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Opioid Contracts Aren’t a Solution to the Overdose Epidemic

Opioid use, abuse, and overdose have reached crisis levels. The opioid epidemic now kills more people in the United States than motor vehicle accidents, firearms, or breast cancer. But pain management contracts – a popular “solution” to the epidemic – may be causing more harm than good.

Of the 42,000 opioid overdose deaths in 2016, more than 40 percent involved a prescription drug, the Centers for Disease Control & Prevention (CDC) reported. That’s more than 46 deaths a day from drugs like OxyContin, Vicodin, and methadone.

Our firm’s said for years that the over-prescribing of painkillers is a huge problem. We’ve taken action against doctors whose prescribing practices put patients’ lives at risk. In recent years we’ve also taken the fight to pharmaceutical companies that put their profits above people. It’s clear that we need to do something to prevent deaths due to prescription painkillers. But opioid contracts put the blame where it doesn’t belong – on patients.

What Is An Opioid Contract?

46 people die every day to prescription opioids

Image Credit:, used with permission

A pain contract or opioid contract is a written formal agreement. Patients sign these forms before they begin long-term opioid treatment for chronic pain. By signing these forms, patients accept certain conditions related to their treatment.

A controlled substance agreement might outline information such as:

  • How to go about getting painkiller prescriptions refilled
  • What responsibilities the doctor prescribing these substances has
  • The patient’s responsibility to take part in other forms of treatment and see the doctor regularly
  • How, how often, and under what circumstances the patient will take the medication
  • What actions could result in the patient being terminated from the practice and from pain management treatment

In theory, pain management agreements “help ensure patients understand their role and responsibilities regarding their treatment,” according to the National Institute on Drug Abuse (PDF Link). The purported goal of a pain medication contract is to “help facilitate communication between patients and healthcare providers and resolve any questions or concerns before initiation of long-term treatment with a controlled substance.”

Naturally, our firm is all about informed consent. We always want patients to be their own advocates. We encourage you to question your doctors if you don’t understand a medical decision. Advocating for yourself can help reduce (but unfortunately, not eliminate) the risk of becoming a victim of a medical error. Yet, whatever the intent behind these pain contracts may be, we’re alarmed that these patient agreements are being touted as the solution to the opioid crisis.

Who’s Responsible for Prescription Drug Problems?

Doctor overprescribing opioid painkillersWhen a surgeon operates on the wrong limb or a nurse puts the wrong dosage of medicine in an IV, no one blames the patient. Yet when it comes to over-prescribing painkillers, healthcare providers are rarely held accountable. Rather than reversing that injustice, opioid agreement forms give doctors a free pass to act carelessly.

The crux of the problem is this: opioid contracts put the onus on patients, not providers. A medication contract makes it the patient’s job to:

  • Make sure the doctor sees them
  • Make themselves available for drug testing at any time with little notice
  • Avoid medication running out at an inopportune time
  • Know the side effects of a medication

Basically, opioid treatment agreements put the burden of avoiding addiction on the patient. This ignores the facts about how these drugs work and absolves physicians of their duty to patients.

Patients aren’t the ones who go through years of schooling and clinical training in medicine. Patients don’t have the benefit of an extensive education in pharmacology. They haven’t studied addiction to know the signs to watch out for. Doctors are the ones who have this knowledge. And – if they adhere to the standard of care, which all doctors should – they’re better suited to the task of putting an end to addiction than patients are.

Opioid Patient Agreement Forms Don’t Protect Patients

Pain contracts reinforce dangerous ideas. That tolerance, dependence, and addiction can’t happen to patients who take the drugs exactly as directed. That people who are really in pain don’t get addicted. That you’ll never overdose if you only take the drugs your doctor gave you.

That signing a piece of paper is enough to keep you safe.

None of these things are true. The reality is that these often-prescribed drugs are in the same class of drugs as heroin. They affect the body in the same way.

Tolerance and Physical Dependence

The addictive nature of opioids isn’t altered by whether or not patients are really in pain. It’s there regardless of whether the drug is prescribed in a doctor’s office or bought illegally on the street.

Long-term opioid treatment leads to tolerance. Your body becomes so used to the effects of opioids that these drugs no longer have the same effect. The only way you can continue to get pain relief from these medications is by taking more of them.

