Dear Patient:
Because of the potential harm associated with excessive use of these medicines (i.e., they are addictive, have many potential side effects, and cause many deaths per year – please read the drug information sheet carefully), I have established a policy regarding their use, which reflects the minimum standard of care. These medicines include:
- Narcotics, e.g., hydrocodone/acetaminophen, Tylenol III with codeine, tramadol
- Benzodiazepines, e.g., alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium)
- Benzodiazepine-like sleep medicines, e.g., zolpidem (Ambien), eszopicline (Lunesta)
- The controlled muscle relaxant carisoprodol (Soma)
The policy is as follows:
No more than 20-30 pills will be prescribed for the first month, and beyond that, no more than thirty (30) pills will be prescribed every three (3) months. Those who request a refill earlier than three (3) months will either need to reduce their frequency of use or find other options (see below). If frequent, long-term use is required, you will be referred to a specialist. In addition, a follow-up visit and completion of my Controlled Substances Questionnaire will be required if it has been more than six (6) months since your last visit for the refill.
I fully understand that there are many people who feel they cannot function without taking these medications more frequently. Having a personal history of significant back arthritis/severe back pain, nocturnal cramps, and chronic insomnia, I have had to rely on narcotics and benzodiazepine-like sleep medicines short-term simply to be able to function. But the key phrase is “short-term.” That is how they are supposed to be used, and they are not FDA-approved or safe for long-term use. In many pain management cases, including mine, a faithful physical therapy regimen is essential and can be quite effective, and careful sleep hygiene can reduce the need for sleep medicine.
Obviously I am in my profession to help my patients feel better, but I must also do what is best for them in the long run. Other options we should always consider to help provide you with the best care include:
- Home or formal physical therapy
- Psychotherapy (“CBT” or cognitive-behavioral therapy)/counseling, or self-help books
- Anti-inflammatory or other pain medicines that are non-narcotic, anti-anxiety medicines that are not sedative-hypnotics, non-controlled sleep medicines, or intentional efforts at better sleep hygiene
- Referral to a specialist (pain management, psychologist, psychiatrist, sleep specialist, or other physician) or for a sleep study
- Treatment of cramps using other muscle relaxants and methods (stretching, heat, electrolytes, etc.)
Take extra care with these medicines. Do not let others know you are taking them, nor ever share them; and keep them hidden away, separate from your other medicines. Without these precautions, as has unfortunately happened to many patients, prescriptions can get lost or stolen. Due to the controlled nature and other potential problems associated with the use of these medicines, you will only be given one “emergency refill” for lost or stolen medicines. In addition, do not seek these medicines from more than one physician.
By signing below, I attest that I understand and agree to the above.