ReviewOpioid Contracts in Chronic Nonmalignant Pain Management: Objectives and Uncertainties
Section snippets
Adherence
The primary goal of opioid contracts is to promote patient adherence to opioid therapy.2, 3, 4 Adherence in opioid therapy is defined as the “self-administration of medications in prescribed amounts and at prescribed intervals,” and “includes obtaining a drug from a single prescriber and avoiding the use of other licit or illicit abusable drugs other than those approved by this single prescriber.”4 This definition of adherence in chronic opioid therapy reflects the problematic aspects of opioid
Opioid contracts: What’s the harm?
We lack both consensus on critical conceptual issues concerning the proper composition and goals of opioid contracts and empirical evidence of their effectiveness in achieving these goals. More conceptual and empirical work is needed to resolve these issues. In the meantime one might ask, “What’s the harm?” One might argue that the reasons for using opioid contracts are sufficiently compelling to justify employing these interventions despite the uncertainties about their use.
We believe that a
Why are opiate contracts so popular?
Opiate contracts are likely to remain widely used. It may be that clinicians who treat pain with opioids in this country inherit opiophobic values that are part of our history and culture. They cannot help but be inundated with the undeniable reality of drug abuse, addiction, and diversion, and the far-reaching social sequelae of these phenomena. In this climate, clinicians who prescribe opioids confront real risks of unwittingly facilitating opioid abuse and diversion and incurring sanctioning
What is a doctor to do?
The lack of empirical evidence supporting their use does not necessarily mean that opioid contracts are not effective or should not be used in clinical practice. What it does mean, however, is that clinicians should pause and critically reflect on why they are utilizing contracts and the contract’s specific content before adopting the practice. The model contracts: (1) emphasize that opiates are part of a comprehensive pain treatment program; (2) stress physician’s responsibility to work with
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2020, JSES InternationalCitation Excerpt :Perhaps patients receiving preoperative opioids within 90 days of surgery may benefit from being weaned off of long-acting opioids prior to elective interventions. Pain contracts have also been investigated and used with some success, although clear data on their effect on outcomes have yet to be shown; in addition, providers exercise caution in their use as the social and ethical implications for patients, and the negative effects of such, are problematic.1 In our patient cohort specifically, because of the nature of the state-mandated databases, we were unable to see if any patients used pain contracts in the preoperative period or to determine the percentage who did so.
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2019, Surgical Clinics of North AmericaCitation Excerpt :Opioid contracts, also referred to as narcotic agreements or pain contracts, are not legally binding documents, and there are no established guidelines on how to administer and enforce them. Rather, opioid contracts or agreements should be considered to improve adherence, obtain informed consent, outline prescribing policies of the provider, and mitigate risk.90 Urine drug testing may be performed at initiation to assess for preoperative opioid use.
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Dr. Arnold was supported by the Project on Death in America Faculty Scholars Program, the Greenwall Foundation, Ladies Hospital Aid Society of Western Pennsylvania, the International Union Against Cancer (UICC), Yamagiwa-Yoshida Memorial International Cancer Study Grant Fellowship, and the LAS Trust Foundation.