Patients should have an individualized treatment plan that addresses all aspects of their lives including physical, psychological, social, and spiritual needs. Although there are no foolproof agreements, each one should define every aspect of care and not merely the use of controlled substances (AAPM, 2002).
The following benefits of using a written treatment agreement have been described in the literature:
- A majority of providers using treatment agreements reported that the use of this tool increased their sense of mastery and comfort with prescribing controlled drugs (Touchet, 2005) Note: The term "contract" was used previously but since has been replaced with "agreement."
- Agreements reinforce expectations about safe use of opioids in higher risk patients (Chou, et al, 2009)
- Agreements make the opioid therapy plan clear for the patient, the patient's family, and other providers of the patient (Chou, et al, 2009)
- Agreements assist in patient education (Chou, et al, 2009)
- Agreements clarify many aspects of treatment (Chou, et al, 2009):
- Responsibilities of provider and patient
- How opioids are prescribed and administered
- Expectations for follow-up appointments and monitoring
- Possible grounds for tapering or discontinuing treatment (including failure to progress toward goals, intolerable adverse effects, or repeated/serious aberrant behaviors) and the strategy for doing this humanely
- Role of opioid therapy as only one part of a multimodal treatment plan
- Realistic expectations in terms of therapy outcome
Research in Support of Treatment Agreements
In a retrospective study of 330 patients with chronic non-cancer pain in an Internal Medicine teaching clinic, over 60% of patients adhered to the agreement and approximately 90% of urine drug tests obtained were positive for illicit substances (Hariharan et al, 2007).
In a survey of 110 responding Internal Medicine residents, 90% found that treatment agreements were useful (Fagan et al, 2008). The majority reported that agreements were at least somewhat helpful to: reduce multiple prescribers and requests for early refills, facilitate the discussion of potential problems, and identify patients who were abusing the medications.