Rheumatology Book

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Controlled Substance Agreement

Aka: Controlled Substance Agreement, Narcotic Contract, Opioid Contract, Pain Contract, Controlled Substance Contract
  1. See Also
    1. Chronic Narcotic Guideline
    2. Chronic Pain
    3. Chronic Pain Management
    4. Somatization
    5. DIRE Score
    6. Opioid Risk Tool
  2. Indications
    1. Long term use of controlled substance (e.g. Opioid pain medications, Benzodiazepines)
  3. Precautions
    1. Pain Contracts are recommended in Chronic Narcotic Guidelines and mandated in some states and by some medical boards
  4. Protocol
    1. List all controlled substances that should fall under the agreement (including agents such as Tramadol)
      1. Differentiate which medications fall under a different contract (e.g. Benzodiazepines prescribed by a psychiatrist)
    2. Document all stipulations (examples)
      1. All controlled substances in the contract must be prescribed by a single provider (with whom the patient is contracting with)
      2. All controlled substances in the contract must be dispensed by a single pharmacy
    3. Medication refills
      1. Must be done during a scheduled appointment (not by phone or after hours to an on-call provider)
      2. Lost prescriptions will not be replaced
      3. Prescription should include date of earliest next refill
      4. Emergency treatment plan should be made clear to the patient (including an acute exacerbation of Chronic Pain)
    4. Compliance
      1. Urine Drug Screening may be ordered
      2. Controlled substance monitoring programs may be accessed
    5. Broken Controlled Substance Contract criteria
      1. Substance Abuse of Alcohol or Illicit Drugs
      2. Drug diversion (e.g. selling or sharing controlled substances)
      3. Drug seeking controlled substances from multiple providers
    6. Consequences of a broken Controlled Substance Contract
      1. Contracting provider will no longer prescribe controlled substances for the patient
    7. Other professionals caring for the patient should have access to the Controlled Substance Contract
      1. Record the last date and location of the contract (e.g. Letters) in the electronic medical record
      2. Consider placing the information in commonly accessed areas of the medical record (e.g. snapshot, problem list) and keep updated
      3. Consider giving a copy of the Controlled Substance Contract to pharmacy as well as emergency department
      4. Patient should also receive a copy of the Controlled Substance Contract
  5. References
    1. (2014) Presc Lett 21(4):23
    2. Manchikanti (2012) Pain Physician 15(3 Suppl):S67-116 [PubMed]

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