I recently raised some questions about narcotic therapy contracts and my readers raised even more issues. Some of these questions deserve further discussion.
First, despite the examples I gave, when I’m speaking about narcotic contracts I am talking about people chronically on narcotics. I don’t normally use contracts for people with self-limited problems. That doesn’t mean these patients aren’t susceptible to the same problems as long-term users of narcotics, but the thinking is (based on what data, I don’t know) that people with a clear, self-limited, anatomic problem, such as a kidney stone or broken hip, are less likely to develop a substance use disorder (depending of course on their baseline susceptibilities to such problems). This assumption may be complete and utter bullshit, and certainly there are people who become addicted after using narcotics for self-limited problems. Still, it seems (from crappy, anecdotal experience) that it’s people with vague, chronic pain that end up causing health care providers the most problems.
Second, despite reservations I may have, and other cogent points made by my readers, I’m not about to stop using this tool. It may be a blunt instrument, but it’s what we’ve got for the time being. Even though we may recognize that these contracts may do more to protect providers than patients, and that narcotic use is not entirely volitional, these contracts serve an important purpose. They recognize that narcotics are not like other drugs. While someone may be dependent on insulin, they do not engage in illegal behaviors to obtain it, and they do not end up using it for that yummy insulin high. They do not grow to crave it.
One, I find it ironic that you include “informed consent” in the title of your article since item 8 of both of the “contracts” you link to basically require the patient to give up his right to informed consent or any type of consent at all. You have to agree to do anything the provider says or you’re back to constant pain. Two, I would like to point out that these “contracts” are signed under duress. “Agree” to this or I’ll leave you in pain. This does not seem to be the most ethical or compassionate behaviour. You don’t want to give up your rights to say no to any treatment, you don’t want to be treated like a criminal, you don’t want to give up your rights to confidentiality? Well, good luck controlling that pain with aspirin and hot packs. And stop that whimpering, it’s more than most people had through out a lot of history.
I have to disagree. Section 8 means you get no choice at all. No autonomy at all. Period. You have to agree to anything that provider wants with out even knowing what it is. What ever he wants, even if it makes your condition worse, or is degrading, or is more dangerous than you would want to risk, or harms you. It’s do it or go back to the pain. Sure, you can walk away any time you want to go back to the pain. If that is a choice, then last year I chose to let burglars have my TV because I did not stay in my house 24 hours a day, seven days a week.
These comments share a lot with narcotic-seeking behaviors in that they basically say that anything that interferes with obtaining narcotics is “bad” and not the fault of the consumer.