The Controlled Substance Agreement

The out-of-control opioid epidemic has left most professionals scratching their heads. “If we could only figure out how to stop
all this madness right in its tracks…” I know it’s something we’ve all felt at one time or another, but can one person even make a dent? Or even two, for that matter? Well, as it turns out, the answer might be yes.

Two industry professionals have recently carved out a strategy which they say has been proven in their practices – The Controlled Substance Agreement.

This Agreement, at its most basic, is a simple contract between the doctor and patient regarding how to best manage the patient’s pain during treatment for their ailment. All too often, this is something not given sufficient consideration at the outset, as both parties concentrate more on how to immediately solve pain, without much concern for unintentional addiction.

Doctors often err on the side of relieving pain by prescribing too many pills – and patients then either use them up or save them for a rainy day, setting them up for alter abuse. Now, with opioids running rampant throughout the country, it’s given everyone greater reason to pause and give this important issue much greater consideration.

Creating a New Set of “Ground Rules”
A model for The Controlled Substance Agreement was recently published in the Cleveland Journal of Medicine. Two of the primary authors are Summer McGee, a bioethicist and the director of the University of New Haven’s Masters in Health Care Administration program, and Dr. Daniel Tobin, medical director of the Primary Care Center at Yale New Haven Hospital’s St. Regis Campus.

The point of the contract is for both patient and doctor to set realistic ground rules balancing the patient’s pain needs against the potential risk of addiction.

While these contracts are not legally enforceable, they contain something much more important: the force of will; keeping both the patient and doctor mindful of the potential consequences.

This contract can be very useful, because it allows a doctor to demand such things as urine tests, or other procedures if the doctor fears the patient is abusing their medication. It also sets out various other rights and duties for both patient and doctor to keep them in check.

“A checklist like this should be used by every provider for every patient across the board,” remarked McGee. “I think it provides a certain protection…I’ve had a lot of positive feedback from clinicians.”

Making a Firm Commitment
While a non-enforceable contract might seem somewhat toothless, the actual practice has proven to the contrary. The simple act of putting something in writing and making a firm commitment makes monitoring more tangible as both patient and doctor buy into the program.

While Dr. Tobin admitted he didn’t necessarily prescribe opioids less often now, he admitted “I provide them more thoughtfully.” The Agreement “forces me to be more deliberate about risks and benefits for my patients.”