If you are in intense pain, and a doctor decides to give you LIMITED opioid pain killers, the first thing the doctor will do is have you take a urine test to be assured you are not an addict or on pain pills. This is mandatory and Stacy first mentioned in her statement under oath that she took Percoset for years….yet by the time she went to DeBary and gave a deposition, Percoset was not mentioned.  Rather, drugs associated with RA were mentioned only.  However, we not only sent her oral under oath statement to DeBary’s attorney but to her attorney as well.   And after reading the following, I understand why DeBary’s attorney asked Ms. Tebo whether she was under psychiatric care.


Besides taking a urine test you have to sign a Treatment Agreement, Conditions and Terms for Treatment.

To receive treatment with or without narcotic pain medication, the patient must meet the following conditions/terms:  (I’ve listed the most important ones)

  • Never been diagnosed with, treated or arrested for substance abuse or drug trafficking.
  • Has never been involved in the sole, illegal possession, dispersion, or transport of control substances (narcotics, sleeping pills, nerve pills, pain pills); or under investigation or arrested for such activities
  • A Female must certified that she is not pregnant
  • The patient agrees to supply the clinic with name address and telephone number of the pharmacy that is filling the prescription for pain medication and will USE ONLY ONE PHARMACY.
  • The patient agrees to allow their physician at this clinic to send a copy of the agreement to the patient’s pharmacy, referring physicians and all other physicians involved in the patient’s care.
  • The patient agrees to take the medication only and exactly as prescribed….and cannot share medications with other individuals.
  • The patient will not drink alcohol with controlled medications and the patient agrees not to take any over the counter medication or herbal remedies.
  • The patient agrees to random urine and/or saliva drug testing. The patient understands that each prescription is for a specific number of pills, designed to last a certain amount of time. Absolutely no early refills will be allowed.
  • The patient understands that NO refills will be given if the prescription does not last until the next scheduled visit.
  • The patient understands that NO allowance will be made for lost or stolen prescription pills or those destroyed by fire, flood, etc. The patient will safeguard medicines at all times.
  • The patient agrees not to obtain pain medication from any other physician, emergency room or other person.
  • The patient agrees to keep all scheduled appointments at the clinic. If the patient is unable to keep an appointment, he/she must give at least 24 hours advanced notice.  However, NO PRESCRIPTION WILL BE CALLED IN.
  • The patient agrees to see the physician at the clinic if the physician feels it is necessary to change the patient’s dosage. If the physician suspects the patient is not following his/her orders
  • When asked to cease use of a controlled substance, the patient permits the clinic to pursue remedies which will disable the patient’s driving privileges. The patient understands not to drive or operate machinery while taking controlled medications.
  • By signing this agreement, the patient certifies they are a legitimate patient needing legitimate care.
  • The patient understands the physicians at the clinic may stop treatment and cancel any prescriptions if any of the following occur: (a) giving away, selling or misusing the pain medication  (b) fails to reach goals, such as decreased pain levels  (c) attempts to obtain pain medication at night, on weekends on holidays, prior to next office visit from any other physician, emergency room or other source (d) the patient is released for any reason from the clinic or fails to show improved functions.
  • The patient certifies they have not provided misleading or false information or false medical history…
  • The patient agrees their record may be given to a Narcotic Detective, DEA, or other authorities and will hold the clinic harmless.
  • The patient agrees to random drug testing.
  • The clinic reserves the right to require the patient to submit to psychological/psychiatric evaluation and/or pain patient profile and release this information as part of any medical records request.
  • The patient understands that impaired control, craving, compulsive use, continued use despite negative consequences, inability to take medications as prescribed, isolation from friends and family, doctor shopping, using illegal drugs, intoxication, apathy, depression, noncompliance and inability to function represent abnormal behavior patterns and agrees to discontinue medications and immediately seek psychiatric care and notify the clinic and the primary care provider.
  • Understand that controlled medications such as codeine, Tylenol #3, Methadone, Morphine, MS Contin, Kadian, Avinza, Percoset, Tylox, Oxy Contin, Roxicet, Darvon, Darvocet, Dilaudid, Lortab, Lorcet, Vicodin, Valium, Xanax, Soma, Ambian, Ativan, Florinal, Restoril, Hydrocodone, etc. have risks associated with their use, such as drug interactions, respiratory, depression, death, addiction, drowsiness, allergic reactions, and that you agree to discuss all risks/side effects with your pharmacist, family members, family physicians, ….
  • Understand that obtaining controlled medications from more than one physician/dentist/clinic is a FELONY.
  • If developing feelings of hopelessness, suicidal thoughts or desire to hurt yourself or others, you agree to immediately seek immediate psychiatric care and notify the clinic and primary care provider. All medications must be returned to the office if these feelings happen.
  • Understand over dosing on medications may cause death.
  • You agree to bring medication in its original container to each office visit.
  • I am aware that certain other medications such as nalbuphine (Nubain), pentazocine (Talwin), buprenorphine (Suboxone) and butorphanol (Stadol) may reverse the action of the narcotic medicine. Taking any of these other medications while taking your pain medications can cause symptoms like a bad flue, called a withdrawal syndrome.


Karin Griffin for the blog

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