Interview

Interview with Kate

Kate is a trilingual Certified Medical Assistant who works at a clinic in Berkeley for over 6 years. I will not mention which clinic in Berkeley she works in for privacy reasons. Kate also deals with getting patients on pain medication contracts with their doctors. She goes over the contract with the patients and has them sign it. She also works along Doctors in pain management groups that discuss the medications patients are taking and if they have any questions. Before I asked her a few questions, Kate gave me a copy of the contract and I typed it all below.

The title is “Controlled Medicines Agreement.”

Purpose:

The purpose of this agreement is to make clear what I can expect when I am prescribed controlled medicines (such as morphine, methadone, oxycodone, Percocet, vicodin, adderall, clonazepam, ativan, xanax, etc) as part of the treatment of my medical condition. It describes what I can expect from my provider and what my provider expects from me.

We________________and________________

(patient)                               (Provider)

Have decided to use controlled medicines to treat:____________________

                                                                             (symptom,cause)

Medicines (brand and generic names, dose, directions, frequency of dispensing)

1.________________________

2.________________________

3.________________________

My provider’s responsibilities

∙To asses my condition and create and monitor a safe personal treatment plan.

∙To make sure that my treatment follows the law regarding controlled substances.

∙To stop prescribing controlled medicines to me if I break this agreement. If that happens, my provider may continue to see me for my primary care.

My Responsibilities

1._______________understand and agree to the following:

∙I will follow the treatment plan that my provider and I agree on. The plan may require diagnostics tests, group visits

Group visits, specialty visits, and non-medication complementary treatments.

∙I will take the medicines as prescribed and will not share, sell, or trade them.

∙I will keep all of my medicine safe and secure.

∙I understand that if I take more medicine than my provider tells me to use I may run out of medicine early.

∙I will not be given any early refills for any reason, including lost or stolen medicine.

∙I understand that I can only request prescription refills during regular clinic hours, and must allow seven working days for my prescription to be refilled.

∙I understand that if I miss my appointment with my provider and call for refills too late, I may run out of medication and go into withdrawal.

∙I will behave respectfully towards my provider, the call center, other patients and clinic pharmacy staff. I will not be abusive or rude. I will not call the center or clinic excessively.

∙I will not seek controlled medicines for any other reasons. I will tell my provider within 24 hours if I get controlled medicines or a prescription for controlled medicines from another provider, the dentist, urgent care, the emergency department, a family member or anyone else.

∙I must see my provider at least every ________ weeks to continue receiving these medicines.

My provider may stop these medicines if I miss appointments.

∙I will not use illegal drugs or unprescribed controlled medicines.

∙I will be asked to provide my urine for drug testing at any time.

If I tell my provider that I took my prescribed medicine in the last 2 days, but it does not show up in my drug test, my provider will stop these medicines.

If my drug test shows illegal drugs to unprescibed controlled drug us, if I tamper with my urine sample, if I refuse to provide a urine sample, or I cannot urinate on the day that I am given the test, my provider will stop these medicines. I understand that I may be called into the clinic to provide a urine sample between scheduled appointments.  My provider may also ask me to bring my medicine to the clinic for a pill count at that time. It is my responsibility to make sure the clinic has my working phone number where they can reach me. If I am called, I must do a urine drug test and submit the appropriate amount of pills within 24 hours or my provider will stop these medicines.

∙I will tell my provider about any other medicines I am taking or providers I am seeing for care.

∙I will tell my provider about my personal/family history of addiction or substance use.

Terms of Agreement:

This agreement will be reviewed at least once a year. It will also be reviewed if I change providers or break the agreement.

Acknowledgements:

I have selected the provider named below to care for my medical needs.

I have been informed of the possible risk and benefits of these medicines.

I have read and understand all of the information included in this form. I have been able to ask questions about this agreement and have them answered. I have been offered a copy of this form.

I am signing this form by my own choice, and I accept all of its terms.

Patient______________

DOB________________

Provider_____________

Date________________

So according to Kate when a patient comes for a consultation and requesting to take medications for a condition the doctor first has Kate go over this with the patient. Otherwise they will not prescribe or dispense any medication to the patient if they do not agree with the form. Mostly all clinics are now required to submit a contract with the patient. It is for safety reasons for both the patient and the clinic.

1.      Are there a lot of patients who come in requesting controlled substance without being in a lot of pain?

Well yeah, some patients cannot stand any pain at all and choose to take these types of medications to help them.

2.      Do you ever get patients who do not wish to sign the contract and do they still get their medications because of their condition?

No, we are absolutely not allowed to prescribe any controlled substance to any patients without them having their signature on that contract. If anything were to happen we would be easily sued.

3.      What made the clinic come up with a pain contract?

Well it is required now, usually all clinics need to do this. And one of the main reasons why we are so hard on this is due to the fact that one of our patients overdosed by not following safety precautions and now we are being sued.

4.      How do you notice when a patient is becoming an addict?

It’s not that hard to tell, usually they deny doing a drug test; we see other drugs not prescribed by us in their urine and are very abusive if they don’t have their medicine on time.

5.      What happens when that becomes a problem? What step does the clinic take next?

If we notice a patients abusing drugs or becoming addicted, we take further measures. The provider will stop prescribing the medicine, the person goes into therapy and the patient goes into withdrawal. Withdrawals are the worst pain a patient can experience, especially if they’ve become addicted.

6.      What are the differences between addiction, tolerance and dependent?

It’s really easy to confuse all three, when a person becomes addicted you start noticing odd behaviors and not compelling to what the provider is asking. Refusing random drug test, being abusive towards staff, families and friends. Tolerance is when they no longer feel the medicine working therefore, an increase of dosage needs to happen and dependent is when the body physically hurts. When that happens your body needs the drug.

7.      Is there a specific age group or younger crowd that gives more trouble?

No, because controlled medicines are usually for people with chronic pain it’s a variety of age. There’s not a specific age group.

8.       Can a patient refuse to sign the contract? If so what happens since she/he is in pain?

There are other ways to treat pain without the need of medicines. That is why we have pain management groups. It’s up to the patient to see if that works for them or not, but regardless without their consent we won’t prescribe anything.

9.      How often does the clinic hold meetings about opioid information?

Since there are new things that came up along the way we like to have meetings to update the staff. The receptionist are the first people patients see and they usually take things out on them so it’s good to educate them on how we go by here with controlled substances. That way they know what to tell the patients and how to help.

10.  What happens when the clinic finds out if a person is selling their medicines?

We’ve had a patient who saw another patient sell his medication to another person. In that case, the provider stops his prescribing and we notify the police.