Ethics of Opioid Contracts as a Prescription Drug Abuse Prevention Strategy

State legislatures, state medical licensing boards, and medical societies have encouraged and/or mandated the use of 'opioid contracts' for patients with non-malignant chronic pain. Despite a paucity of evidence supporting their effectiveness in improving patient care, use of these documents has proliferated in recent years as the principle means to increase opioid therapy adherence and prevent opioid abuse and diversion. They have also become a de facto form of patient consent to treatment involving opioids. Contract proponents laud these as sufficient demonstration of informed consent, including patient responsibilities, and requirements for drug testing, compliance monitoring and a treatment plan. Despite concerns that we briefly review, it is stipulated that contracts likely will remain the default form of consent and compliance monitoring for opioid treatment. Given this fact, we argue that a better form of contract must be developed, and submit a model for consideration. 

We propose an evidence-based and ethically defensible form of opioid contract as a part of informed consent for treatment of non-malignant chronic pain. Minimal requirements are: appropriate readability level, balanced obligations of physicians and patients, and a mutually developed and agreed upon treatment plan without mandatory requirements for drug testing or pill counts. Through examination of a model contract, it is possible to create a template for a document that can engender rather that harm mutual trust, honor the dignity of the patient and provider, and help prevent prescription drug abuse and misuse.