Services Our Team Schedule Appointment Locations Patient Resources Research and Publications Links		Narcotics Agreement Northwest Sports and Spine Physicians is dedicated to providing you the best treatment we possibly can. We recognize that adequate pain treatment is an integral part of the comprehensive treatment program. If your physician prescribes pain medication, we request that you read and follow our opioid contract. Northwest Spine and Sports Physicians, P.C. does not prescribe long term narcotic pain medications. In the event that after completing our comprehensive rehabilitation program you have ongoing pain that requires chronic narcotic pain medications you will be referred to a pain management specialist for all narcotic medication needs. The following medication policy is intended for the safety of our patients and to limit the chance of drug interactions. I agree to the following: I understand that I have a pain problem which currently requires the prescription of opioid (narcotic) pain medications designed to help me improve my ability to function. I understand it is in my best interest to have the opioid (narcotic) medications prescribed to me in a controlled environment to decrease the chance for development of psychological dependency or addiction. I am currently not abusing prescription or non-prescription drugs, and I am not undergoing treatment of addiction or substance abuse. I certify that I have disclosed to my physician any past diagnoses or treatments of psychiatric conditions, drug or alcohol abuse. I agree that while I am being treated with narcotic medication I will abstain from alcohol use. I understand the dangers involved in using alcohol while also taking narcotic medications. I have never been involved in the sale, illegal possession or transport of controlled substances such as narcotics, sleeping pills, pain pills or other illegal substances. I agree to obtain all prescriptions for narcotic medications or sleeping pills only from Northwest Spine & Sports Physicians. I agree to use only one pharmacy for filling of narcotic medications, and I will supply that pharmacy name and number to Northwest Spine & Sports Physicians, P.C. I agree to allow my spine physician at Northwest Spine & Sports Physicians to communicate with referring physicians and pharmacists regarding my pain medications. I agree to follow the treatment plan as outlined to me by my physician at Northwest Spine and Sports Physicians, P.C. This includes all visits to physical therapy, pain management specialists and other physicians, chiropractors and allied health professionals to whom I may be referred. I agree to take my pain medications exactly as prescribed by my Northwest Spine & Sports Physicians, P.C. physician. If the medication loses its effectiveness in increasing my function, I agree to contact my physician, who will help me find a more effective solution. I WILL NOT alter dosage or timing of the medications without first consulting my physician. I certify that I am not pregnant, and will stop taking narcotic medications if I become pregnant. I agree to keep all scheduled appointments at Northwest Spine & Sports Physicians. I agree to have a urine or blood test done randomly at my physician’s request. I understand that lost, stolen or misplaced prescriptions or medications will not be replaced. I understand that NO refills will be made before their scheduled time or after normal office hours during the week, on holidays or the weekend. If I request a refill I must do so at least two business days before the medication is due. I understand that pain medication may cause drowsiness. If I feel impaired, I will not operate a car or potentially dangerous machinery. If I deviate from the above guidelines, I understand the medication could be tapered in a manner that will attempt to minimize the severity of any withdrawal side effects and could result in termination of care at Northwest Spine and Sports Physicians, P.C.