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What’s the deal about opiate contracts?

As you might know, abuse of opiate prescription drugs is a serious global problem, and it is a major problem in the US. It is now estimated that over 2 million people in the US have a serious opiate abuse problem and the numbers of unintentional deaths from opiate overdoses has quadrupled in 1999. Prolonged use of opiates at a high level, even when these drugs have been prescribed under clinical supervision, can have serious effects. Tolerance increases so the brain demands ever higher levels of the drug, withdrawal symptoms are common, addiction can set in and there is a risk of an overdose, which could even be fatal.

Given this, it is not surprising to see the US government has made attempts to crack down on this problem. Unfortunately, some are having a serious impact on the lives and wellbeing of chronic pain sufferers. There are some horror stories of people who were overprescribed opiates and have become dependent suddenly finding their doctors reducing their pain medication with little warning and little back up and alternatives being offered. Many doctors admit that it is difficult to manage something as complex as pain in the time they have with each patient and so some are even steering clear of seeing patients with chronic pain at all.

It is now pretty clear that constant high dosage of opiates has more risks than benefits, but lowering the dose needs the patient to be supported and helped in other ways.


In the US, it has become standard for people to have to sign contracts when they are prescribed opiates. These can include things such as very restrictive conditions on where you can pick up a prescription and demands that you submit to drug screening. For example, Crystal Lindell writes on the pain network website that she takes hydrocodone for her intercostal neuralgia and has been subjected to drug tests on a regular basis.

These ‘pain contracts’ between physicians and patients are based on a good intention, to combat the increasing problems of opiate addiction. These contracts can be positive and helpful to patients, as they do alert both patients and doctors to the dangers of dependence and addiction. They can, however make patients feel they are being unfairly targeted and tested and even make them feel like criminals.

Arianne Grand Gassaway from California writing on the pain network website says she refused to sign a pain contract and was told that she could not have medication. She says: I asked if I was being accused of something (because that is what it felt like) and was told that “there is a drug epidemic in our country”.

She feels her rights have been violated and has decided to speak out. She says “most people taking controlled pain medication will seldom speak out about their experiences of shaming, discrimination or being treated with a lack of compassion and dignity.”

I am very concerned if pain contracts are making people feel this way as it will make it even harder for them to manage their pain. As in the United States, here in the UK it is usually the first resort to offer pain medication. This can help but, because these drugs become tolerated by the patient and they can become dependent, they carry huge risks.

Fortunately, there is increasing acceptance that an understanding of pain means appreciating the key role which is played by the mind in how we perceive pain. If we can change that perception, and thereby help the patient reduce the pain, then we have a safe, non-addictive way of managing pain. I advocate using talking therapies and psychological methods for dealing with chronic pain and know that, properly applied by experts they can be very very effective.


In my pain management clinics I see how people’s lives can be transformed with talking therapies. If you suffer from chronic pain then contact me.

The month’s honourable mention: The Association for Applied Sport Psychology


pain tolerance in sport image


If you suffer from pain and would still like to play sports, then this article will give you hope. I so liked the way its author Eddie O’Connor stresses that the perception of pain is all important and how and when it is right to see pain as threatening. I know that exercise and even some sports can be so helpful when dealing with chronic pain, both by strengthening the body and helping combat conditions such a depression. It’s great to see this message being put across so well.

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