Wintergreen Medical Center
324-A Beacon Drive
Winterville, NC 28590
Calvin Ellis, PA-C
Carol Gates DNP, FNP-BC
Chronic Pain Patients
Clearly, there are many patients in our community (and all over the country) who have been inappropriately
prescribed very potent opioid narcotic pain medications by well intentioned but misguided physicians.
Several years ago, Oxycontin was touted as being less habit-forming than rapid acting oxycodone, and that
turned out NOT to be the case. Oxycontin became immensely popular, and many of these patients are now
on Percocet or Endocet as a result of their being dependent on the ingredient oxycodone. Another part of
this problem stemmed from the mainstream medical literature espousing the need to treat any and all chronic
pain. Though the literature was referring to pain such as cancer pain, other pain syndromes such as
fibromyalgia became recognized, and we believe that many physicians were too eager to treat any form of
chronic pain with inappropriately potent medications, sometimes without the most basic medical workup
searching for the cause of the reported pain.
This has resulted in vast numbers of patients being both psychologically and physically dependent on these
potent painkillers, many for clearly inappropriate reasons, including degenerative arthritis, fibromyalgia,
headaches, mechanical low back pain, diabetic neuropathy, and other undiagnosed pain syndromes.
We believe that it is both medically inappropriate and harmful to maintain patients on potent opioid narcotic
pain medications when, in our opinion, many of them should not have been started on them in the first place.
Though we cannot control the actions of your previous physicians, we can and will control our prescribing of
these medications. We wish to be part of the solution to this problem, and a part of the problem.
Unfortunately, patients are left confused since once a (misguided) physician placed them on this medication
in the first place, then any physician who subsequently feels otherwise, may seem to the patient to be "cruel."
Of course, once a patient has taken oxycodone, there is nothing, besides possibly morphine, that works as
well for their individual pain. This is because oxycodone is indeed one of the most potent narcotic painkillers
available. Furthermore, it causes both psychological and physical dependence, as well as being highly
sought after on the streets by illegal drug users.
We will be glad to treat patients with narcotic pain medications when their condition warrants this treatment.
We believe that patients with untreated or untreatable terminal cancers should not be forced to live the rest
of their lives in pain, and we will do everything in our power to alleviate this pain. We also believe that
acutely painful conditions such as passing a kidney stone or bone fractures or postoperative pain should be
treated with a short course of potent painkillers that is tapered off over the course of a few days or weeks.
However, there are many medical conditions where strong pain medications are clearly inappropriate.
Conditions we will not treat with a narcotic pain medication include degenerative arthritis, fibromyalgia,
"bulging disks" (unless we see clear and convincing evidence of impingement on the nerve roots or spinal
cord), chronic mechanical low back pain (in the absence of any xray or MRI evidence of pathology),
noncancer headaches, most diabetic neuropathy, and rheumatoid arthritis, among many other diagnoses.
If you want to receive medical care in our office, and you are taking a narcotic pain medication on a regular
basis (month after month), then before we prescribe the medication for the first time, you must
provide us with detailed written evidence for the diagnosis that is being treated with this
medication. This may include blood tests, xrays, nerve studies, or other tests. This evidence must provide
us with clear and convincing evidence for the cause of your pain and for the severity of your pain, and only
when we are satisfied that these conditions are met, will we consider prescribing any chronic narcotic
medication. This decision will be based entirely on our clinical judgment after reviewing the records you
provide. Go here to download new patient materials, including release of medical record forms
If or when we do ever agree to prescribe any chronic narcotic medication, we must insist on several
requirements for you to receive this medication:
1. You must sign our Narcotic Pain Medication Contract.
2. You must agree to having only one physician provide all of your pain medication and all of your
physicians will receive a copy of our contract, with the narcotic prescribing physician named.
3. You must agree to receive all of your narcotic medications from only one pharmacy and that pharmacy will
receive a copy of our contract.
4. You must agree to submit to random urine drug screens, at your out of pocket cost of about $75, at our
request, at any random office visit. Insurance will not pay for this, and the reason for the drug screen is that
many patients sell their narcotic pain meds on the street to maintain other illicit drug habits or use. If we find
an illicit or unprescribed drug in the urine sample, we will no longer prescribe the narcotic.
5. You must make a periodic (usually monthly) visit to our clinic for regular evaluation of the need to
continue the medication, to discuss side effects, and to decrease or increase the dose accordingly, or for a
drug screen. This periodic visit may be required even if the medication such as hydrocodone could, by state
law, be refilled. This requirement is entirely at our discretion.
6. You may not request a refill of any narcotic medication by phone; you must be seen in the office for all
refills, at a scheduled appointment (not as a walkin appointment).
7. If you "lose" your medication or prescription, you will not receive another one until your next scheduled
visit, unless you provide us with a detailed police report of the theft or loss.
8. If you attempt to obtain a narcotic or any other controlled substance by illegal means, you will be
prosecuted, by us, to the full extent of the law, and you will be reported to the state pharmacy database,
which will make your name available to all pharmacies in the state of NC.
9. Failure to meet any of the above requirements will result in your dismissal from our practice with 30 days
notice, and you will not receive any more of the narcotic medication during that time.
Our Opinion of the Problem
What We Will and Will Not Prescribe
If You Take Narcotic Pain Medication and Want Treatment at Our Office