The Ins and Outs of Narcotic Contracts: What Pain Management Doctors Want You to Know

What is a Narcotic Contract?

A narcotic contract is a written agreement between a patient and their pain management doctor that outlines the rules and expectations for using narcotics to manage chronic pain. The contract is designed to protect both the patient and the doctor. The goal of the contract is to ensure that the patient uses the medication as prescribed and does not abuse or sell it. It also helps the doctor monitor the patient’s progress and adjust the treatment plan as necessary.



narcotic contract


Why Are Narcotic Contracts Necessary?

Narcotic contracts are necessary because the use of narcotics for chronic pain management comes with risks. These risks include addiction, overdose, and death. According to the Centers for Disease Control and Prevention (CDC), more than 47,000 people died from opioid overdoses in the United States in 2018. By signing a narcotic contract, patients agree to take their medication as prescribed and to inform their doctor if they experience any side effects or issues.


The Risks of Taking Narcotics for Chronic Pain

While narcotics can be effective at managing chronic pain, they come with risks. Some of the risks associated with taking narcotics for chronic pain include:

  • Addiction: Narcotics can be highly addictive, and some patients may develop a dependence on them.
  • Overdose: Taking too much of a narcotic medication can lead to an overdose, which can be fatal.
  • Side effects: Narcotics can cause a range of side effects, including constipation, nausea, dizziness, and drowsiness.
  • Interactions with other medications: Narcotics can interact with other medications, including over-the-counter drugs and herbal supplements, leading to dangerous side effects.
  • Respiratory depression: Narcotics can slow down a person’s breathing, which can be especially dangerous for people with respiratory problems.

The Need for Narcan

Narcan is a medication that can reverse the effects of an opioid overdose. It’s important to have narcan available when taking narcotics, especially if you have a history of substance abuse or have previously experienced an overdose. Some pain management doctors may require their patients to have narcan on hand, and may even provide them with a prescription. Having narcan available may be a requirement in their narcotic contract.


Common Reasons for Breaking a Narcotic Contract

Unfortunately, some patients may break their narcotic contracts, either intentionally or unintentionally. Common reasons for breaking a narcotic contract can include:

  • Failing to take medication as prescribed
  • Sharing medication with others
  • Using opioids for non-medical purposes
  • Using alcohol in combination with opioids
  • Using illegal drugs while on opioids
  • Refusing to submit to drug testing
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If a patient breaks their narcotic contract, the consequences can be severe. This can include being dismissed from the practice, being reported to authorities, or being referred to addiction treatment.  Please note that many narcotic agreements state that any violation may result in the immediate termination of the doctor/patient relationship.  This puts patients at risk of severe withdrawal from the narcotic medications.  


The Morality Clause

Some narcotic contracts may include a morality clause, which states that the patient must not engage in any illegal or immoral behavior while taking the medication. This can include drug use, selling the medication, or other criminal activities. Breaking the morality clause can result in the termination of the contract and dismissal from the practice.


The Contents of a Narcotic Contract

A typical narcotic contract will include several key elements:

  • The purpose of the contract, which is to outline the expectations and responsibilities of both the doctor and the patient.
  • A list of the medications that will be prescribed, including the name, dosage, and frequency of each medication.
  • The responsibilities of the patient, including the requirement to take the medication as prescribed, to report any adverse effects or concerns, and to attend all scheduled appointments with the doctor.
  • The responsibilities of the doctor, including the requirement to closely monitor the patient’s use of the medication, to provide regular check-ins and follow-up appointments, and to adjust the treatment plan as necessary.
  • Provisions for drug testing to ensure that the patient is taking the medication as prescribed and not misusing it.
  • Information about the risks associated with the use of opioids, including the potential for addiction, overdose, and other adverse effects.
  • Information about the importance of Narcan in case of overdose, and instructions for the patient on how to use it.
  • The consequences for breaking the contract, which may include dismissal from the practice.

Medical News Today reached out to Dr. Guiang to discuss this very topic.  Click below to read the full article.

About the author: Rainier Guiang, MD is board certified in Pain Management and Anesthesiology and has been in academic and private practice since 1999.

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