Benefits Of Using A Treatment Agreement When Prescribing Opioids For Chronic Pain Management

The national focus on opioid addiction has made it increasingly more challenging for healthcare providers to prescribe opioids for safe and reliable chronic pain management.   Using a treatment agreement can be an effective way to actively engage patients in this important aspect of their care.

A treatment agreement promotes communication and educates the patient about the role they play in safe use of opioid medication.  The agreement is best introduced when initiating opioid medications into a plan of care. However, it can also be a great way to re-engage patients who may have been prescribed a controlled substance for chronic pain management for some time.  The agreement provides context to the significance and importance of safe practices when opioids are prescribed for chronic conditions.

Mutual Understanding

The agreement is not designed as a “contract”, but rather a tool that sets forth important information about potential risks, benefits, safeguards, expectations, and patient responsibility.  It is a defined way to assure that the patient and prescriber are on the same page.  The agreement should also address potential consequences of not following the treatment plan.

The written agreement does not replace or substitute the prescriber and patient having a dialog. It simply provides a foundation and structure for education and discussion, and serves to document the mutual understanding between the patient and prescriber to facilitate safe care.

Consider including the following elements as part of the treatment agreement:

• The importance and purpose of the agreement
• Acknowledge any applicable State requirements that may be imposed on prescribers, such as querying a State maintained data bank
• Benefits of treatment
• Risks and potential side effects
• Safeguards or parameters the prescriber will follow when prescribing long-term opioids
• What is expected of the patient
• Recommendations for safely handling and taking the medication
• How to obtain refills
• Consequences of not following the agreement

The importance of the agreement is solidified by having the patient sign to certify their understanding and having the prescribing clinician sign to confirm the agreement was discussed.   In the event the patient gets off-course with this aspect of their care, the agreement provides a foundation for discussion as to the potential consequences and solutions.