PATIENT OPIOID CONTRACT ( REQUIRED )
If on a controlled / narcotic medication regimen, you must be seen every 30 DAYS by the physician at Tysons Pain Center ,P.C., for re-evaluation of your condition and treatment plan. EARLY REFILLS ARE NOT PERMITTED FOR ANY REASON.
You must have an appointment in order to be treated. Walk-in visits for medication refills are not acceptable. It is your responsibility to make an appointment in advance.
You will obtain opioid pain medication prescriptions only from one physician to avoid possible over-dosage or misuse of controlled medication. As of today you are under the pain management care of Dr. Nagia, M.D.
You will NOT receive other controlled medications such as sleeping pills, tranquilizers, or stimulants from other physicians without authorization and/or knowledge from Dr. Nagia. M.D. This is to ensure your health and safety & reduce risk of possible over-dosage.
You will take your medication exactly as prescribed. Medication is prescribed to last a full 30 days.
If you lose or misplace your prescription or medication, you must report this to the police per DEA requirements, and provide Dr. Nagia with a copy of the report including the officer’s contact information and case number. Contact the office and Dr. Nagia will determine whether a replacement will be issued. (This is uncommon). It is your responsibility to secure your medication.
We will not provide medication refills or dose changes over the telephone. All refills and medication changes require an office visit with the Doctor & submission of your old prescription or medication. (Amendment made to accommodate worldwide pandemic of the novel Coronavirus, also known as Covid-19. Telehealth treatment is permitted, and covered per CMS temporarily during the health crisis).
You will be provided a prescription only during regular office hours (Mon-Thurs. 9:30am-3:00pm) at your scheduled appointment with your physician.
You will not share or sell your prescription per Federal Law / DEA regulations.
As a chronic pain patient, you agree to random medication counts of your unused pain medication upon the request of your physician, per pain management guidelines. Failure to comply will result in termination of care.
As a chronic pain patient, you agree to random urine or blood specimen at least twice per year upon your physician’s request for evaluation of your treatment regimen & compliance, per pain management guideline & DEA regulations. Failure to comply will result in termination of care.
You understand that your doctor will gradually take you off your opioid medication if you do not follow the above plan, or if your doctor believes the opioids are not helping or are harming you.
Your opioid medication will be continued if there is demonstrated improvement in your pain level and function as determined by your doctor. If all treatment measure recommended by Dr. Nagia, M.D. have been exhausted, you will be discharged and referred to another facility that will better control your condition(s).
COMMON REASONS FOR TERMINATION OF PAIN TREATMENT PER SAFETY GUIDELINES:
Abuse or misuse of medication, use of sedatives, use of marijuana, consumption of marijuana, Cannabis consumption / CBD treatment, or over use/abuse of alcohol in conjunction with a controlled medication, the use/abuse of any and all illegal / illicit drugs. **Behavior such as this is not advised while under active pain management treatment, especially if you are on a controlled medication regimen.
Important Information to know in case you are prescribed a controlled medication:
Risk To Unborn Children
If you become pregnant, you will stop all medications and notify Dr. Nagia as soon as pregnancy exists in order to protect the health of your unborn child and modify your treatment. Children born to women who are regularly taking opioids will likely be physically dependent at birth. Women of childbearing age should maintain safe and effective birth control while on opioid therapy.
You have agreed to a trial of opioid (narcotic) treatment for your pain. Opioids include medications such as Percocet, Oxycodone, Morphine, or any other controlled medications on a certain medication schedule. The purpose of this treatment is to reduce your pain and to improve your level of function at work at home and/or other valued activities. Alternative therapies have been explained and offered to you. You and your doctor have elected a trial of opioid therapy as one component of treatment. It is important that you be aware of the potential risks and side effects of these medications. Common issues are discussed below.
Physical Side Effects
Possible side effects include mood changes, drowsiness, dizziness, constipation, nausea and/or confusion. Many of these side effects, if they occur, gradually resolve over days to weeks. Constipation often persists and may require management with medications. If other side effects persist, trials of alternative opioids may be necessary, or opioids may need to be discontinued. You should not drive any vehicle or operate machinery while your dose is being increased or if the medication makes you drowsy. The sedating effects of alcohol and other sedatives are additive with the side effects of opioids. It is strongly advised patients avoid alcohol while receiving opioid therapy.
Physical dependence is an expected side effect of long-term use of opioids if they are prescribed on a daily basis. This means that if you take opioids continuously and stop them abruptly for any reason, you will experience a withdrawal syndrome. This syndrome often includes sweating, diarrhea, irritability, sleeplessness, runny nose, tearing, muscle and bone aching, and dilated pupils. To prevent these symptoms, medications must be taken regularly if physical dependence is present. When opioids are discontinued, they should be tapered under the supervision of your physician. Do not abruptly stop taking your prescription without consulting your physician.
Addiction is present when an individual experiences loss of control over the use of medications, is constantly seeking drugs, and/or experiences adverse consequences as a result of drug use, yet continues to take the medication. Most patients who use opioids are able to take medications as prescribed on a scheduled basis. They do not seek other drugs when their pain is controlled, and experience improvement in the quality of life as a result of the opioid medications; thus they are NOT addicted. Physical dependence does NOT indicate addiction. Individuals with a history of alcoholism or other drug addiction may be at increased risk for the development of addiction while using opioids.
Tolerance to Medication
Tolerance to the pain-killing effects of opioid medications is possible with continuous use. This means that although there has been no physical change in the underlying condition, an increased dose of medication is required to achieve the same level of pain control experienced when the medications were initiated. We do not fully understand why, or understand under what conditions, tolerance to the pain-killing effects of opioids occurs. When it does occur, it may require tapering and discontinuation of the medication. Sometimes tolerance can be handled by substituting a different opioid medication.
Prescriptions are sent digitally to your pharmacy.
Controlled medications are strictly monitored and are prescribed and dated every 30 days.
**IF YOU ARE ON A CONTROLLED MEDICATION REGIMEN,
THIS IS A FRIENDLY REMINDER THAT YOUR PRESCRIPTION IS WRITTEN TO LAST NO LESS THAN 30 FULL DAYS
REFILLS ON THE "28TH-DAY" SCHEDULE IS NO LONGER PERMITTED
DUE TO REPEATED
CONFUSION WITH MEDICATION USAGE
AND REFILL DATES**
IF CONTROLLED MEDICATION IS FINISHED BEFORE THE 30TH DAY,
THIS IS AN INDICATION THAT YOU ARE NOT TAKING IT AS PRESCRIBED WHICH IS UNSAFE
AND TERMS FOR BEING DISCHARGED.