Opioid Treatment Agreements and Palliative Care
Joshua S. Barclay, MD FACP, and Leslie J. Blackhall, MD
The use of opioids has increased substantially over the past decade, associated with a concomitant rise in prescription drug abuse. However, issues related to substance abuse are not relegated only to chronic nonmalignant pain but affect all patients, including those with cancer and advanced illness. Concerns about adverse events and the regulatory response have led medical societies to recommend increased attention to risk reduction. One technique often employed is the opioid treatment agreement. Sometimes referred to as a “contract,” this document specifies the requirements patients must adhere to in order to continue therapy as well as policies for violations. They are used for preventing substance abuse, protecting the provider from legal consequences, and educating patients about the risks of misusing opioids.
Despite widespread use, the efficacy of these documents is not well studied. Limited observational studies of fair to poor quality suggest reduced service utilization and improved provider confidence in pain management with the use of opioid treatment agreements.1 The utility of opioid treatment agreements in protecting providers from legal risk is uncertain, and they may only serve to reduce physician flexibility in patient management by defining rigid policies for specific patient actions.2