A pain contract, also known as an opioid treatment agreement or controlled substance agreement, is a formal, written document signed by a patient and their prescribing healthcare provider. This agreement is used when a provider prescribes controlled substances, such as opioids, for chronic pain management. The document outlines the responsibilities of both parties concerning the safe use, monitoring, and dispensing of these medications. Signing the agreement is required for a patient to begin or continue receiving opioid therapy from that practice.
The Purpose of Pain Management Agreements
These agreements serve a dual function aimed at patient safety and risk mitigation. They establish clear boundaries and expectations for patients receiving medications that carry a risk of misuse or physical dependence. The agreement ensures that the patient understands the proper use of the prescribed medication, including the exact dosage and frequency.
The agreements minimize the public health risk associated with prescription drug diversion (sharing or selling controlled substances). They also help prevent unintentional misuse, such as combining the opioid with other sedating substances. Furthermore, the agreement helps providers monitor for “doctor shopping,” where a patient attempts to obtain prescriptions from multiple physicians simultaneously.
The document explicitly states that the patient will only receive controlled substance prescriptions from the signing provider. This provides a structured, transparent framework for long-term opioid therapy while maximizing patient adherence to safety protocols.
Key Commitments Required of the Patient
The core of a controlled substance agreement involves several terms the patient must uphold throughout treatment. A primary commitment is the Single Prescriber Rule, mandating that the patient will only obtain opioid prescriptions from the provider who signed the agreement. This means controlled substances cannot be sought from other doctors, dentists, or emergency rooms without prior approval.
Patients also agree to the Single Pharmacy Rule, committing to fill all controlled substance prescriptions at one designated location. This allows for better communication between the provider and the pharmacist, aiding accountability and monitoring. The patient must also agree to take the medication precisely as directed, without increasing the dose or timing without explicit instruction.
Compliance monitoring is addressed through mandatory, unscheduled requirements like Urine Drug Screens (UDS) and pill counts. Urine drug testing confirms the presence of the prescribed medication, verifying adherence to the treatment plan. It also screens for unprescribed or illegal substances, which indicates potential misuse.
The agreement stipulates policies for managing lost or stolen medication. Most agreements state that lost, stolen, or damaged medication will not be replaced, requiring the patient to safeguard the controlled substances. Patients are also prohibited from seeking early refills, a common indicator of potential misuse. Finally, the patient must agree not to share or sell the medication to any other person.
What Happens When the Agreement is Broken
A violation of the controlled substance agreement can result in termination of the agreement and discontinuation of the prescribed opioid medication. Examples of non-adherence include failing a mandatory urine drug screen, seeking prescriptions from a different provider, or repeatedly requesting early refills.
In these situations, the provider’s goal shifts from prescribing controlled substances to ensuring the patient’s overall well-being. The physician will often taper the patient off the opioid to safely manage physical dependence and prevent withdrawal symptoms. Following termination, the provider typically transitions the patient to non-opioid pain management strategies, such as physical therapy or non-narcotic pain relievers.
If the violation involves evidence of substance misuse or addiction, the provider will offer referral to a specialized treatment program. While the provider ceases prescribing controlled substances, they adjust the focus of care to address the non-adherent behavior and prioritize a safer, multi-modal approach to pain management.