What is a patient contract for a patient requiring an opioid (narcotic analgesic) agreement?

From the Guidelines

I strongly recommend implementing a comprehensive opioid treatment agreement that prioritizes patient safety, informed consent, and clear expectations for opioid therapy, as outlined in the most recent guidelines from the CDC in 2022 1.

Key Components of the Agreement

The contract should include the following essential elements:

• Patient identification information and a statement acknowledging that opioid medications are being prescribed for pain management
• Specification that the patient will obtain prescriptions only from one designated provider and fill them at one pharmacy
• Requirements for patients to take medications exactly as prescribed, attend all scheduled appointments, submit to random urine drug screenings, and agree to pill counts when requested
• Prohibition on sharing, selling, or trading medications, and explanation that lost, stolen, or damaged medications will not be replaced early
• Agreement to safely store medications away from others, especially children
• Outline of grounds for termination of opioid therapy, including evidence of misuse, diversion, or obtaining opioids from multiple providers

Importance of Informed Consent and Patient Education

The agreement should also emphasize the importance of informed consent and patient education, including:

• Discussion of expected benefits and risks of opioid therapy, including potential for dependence, addiction, overdose, and side effects like constipation and respiratory depression
• Review of alternative pain management options and the importance of a comprehensive pain management approach
• Emphasis on improvement in function as a primary goal, and that function can improve even when pain is not eliminated
• Advice on safe storage and disposal of opioids, and the importance of periodic reassessment to ensure that opioids are helping to meet patient goals

Prioritizing Patient Safety and Well-being

The agreement should prioritize patient safety and well-being, including:

• Regular monitoring of opioid use and potential risks, such as overdose or opioid use disorder
• Use of precautions to reduce risks, including naloxone for overdose reversal and clinician use of PDMP information and toxicology screening
• Consideration of cognitive status and the potential need for a caregiver to comanage medication therapy By implementing a comprehensive opioid treatment agreement that prioritizes patient safety, informed consent, and clear expectations, healthcare providers can help ensure that patients receive appropriate pain management while minimizing the risks associated with opioid therapy 1.

From the FDA Drug Label

To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a Risk Evaluation and Mitigation Strategy (REMS) for these products Consider using other tools to improve patient, household, and community safety, such as patient-prescriber agreements that reinforce patient-prescriber responsibilities

A patient contract for a patient requiring an opioid (narcotic analgesic) agreement is a patient-prescriber agreement that reinforces patient-prescriber responsibilities, as part of the Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) 2.

From the Research

Patient Contract for Opioid Treatment

A patient contract for a patient requiring an opioid (narcotic analgesic) agreement is a document that outlines the terms and conditions of opioid treatment, including the patient's responsibilities and the consequences of non-compliance.

• The contract typically includes provisions such as:
  • Not sharing or selling opioids to others
  • Not using illegal drugs
  • Using the medication as prescribed
  • Attending regular clinic visits for drug testing and pill counts
  • Understanding that violation of the agreement may result in termination of opioid treatment 3
• The purpose of the contract is to reduce the misuse and diversion of opioid medications, while also ensuring that patients receive safe and effective pain management 4, 5

Components of an Opioid Contract

The components of an opioid contract may vary, but they typically include:

• Patient education and informed consent
• A statement of the patient's responsibilities and obligations
• A description of the consequences of non-compliance
• A plan for monitoring and managing the patient's opioid use, including urine drug testing and pill counts 6, 7
• The contract may also include provisions for regular review and revision of the treatment plan, as well as a process for addressing any concerns or issues that may arise during treatment 3, 5

Implementation and Effectiveness of Opioid Contracts

The implementation and effectiveness of opioid contracts can vary widely depending on the specific context and population being treated.

• Some studies have found that opioid contracts can be an effective tool for reducing opioid misuse and improving patient outcomes, while others have raised concerns about their ethical implications and potential for misuse 3, 5
• Further research is needed to fully understand the benefits and limitations of opioid contracts, as well as to develop best practices for their implementation and use 5