive psychiatric care in part to get the health care I need, e.g., my gastroparesis is not an eating disorder; my pain is real; I don’t have somatoform disorder. I resent having to use the psychiatric care I receive for that purpose. But, many of us who have rare, complex, chronic illness and pain have to do that in order to get other doctors to provide the health care we need.

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    1. Zyp Czyk Post author

      I’m not having a material problem with the terms of my contract either, but it’s the complete one-sidedness and leaving the patient completely unprotected that’s my gripe. By this contract, a doctor can kick a patient to the curb without notice and send them into withdrawals, which is NOT proper medical practice. I believe the contract should also require doctors to deal with transgressors professionally and thus taper them down gradually, instead of simply kicking them out.

      These contracts give doctors god-like powers and patients have no right to appeal, and that’s what really bothers me.

      Plus, I live an hour away from my pain doc, so if she ever asked for a “surprise” pill count it would take me at least an hour, and that would technically break the contract because it says I have to be present within half an hour.That’s exactly the kind of standard rigidity and inappropriate control I find downright un-American. Everyone else is trying to cover their butts, while pain patients are thrown to the wolves without a second thought.

      Even though I personally have a great doctor who would never treat me as badly as the contract allows, I would never sign such a contract if I weren’t coerced. Isn’t it illegal to coerce someone into signing a contract that ONLY benefits the other party? That’s another un-American aspect.

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  5. Pingback: Appropriate Use of Opioids in Managing Chronic Pain | EDS Info (Ehlers-Danlos Syndrome)

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