Usual contents of the agreement:
(1) To receive opioids or the controlled substance only from one physician.
(2) To use a single pharmacy to have the prescriptions filled.
(3) To not share, sell or otherwise divert the prescribed medications.
(4) To submit to urine drug tests to detect drugs of abuse and the prescribed drug.
(5) To not abuse alcohol, cocaine, amphetamines or other drugs of abuse.
(6) To request a medication renewal only in person and during certain times.
(7) To accept that any loss of a prescription (theft, misplacement, other) will not be replaced without a clinic visit and an evaluation of the circumstances.
(8) To submit to a background check.
(9) To provide a list of other physicians involved in care and the medications prescribed.
Additional items that may be included in the agreement:
(1) Identification of marijuana may or may not be included in the agreement. If it is not the patient is advised to discontinue its use.
(2) To keep medications in a locked and secured place to prevent theft.
(3) To keep appointments with the physician and to be compliant with instructions.
(4) To file a police report if a prescription or medication is stolen.
Discontinuation of care:
(1) is done gradually to allow for weaning of the patient from the prescribed drug
(2) is done so that the patient is not abandoned
