Medication agreements: Why don’t you trust me?

Emily, a 45-year-old senior analyst at a major software company, had been suffering with chronic back pain for months. She tried rest and mild exercise, but nothing was helping. Her longtime health care provider suggested adding a trial prescription opioid (narcotic) pain medication to help her better manage the pain. Emily was shocked when he explained that both of them would sign a written medication agreement before she received the prescription. She became even more upset when her provider told her that the agreement might include random tests of her urine. “Why don’t you just trust me?” she demanded. “After all these years you should know that I’m a smart, responsible person.”

Medication agreement: A positive roadmap for safety

Emily was not being singled out or punished. Health care providers and patients might best be served if all patients and health care providers jointly signed similar agreements before receiving prescription pain medications, because these medications can be dangerous if used incorrectly.

A medication agreement is not about a lack of trust; it is rather a statement of mutual responsibility, and that is why you and your health care provider both sign it. The agreement helps you understand exactly how to use your medication, describes how your provider will ensure that you (and others) remain safe, and how your provider will respond to your need for treatment for chronic pain. Instead of feeling helpless or powerless with your pain, think of this as a “positive roadmap for safety” and a way to take an active role in your health care, protecting yourself as well as others.

Health care providers have been encouraged to follow recommended clinical guidelines for the treatment of chronic pain with opioids in their clinical practice. These guidelines are in place to be sure that patients get the safe and appropriate treatment they need, while discouraging incorrect use of medications that have the potential to harm. Clinical guidelines are standards that are recommended as a good way to care for patients. Some experts have recommended, and clinicians use in their practices, the principal of “universal precautions.” That means that all patients, regardless of individual factors, should be treated with the same safety standard. Written medication agreements and urine testing are two important ways that clinicians assure safe use of opioid pain medications.

Before you sign a medication agreement

Make sure you completely understand what is written, and if you don’t, ask for an explanation. You have the right to know! Recognize that this agreement is not “carved in stone.” You and your provider should regularly discuss if your treatment is working, and, if not, decide together on any changes. In general, this is what you will be expected to agree to do when you sign a medication agreement:

  • You agree to take prescription pain medication only as prescribed
    This means that you will not take more or less medication without talking with your provider. Changing the dose of a medication can be very dangerous because you don’t know how your body will react.
  • You agree never to mix prescription medications with other substances without first discussing it with your health care provider
    This includes over-the-counter drugs, alcohol, other prescription medications, any herbal remedies and illicit substances, like street drugs.
  • You agree never to share your prescription medications with anyone else
    Something that works for you may be dangerous to someone else.
  • You agree to make sure that no one else has access to your prescription pain medication
    Be aware of those around you. Don’t leave your medication on the kitchen counter or even in your medicine cabinet where someone could find it. It should be stored in a spot only you know about, or even locked up.
  • You agree to return for regular follow-up visits and to have any necessary tests to monitor how the drug is affecting your body
    This is an important way to make sure that your medication plan—and your opioid medication agreement— are still working for you.

What about your health care provider?

By signing the agreement, your health care provider agrees to:

  • Give you clear instructions about how to use your prescriptions, and make sure you understand them
  • Remain available for any questions or concerns you might have
  • Monitor your treatment at by reassessing your pain and your ability to meet your functional goals at follow-up appointments

Take pride in your signature

By signing a medication agreement along with your provider, you are both putting on paper your commitment to communication, trust and honesty. If you make a mistake, or if problems arise, you and your provider can work together to find a solution.


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