Wintergreen Medical Center
324-A Beacon Drive
Winterville, NC 28590
Office 252-551-5595
Fax 252-321-7762
324-A Beacon Drive
Winterville, NC 28590
Office 252-551-5595
Fax 252-321-7762
M. Craig Simpson, MD
Calvin Ellis, PA-C
Calvin Ellis, PA-C
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 some 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.
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 some 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 NOT a part of the problem.
Unfortunately, patients are left confused, because 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.
Hydrocodone also causes physical and psychological dependence, and has become a major drug of abuse.
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 NOT a part of the problem.
Unfortunately, patients are left confused, because 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.
Hydrocodone also causes physical and psychological dependence, and has become a major drug of abuse.
We will be glad to treat patients with narcotic pain medications when their acute 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.
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 we will be happy to provide your medical care for all other nonpain issues, but we will refer
you to a local pain clinic for ongoing treatment with narcotic medicine. We will rarely prescribe narotics on an
ongoing basis at this clinic..If we agree to do this, 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.
(month after month), then we will be happy to provide your medical care for all other nonpain issues, but we will refer
you to a local pain clinic for ongoing treatment with narcotic medicine. We will rarely prescribe narotics on an
ongoing basis at this clinic..If we agree to do this, 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.
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.
The Problem
Our Opinion of the Problem
What We Will and Will Not Prescribe
If You Take Narcotic Pain Medication and Want Treatment at Our Office
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