View Full Version : Asked to sign contract

01-13-12, 09:30 PM

I called my family clinic yesterday to get a refill. I have about a week left but since where I live, it can take up to a week to get the medication sent to the pharmacy. When I went in today, I was told that I need to give a UA. They said that I was on the contract. I said that I didn't sign a contract or was even informed about it. They confirmed it-not in file. They asked me to sign one, give UA, and then I get the script. They said that all patients that are on class 2 medications are on contracts and they need to give random UA. As a professional, I find this very demeaning. I use this medication to manage my ADHD. I never ever used illegal drugs. This is the first time that a clinic has ever done this. I was on Dexedrine before and never experienced that from my previous clinic. I felt like I was treated like a druggy.

Why would a clinic do this? Has this happen to anyone else? I will be going to a specialist in a couple weeks to take over this medication. I called them and they said that they never do this.

I signed it and gave them the UA. I have nothing to hide but I felt like the trust is broken between patient and dr.


01-13-12, 10:06 PM
Wow, this is your family clinic, you gp? Did they say what they are looking for specifically in the UA?

I'd definitely switch to a pdoc who specializes or has extensive experience diagnosing and treating ADHD.

I know that if I had to submit a UA just to get my prescription (with no prior history of abuse) it would beyond rub me the wrong way.

01-13-12, 10:32 PM

They said that they do this to every patient that is on a controlled substance. The nurse pointed out that they can call me at any time and request an UA. It has rubbed me the wrong way. They didn't tell me what they are looking for. They just said it was a toxic screen.

I am switching over to a Psychtriast because I do not trust my family dr with managing ADHD and medications. I went around and circles with replacing Dexedine. Two weeks later, I was put on moderately high dose of Concerta only to have problems. They lowered it and then moved me back up. No problems now. She should have known to increase it gradually. I am sure any Pdoc would know that.

I went over to the clinic where I go to counseling and asked them if I have to jump through hoops and request UA and they said no. She was shocked. Like I said, I never had any history of drug abuse. I don't care about doing it. I have nothing to hide because all I take is the Concerta. I just find it demeaning.


01-14-12, 01:32 AM
We have to do that here too, but in my area there is a bad methamphetamine problem, so I understood the reasoning behind it (even if I felt a bit insulted). The entire health system in my area uses that policy for accountability (and probably liability) reasons. Still felt crappy though, since I have absolutely no history of substance abuse or problems.

01-14-12, 05:37 PM

I think we may have the same problem here as well after thinking about it. The nurse made a comment that you would be surprise with what people with do with these meds. It stinks that others wreck it for those that need it. I was very insulted to say the least.


01-14-12, 06:19 PM
Sounds like in-house CYA. I live in a fair sized American city. If you want it you can find it. (Correction: it will find you.) I have never had to submit a UA to receive my medications -- irregardless of whether I was seeing a private doctor or going to a public clinic.

01-17-12, 06:48 PM
Doctors use "narcotic contracts" to protect themselves from criminal prosecution and lawsuits. They are advised by attorneys and expert witnesses to use these, especially when they prescribe large amounts of controlled substances in the course of their practice. Doctors are often concerned that they may be perceived by the authorities as giving out a disproportionate number of controlled substance prescriptions for the size of their practice, possibly because they are an easy mark for drug seekers.

The "narcotic contact" and the urinalysis tie together. The contract will specify that the prescribed controlled substance will only be used as prescribed, that street drugs are not to be used, and that controlled substance prescriptions will not be obtained from other doctors without prior approval. Urinalysis is used to verify the first second condition are being complied with. If the state in which the doctor and patient live has a controlled substance registry, then the doctor will use it to verify that the patient is not getting controlled substances from another doctor. The patient's compliance is documented and failure to comply results in the doctor refusing to prescribe controlled substances to the patient.

I can understand the OP's position that she felt that her doctor's policies meant that she was not trustworthy. However, her doctor may be feeling the heat from the authorities and seeking a safe way to continue prescribing controlled substances.

