Pain Contracts, Screening, and Prescription Drug Databases

Doctor writing a prescription
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If you believe you need pain relief in the form of a prescription pain drug like opioids or narcotics, you should be aware of the steps being taken by doctors, individual states, and provinces to determine which individuals do need pain drugs, how they manage the taking of those drugs, and whether or not they're developing a substance use problem.

Pain Contracts

Some doctors now require people who are prescribed pain medications to sign pain contracts. The individual must read and agree to these contracts, or the doctor will not prescribe the pain-relieving drugs that the individual needs.

The contract lays out the important points people must agree to, including statements like:

  • I will not attempt to obtain drugs from any other source.
  • I will not sell the drugs you prescribe for me.
  • I will safeguard my prescription so it won't get stolen.
  • I will agree to undergo screening tests to measure whether I am abusing pain drugs during the time I take them.
  • I agree not to try to refill the prescription too early (which can mean that the individual is taking too much of the drug too fast).

A final statement says that if they violate any of the points, the doctor will stop prescribing the meds for them, or will dismiss them from their practice. It's one reason people may be blackballed or blacklisted.

You can find a sample pain contract online.

The use of these pain contracts is a point of contention among doctors, as they feel that asking people to sign such a contract violates doctor-patient trust. Doctors who use them anyway may feel reluctant about asking people to sign these agreements, but they do use them because they feel that people need to know the problems that may develop through the use of the drugs, and protect themselves from legal problems.

In the U.S., pain contract requirements may vary from state to state. They may also be specific to a doctor's office or hospital.

Urine Tests

One way doctors can tell if people have either taken too much of an opioid drug or have been compounding the drug with other substances—including other drugs, marijuana, or alcohol—is to administer a urine test.

If the urine test reflects only the drug that has been prescribed by the doctor, in an acceptable amount, then the individual has a better chance of continuing to work with the doctor, to receive the needed medication, to undergo another therapy to slowly stop taking the drug, or to relieve pain in another way.

On the other hand, if other substances or too much of the prescribed medication is found in the urine, the doctor may dismiss the individual or simply refuse to write a new pain drug prescription. Not all urine tests are able to determine the exact amounts of opioids in your system.

There are stories about people who have gone to the emergency room for problems that may or may not reflect the pain meds they take, who are then prescribed new pain relievers in the ER. It's possible that their regular doctor, who had been helping them with pain over time, could, as described above, learn about the additional drugs from a urine test and then refuse to treat them further.

Statewide Databases

The Centers for Disease Control and Prevention provides funding for 29 states to improve opioid prescription practices and prevent overdose. In Canada, most provinces as well as the territories have established databases to help track opioid and narcotic drug prescriptions.

These databases will typically track when doctors prescribe these drugs, when pharmacies dispense these medications, and when people have their prescriptions filled.

When people see their doctor, and the possibility exists for writing them a pain-relieving drug prescription, the doctor will be able to access the database to be sure that people are not attempting to "doctor shop" in order to amass more prescription drugs than they are legally or medically entitled to, or that may pose an overdose risk.

Discussions are underway to make sharing this information possible across state lines so people cannot go doctor shopping in other states.

While many people may be upset that such a database violates their privacy, there are actually important reasons to support the use of this kind of tool.

  • Doctors will be able to more confidently prescribe drugs for those who need them, at appropriate times, with less fear that they can get in legal trouble.
  • When emergency room personnel can access such a database, people who go to the ER will be less likely to be prescribed drugs that can conflict with the pain drugs they already take. Or, those same people will be less likely to be dismissed by their regular doctors if they've been to the ER for some other reason (see urine testing above).
  • Many people continue to take pain-relieving drugs when they think they are dependent on them, even when they are not. People who are capable of being weaned off these drugs will be compelled to do so, even when they think it's impossible. Doctors will have complete information about their patients' pain drug history, including prescriptions written by other doctors, prior to their relationship with the individual.

The U.S. Department of Justice Drug Enforcement Administration maintains a list of which states are using what kinds of tools to control narcotic and opioid drug abuse.

As time goes on, the laws may be tightened even further, and it may become more difficult for people to obtain the drugs they want and need for controlling their pain.

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  1. National Institute on Drug Abuse. Sample Patient Agreement Forms.

  2. Philpot LM, Ramar P, Elrashidi MY, Mwangi R, North F, Ebbert JO. Controlled Substance Agreements for Opioids in a Primary Care Practice. J Pharm Policy Pract. 2017;10:29. doi:10.1186/s40545-017-0119-5

  3. Dineen KK, Dubois JM. Between A Rock and A Hard Place: Can Physicians Prescribe Opiods to Treat Pain Adequately While Avoiding Legal Sanction?. Am J Law Med. 2016;42(1):7-52.

  4. Centers for Disease Control and Prevention. Urine Drug Testing.

  5. Milone MC. Laboratory testing for prescription opioids. J Med Toxicol. 2012;8(4):408-16. doi:10.1007/s13181-012-0274-7

  6. Centers for Disease Control and Prevention. Prevention for States.

  7. Centers for Disease Control and Prevention. Doctor Shopping Laws.

  8. U.S. National Library of Medicine. Opioid addiction.

  9. U.S. Department of Drug Enforcement Administration. State Prescription Drug Monitoring Programs.

Additional Reading