Contracts

Opioid Agreements/Contracts: The American Academy of Pain Management's Take on the Subject

The American Academy of Pain Management's Board of Directors unanimously endorsed the Conjoint Statement of the American Pain Society and the American Academy of Pain Medicine concerning the use of long-term opioid therapy for patients suffering with chronic pain in September 1998. Rather than create another position statement, the Academy's Directors elected to support the 1997 Conjoint Statement of the other pain organizations. The Academy does not recommend opioid medications alone or in combination with other therapies for all patients under all circumstances, but advise practitioners with prescribing privileges to consider all potential therapies when working with patients suffering from painful disorders. Patients should have individualized plans for care that comprehensively address their physical, psychological, social and spiritual needs. To do less is to offer only fragmented care with little likelihood of addressing all of their treatment needs.

Practitioners must fully realize what an agreement/contract signifies when negotiating treatment options with patients for any medical services including, but not limited to, the prescribing of controlled substances. Agreements/contracts between practitioners and patients minimally define behavior between both parties of the agreement/contract. There are no "bullet-proof" agreements/contracts that are binding for all patients, under all circumstances, for all states and legal jurisdictions. Practitioners using agreements/contracts with their patients taking controlled substance medications should obtain legal advice specific for the jurisdiction where they practice before using these documents.

Minimally, agreements/contracts should define all aspects of care, not just the use of the controlled substances. Patients receiving opioid therapies must have clearly articulated treatment goals (pain will be reduced or performance of activities of daily living will be enhanced), defined measures for outcome (pain level will be "x"/10 or number of blocks walked each day will be "y", etc.), identified/defined "other services and treatments" beyond only controlled substances (PT, OT, home stretching program, use of biofeedback, hours of TENS wear per day, etc.), and clear rules with consequences for contractual violation (lost prescriptions, need for a police report if medications is stolen, requirements for urine drug testing, etc.). Since agreements/contracts tie all parties, these documents should be as comprehensively written as possible.

All Downloadable

  1. American Academy of Pain Management - Prescribing Issue - Opioid Agreements and Contracts - The article from which the above information was obtained, contains a sample contract on page 9
  2. Sample contract from PainEDU.org
  3. Patient -Prescriber Expectations and Responsibilities Form - Establish boundaries to ensure safe opioid use by defining patient-prescriber expectations and responsibilities.
  4. Another sample contract
  5. Another sample contract
  6. Low literacy contract from PainEDU.org

Our preferred type of Patient Agreement/Contract is Goal Oriented

  1. Goal Oriented Patient Agreement - Sample 1
  2. Goal Oriented Patient Agreement - Sample 2

Please NOTE that podcast Letter g on our Resources 2 page, discusses goal oriented patients agreements. It is entitled Managing opioid misuse with treatment agreements and urine drug testing: Interview with Barbara Turner, MD, MSED, of the University of Pennsylvania; plus a summary of the articles in the issue. Annals of Internal Medicine. RUN TIME 34:20 DOWNLOAD 16MB