Developing tolerance to your painkillers is a natural response of the body to taking opioids. As tolerance grows, you can also develop physical dependence. When you don’t have opioids in your system, you begin to experience withdrawal symptoms. These symptoms include nausea, vomiting, muscle aches, and abdominal cramping.

Withdrawal symptoms are so unpleasant that even people who aren’t “addicted” may take the drugs to avoid getting sick. As tolerance keeps increasing, the amount of opioids a patient must take keeps rising, too.

Deaths From Taking Opioids as Prescribed sarah fuller opioid article

You don’t have to develop an addiction – the compulsion to keep using the drug despite negative consequences – to be at risk of an overdose. In fact, our attorneys have represented the families of patients who died taking high doses of opioids as prescribed by their doctors. These doctors could have weaned patients off of the painkillers and tried other treatments for chronic pain. Instead, they just kept upping the dosages of opioids to dangerous, and ultimately lethal, levels.

Having an opioid contract wouldn’t have protected these patients. If anything, contracts that (wrongly) suggest “following the rules” can keep you safe stop patients from getting help before it’s too late.

What Happens If You Violate a Pain Management Contract?

At best, controlled substance contracts make patients aware of the risks of addiction. But these forms don’t do the task of educating patients of the risks any better than a diligent doctor could do without the documents.

And as for that whole “facilitating communication” thing? Effective patient-doctor communication requires trust. That doesn’t mean a physician trusting that a patient will be scared by a form, but rather, a patient trusting the doctor enough to raise concerns about any dependence or addiction that develops.

old man without options

Yet many pain contracts don’t foster that trust. Some opioid contracts go so far as to forbid patients from calling the office at certain hours for certain purposes. Patients who have to go to the emergency room for unrelated problems can’t focus on getting better or advocating for themselves. Their first priority needs to be notifying their prescribing doctor of the new meds. Otherwise, the patient will be cut off not only from their opioid medications, but also from any other course of treatment the doctor had ordered.

That’s not just putting an end to drug-seeking behaviors. It’s preventing patients from recovering, from having any quality of life to speak of.

And what about patients who do become addicted? Do opioid contracts give them the help they need to recover and get their lives back? Some of them promise to. But then, the compulsive behavior that is part of the very definition of addiction is enough to get a patient “fired” from the practice.

Patients on long-term opioid treatment who fail drug tests, miss appointments, or lose pills need more help escaping the clutches of addiction. Instead, they’re cut loose. When withdrawal rears its ugly head, unpredictable street drugs like heroin can seem like the only option to stave off getting sick. We’ve handled these cases, too – so we know that many patients who were over-prescribed and then abruptly cut off, without access to substance abuse treatment, turn to illegal opioids. Thousands end up dying from them.

So, What Is the Right Answer to the Opioid Epidemic?

Some of the statements included in a standard opioid contract are great suggestions. It’s certainly a good idea to store opioid medications safely out of the reach of children and dispose of unused medication correctly. It’s important to be open with your doctor about any other medications you are taking. And it’s always appropriate to treat your healthcare providers with respect.

But stopping the opioid epidemic takes more than a couple of forms.

For starters, we can stop stigmatizing addiction and start recognizing it as a real public health crisis. It’s the only way people who struggle with addiction can actually get help.

We can make rehabilitation from addiction a bigger priority. Removing the obstacles that stand in the way of recovery can go a long way toward stemming the flood of fatal overdoses.

We can insist that doctors take responsibility for the opioids they prescribe rather than pushing that burden onto patients. And when signs of addiction do emerge, we can hold them to fulfilling their obligations to patients – obligations like monitoring for signs of abuse and getting the patient in touch with addiction treatment specialists.

Opioid contracts may be more prevalent now than they once were, but they’re not new. They’ve been around for over a decade, according to the Cleveland Clinic Journal of Medicine. Yet all this time, opioid overdose rates have continued to skyrocket. A piece of paper, an excuse to abandon patients, an attempt to shift responsibility – none of these quick fixes gets at the root cause of opioid overdoses. Instead, we need to prevent addiction and promptly help patients who find themselves addicted.

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Opioid Contracts Aren’t a Solution to the Overdose Epidemic


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