6. I understand that driving a motor vehicle must be monitored at times while taking controlled substances and that it is my responsibility to comply with the laws of this state while taking the medication prescribed.
7. I agree to have a random drug screen performed at any time at the request of Dr. Bailey. I agree that I may be subject to pill counts at Dr. Bailey's office within a reasonable amount of time from the notification that a pill count is to be performed. If I fail to appear in a reasonable amount of time on the day the pill count is to be performed and prior to the close of normal operating hours at Dr. Bailey's, that I am subject to dismissal from his care.
8. I understand that the main treatment goal is to improve my ability to function and/or work and/or reduce pain. I understand that it is not appropriate for me to attempt total relief of the pain with the use of opioid medications. To do so places me at risk of respiratory depression, sedation, nausea, constipation, and tolerance. A 50% reduction in pain is a realistic goal. In consideration of that goal and the fact that I am being given potent medication to help me reach that goal, I agree to help myself by the following better health habits: exercise, weight control, avoiding the use of tobacco and alcohol. I understand that I must learn new pain management strategies and will strive to increase my activities. I must also comply with the treatment plan as prescribed by my doctor. I understand that only through following a healthier lifestyle can I hope to have the most successful outcome to my treatment.
9. I understand the goal in prescribing pain medications is to reduce the need for them in a reasonable amount of time. For example, the underlying pain may decrease over time, and I should attempt to learn safer ways to manage my pain (e.g., relaxation techniques, self-hypnosis, biofeedback, exercise program, etc.)
10. I understand that if I violate any of the above conditions, my controlled substance prescriptions and/or treatment will be ended IMMEDIATELY. Unethical behavior will be grounds to discontinue care of you (e.g., diversion or selling opioids to others or taking opioids for emotional reasons). If violation above, or the concomitant use of non-prescribed illicit (illegal) drugs, I may also be reported to my physician, medical facilities, and other appropriate authorities.
I have been fully informed by Dr. Bailey regarding psychological dependence (addiction) of a controlled substance, which I understand is rare. I know that some people may develop a tolerance, which is the need to increase the dose of the medication to achieve the desired effect, and I know and understand that I will become physically dependent on the medication. This will occur if I am on the medication for several weeks, and when I stop the medication, I must do so slowly and under medical supervision, or I may have withdrawal symptoms. By signing this agreement, I give Dr. Bailey the right to contact their physicians or pharmacies concerning the use of the narcotics.
I have read this agreement and the same has been explained to me by Dr. Bailey. In addition, I fully understand the consequences of violating this agreement.