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