Pain Medication Policy

As a doctor, I have a first-hand understanding of the important and legitimate need for powerful medication to help people deal with chronic or acute severe pain. If you have had a family member or loved one touched by a serious illness or injury, you understand it too. But as you perhaps know, more Americans now die every year from drug overdoses than they do in motor vehicle crashes. Opioid medications were involved in 28,648 deaths in 2014, according to the CDC. The medical community is deeply concerned about this growing epidemic, and I am personally disturbed by the toll it has taken in communities here on Long Island.

Our first and foremost concern is the well-being of our patients. We understand that you are in pain: however, FOR CHRONIC PAIN there is NO magic pill or pain medications to make all of your pain go away. Fortunately, in many cases we have superior alternative treatment options to Opioid medications for long term chronic pain. Due to the addiction potential and legal issues involved, pain medicine and management of pain medications will be under the following guidelines.

We ask individuals inquiring of this practice to become patients, acquaint themselves with the following policies:

  • Medications will last a specific number of days and NO medication will be called in prior to that date.
  • Narcotics will NOT be phoned in after hours or on weekends.
  • Patients may be terminated from the practice with thirty (30) day notice for non-compliance in the taking of medications.
  • We will NOT refill prescriptions which have been lost or misplaced. You MUST take the responsibility for keeping up with your medications.
  • Stolen medications will not be replaced without a valid police report. We will only do this ONE time!
  • Your signature on this form will also constitute a release which allows our office to obtain you prescription history/information from any pharmacy we may call on your behalf.
  • All medications must be process through an insurance company. We do not discuss medications with patients who have not be examined by Dr. Golpariani and accepted as patients of this practice.

Patient Printed Name: __________________________________________ DOB:__________________________________________

Patient Signature:__________________________________________ Date:_________________________________