George Kamajian DO
Largo Clinic
10500 Ulmerton Suite 360
Largo, Florida 33771

Consent form for chronic opioid therapy

I understand that Dr Kamajian is prescribing opioid (narcotics) medication to me for my diagnosis of chronic pain as defined by the State of Florida under statue 458.3265. I am making this decision together with Dr Kamajian because other treatments have not helped my pain.

I understand that taking narcotics is associated with, but not limited to: sleepiness, constipation, nausea, itching, vomiting, dizziness, allergic reactions, slowing of breathing rate, slowing of reflexes and reaction time, physical dependence, tolerance, addiction and death.

I understand that it is forbidden to operate machinery or drive while taking these medications.

Addiction, defined as the use of a medication even if it causes harm, having cravings for a drug, feeling the need to use a drug even if it causes a decreased quality of life is possible with narcotic use.

Physical dependence, defined as the experience of withdrawal symptoms if my pain medication is decreased, stopped or reversed, is normal after using narcotics for any length of time.

Tolerance, defined as the need to require more medication to get the same amount of pain relief is normal after using narcotics after any length of time.

MEN: I understand chronic narcotic use can be associated with low testosterone levels that may affect my mood, stamina, sexual desire and sexual performance.

WOMEN: I understand that narcotics are not considered safe if I am pregnant or am planning on becoming pregnant. I am aware that should I carry a baby to delivery while taking narcotics, the baby will be physically dependent upon opioids and runs the risk of having birth defects.

It is our goal to eventually decrease your use of narcotics. We will help you to control your medication in a safe and consistent manner. Definitive and periodic follow ups with appropriate specialists will be routinely recommended but it is up to you, the patient to make those appointments and complete those tests. Imaging studies such as MRI’s must be updated to reflect the current status of your medical or surgical problem. If we do not give you a hard time about the quantity of the medications you are taking then we are not doing our job.

Trigger point injections may be offered for pain. These are injections of long acting Marcaine and/or a steroid that are injected into the soft tissues in the area where you have pain including back, neck, joints and headaches. We do not give injections into the spine or the spinal cord or the epidural region of the spinal cord. In some individuals these shots cause dimpling and/or skin pigment changes that may be permanent.