01-17-12, 06:54 PM
They just want to make sure your taking your medications. There is a lot of people out there that have perscriptions and sell the meds for profit.

01-17-12, 07:16 PM
I wouldn't take it personally at all. I had to sign a contract when a new doctor took over from my previous one. I hadn't had to sign one under the old doctor, but this new one was young and I assumed that he wanted to be as thorough and conscientious as possible.

Since all patients on the meds are asked to sign the same contract, it can't possibly be construed as a lack of trust in you. It's just one of those policies that exists for everybody and does not single out any one person. I've been asked to take periodic tests as well.

When I had to sign the contract, I chose to see it as a positive. People who abuse or misuse the drugs make it harder on those of us who need them. The measures that are taken to make abuse and misuse more difficult, benefit all of us who are keeping our noses clean.

It sounds like you have issues with the way your doctor has approached your treatment, and that's understandable. However I wouldn't spend any more time worrying that the contract and UA policy reflect on you personally at all.

01-17-12, 07:18 PM
They just want to make sure your taking your medications. There is a lot of people out there that have perscriptions and sell the meds for profit.

Exactly. And the more that happens, the harder it makes things for those of us who need the meds and use them legitimately.

01-18-12, 12:21 AM

Would Concerta show up on the UA?

I was more frustrated at how it was handle and how the receptionist and nurse handled it. It seemed unprofessional to me.


01-18-12, 12:31 AM
It's my understanding that certain drugs aren't usually picked up on drug screens. Methylphenidate is one of those.

01-18-12, 02:48 AM
I have a contract with my doc. It does say that they can do random UA.

Where I am, the "contract" is a CYA move and nothing more. I raise a stink if I'm told to take aspirin. My doc knows fine well that I am only barely compliant in taking the stuff I'm prescribed. Chance that they would ask for a random UA? None. Can they? Yep. Would I comply? Yep.

My doc was careful to explain the "WHY" of the contract. He made sure to let me know that this wasn't a trust issue between he and I. He also explained what the UA would screen, what it wouldn't, and what the procedure was.

I hope that you are willing to let both your doc and the medical system he works in know WHY you are upset about this. Take this as an opportunity to teach the otherwise blase that you are a person, have feelings... and have the ability to choose your healthcare team- people whose interests and goals align with yours to insure your best health.

You have the ability to direct your healthcare dollars. If you aren't receiving proper service, you can direct those dollars elsewhere. MDs may not acknowledge this reality but I guarantee that the Chief of Staff or other highly placed administrator DOES.

01-18-12, 07:31 AM
a pdoc isn't only prescribing stims, but narcotics as well. the contract is more about the narcotics. It sounds like maybe some pharmacist gave the office a hard way to go at some point. where I live, pharmacists can and will turn in a doc they think is prescribing too many narctoics.

pain managment docs do this as well.

but your observations about how your meds are being jerked around seems pretty legit. Seeing a psychiatrist might be a good idea, they'll have more specialized knowledge.

01-18-12, 04:32 PM
Don't take it personally. The DEA is sending threatening letters to different clinics that prescribe large amounts of narcotics and making sure they have monitoring programs, although from what I understand compliance is optional. Because of this pressure some clinics basically refuse to prescribe controlled substances, including stimulants.

What they are looking for is 3 things:
1) That the drug in question or its metabolite is in your pee (to make sure you are taking it not selling it)
2) That its at the expected concentration, based on some algorithms, or compared to your previous tests (to make sure your not abusing it), and
3) That you don't have any coke or marijuana or anything in your system (to rule out that your a drug addict).

If you have the option I would switch clinics/doctors, because all it takes is one faulty pee test and you are accused of being an addict or dealer. I know this because it happened to me. All of my drug screens were consistently negative, and after arguing with the doctor, I took the medication in front of her and peed in the cup to prove the test was inaccurate. She came back with a sheepish explanation about maybe my liver metabolizes it fast, but this was after being outright accused of being a dealer/addict and threats to throw me out of the clinic.