Narcotics Policy


Occasionally we do come into contact with people who overuse prescription anxiolytic and narcotic medications. At The Country Doctor, Ltd., we have the following policy, which all patients must sign and adhere to, prior to receiving any prescriptions for narcotics. anxiolytics, or other potentially abusable drugs. This policy is based on a policy from the WWW.AAFP.ORG/FPM. We are not accusing anybody of overusing narcotics, but we have had a few "drug seekers" and "doctor shoppers." Thanks to a few bad apples, all people who receive potentially abusive medications from The Country Doctor must sign the following policy, which is summarized below.

We are very hesitant to prescribe narcotic and/or benzodiazapine medications, such as Vicodin, Duragesic, Dilaudid, Demerol, Lorcet, Darvon, Codeine, Darvocet, Tylenol #2-#4, Xanax, Valium, Ativan, With the exception of terminal cancer patients, we no longer prescribe Percocet, Roxanol, Oxycodone or Oxycontin.

Please note that if you are a new patient, you may be limited to fewer than 10 pills and/or less than one week of a supply for your first prescription, until you can be verified at the pharmacies. Under Illinois law, pharmacies have the right to notify physicians of a patient who is getting narcotics from multiple physicians.

Rarely, if ever, will prescriptions be given for narcotics that are greater than a 1-2 week supply. We are not a pain clinic. With the exception of our terminally-ill cancer patients or our patients who have an illness that causes chronic pain with documentation to verify the illness, we do not prescribe long-term pain medications. If you are a prescription medication or illicit drug abuser, please call one of the drug rehabilitation centers for treatment. If you are a regular patient who needs drug addiction treatment, we will assist you in locating a treatment center. All patients on narcotics or anxiolytic medications must have at least monthly appointments, with new patients requiring follow up appointments within a week of the prescription for narcotics or anxiolytics. Anyone who receives a narcotic or benzodiazapine prescription from multiple doctors during the same treatment period or same month may be reported to the DEA.

The Country Doctor's Narcotics Policy for ALL Patients

I understand that a physician at The Country Doctor is prescribing either short term or long term narcotic pain medication(s) and/or controlled benzodiazapine medication(s). I will take the medication only as prescribed and only will receive these controlled medications from a physician at The Country Doctor, including not seeking or accepting any medications for pain other than those prescribed by my doctor at The Country Doctor. "Medications for pain" includes prescriptions from other doctors, medications borrowed or accepted from family or friends, and any illicit or street drugs.

I understand that my physician is under no obligation to provide these medications to me, and that the physician reserves the right to discontinue these medications at any time. At the appointment for prescriptions containing narcotics or benzodiazapines, the patient must provide a pharmacy name and number, where the patient will go each time for the medications, unless the patient notifies the physician of a change in pharmacies. I agree that, prior to, during, and after the prescription of narcotics or benzodiazepines, a representative of The Country Doctor may contact physicians, pharmacies, and other resources to verify that I am receiving narcotics from only The Country Doctor. At my doctor's discretion, I agree to cooperate with random drug testing, which may be requested at any time. If I refuse, I understand the medication will be stopped.


Medication refills will be provided as written prescriptions and usually will require MONTHLY appointments to evaluate the patient's symptoms. No refills will be given prior to the next scheduled appointment date. If I do not keep my appointment, I will not receive a refill. Two (2) appointment cancellations with less than one working day's notice or two (2) no-show appointments may constitute grounds for immediate termination of this agreement. I understand that my doctor may require specialist evaluation of my treatment, and I agree to keep appointments when my physician refers me. My doctor will send a report of my care and a copy of this agreement when a referral is made.

Duplicating, copying, forging, or representing The Country Doctor by phone, written prescriptions, or other methods regarding any prescription will result in withdrawal of care of the listed patient by any physician or representative of The Country Doctor, Ltd, along with potential legal prosecution. I understand that immediate termination of the narcotics agreement will happen if I give, sell or in any way distribute prescribed medications to any other person(s); I in any way attempt to forge or alter a prescription; my medical condition declines to the point at which, in the judgment of my doctor, continued therapy with this medication presents a danger to my well-being or safety; there is evidence that I am no longer receiving a reasonable therapeutic benefit from the medication, or my doctor determines that I am no longer a good candidate to continue the medication.

I agree to fill my prescriptions only at the pharmacy I listed below. If I change pharmacies, I will contact my doctor's office and provide them with the name, address and phone number of the new pharmacy. Under no circumstances will I obtain medications from more than one pharmacy or physician at a time.

I understand that any alteration in my medication prescriptions will require a new written agreement. I understand that by signing this agreement, I must abide by the rules reviewed above and that failure to abide by these agreements will result in the termination of medication prescriptions and possibly the termination of services from my doctor and his or her practice.


In addition to the above policy, any violators of this policy may be reported to the Drug Enforcement Agency's Diversion Unit at (314) 538-4600. Reporting narcotic abusers is NOT a privacy violation, as the illegal use of narcotics, including receiving prescriptions from multiple doctors, going to multiple pharmacies to fill prescriptions to avoid the 30 days between prescriptions, and forging prescriptions, are all reportable offenses to the Drug Enforcement Agency.

Drug Addiction Outpatient and Inpatient Centers in the area

*The Narcotics Anonymous program is highly recommended, as it is free and anonymous.

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The Country Doctor, Ltd.
2310 Country Road
Shiloh, IL 62221-2570
Voice (618) 277-3197
Exchange (618) 277-3214
E-MAIL The Country Doctor