Long-Term Opioid Contract Use for Chronic Pain Management in Primary Care Practice. A Five Year Experience
- 642 Downloads
The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such contracts.
To describe the long-term outcomes of a medication contract agreement for patients receiving opioid medications in a primary care setting.
Retrospective cohort study.
All patients placed on a contract for opioid medication between 1998 and 2003 in an academic General Internal Medicine teaching clinic.
Demographics, diagnoses, opiates prescribed, urine drug screens, and reasons for contract cancellation were recorded. The association of physician contract cancellation with patient factors and medication types were examined using the Chi-square test and multivariate logistic regression.
A total of 330 patients constituting 4% of the clinic population were placed on contracts during the study period. Seventy percent were on indigent care programs. The majority had low back pain (38%) or fibromyalgia (23%). Contracts were discontinued in 37%. Only 17% were cancelled for substance abuse and noncompliance. Twenty percent discontinued contract voluntarily. Urine toxicology screens were obtained in 42% of patients of whom 38% were positive for illicit substances.
Over 60% of patients adhered to the contract agreement for opioids with a median follow-up of 22.5 months. Our experience provides insight into establishing a systematic approach to opioid administration and monitoring in primary care practices. A more structured drug testing strategy is needed to identify nonadherent patients.
Key wordschronic pain contract outcomes
The Authors wish to thank Chris A. McLaughlin (from the Department of Family Medicine Academic, Medical College of Wisconsin, Milwaukee, Wisconsin) for editorial support.
Potential Financial Conflicts of Interest
- 11.Sanders SH, Harden RN, Benson SE, Vicente PJ. Clinical practice guidelines for chronic non-malignant pain syndrome patients II: an evidence-based approach. J Back Musculoskelet Rehabil. 1999;13:47–58.Google Scholar
- 12.Practice guidelines for chronic pain management. A report by the American Society of Anesthesiologists Task Force on Pain Management. Chronic Pain Section. Anesthesiology. 1997;86:995–04.Google Scholar
- 14.Guidelines for the assessment and management of chronic pain. Wisconsin Medical Society Taskforce on Pain Management. WMJ. 2004;103(3):15–42.Google Scholar
- 20.Fishman SM, Kreis PG. The opioid contract. Clin J Pain. 2003;18(4)(Supp):S70–S75.Google Scholar
- 25.Katz N, Fanciullo GJ. Role of urine toxicology testing in the management of chronic opioid therapy. Clin J Pain. 2002;18(4)(suppl):S76–S82.Google Scholar