Opioid contracts in chronic nonmalignant pain management: objectives and uncerta

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Am J Med. 2006 Apr;119(4):292-6.

Opioid contracts in chronic nonmalignant pain management: objectives

and uncertainties.

Arnold RM, Han PK, Seltzer D.

Department of Medicine, University of Pittsburgh, Pittsburgh, Pa

15213, USA.

In this article, we review the principal objectives and ideal

elements of opioid contracts, as articulated by proponents of the

practice. We examine the limited empirical evidence for the

effectiveness of opioid contracts in achieving their intended

objectives and identify areas of uncertainty and of ethical concern

regarding their implementation. We argue that the challenge in

deciding about implementing opioid contracts in clinical practice

relates to the multiplicity of potential objectives they might serve,

to a lack of empirical evidence regarding their effectiveness, and to

ethical concerns over their implementation. Specialty and primary

care clinicians contemplating the use of opioid contracts in treating

patients with chronic nonmalignant pain need to be sensitive to these

considerations, and further debate and research is necessary to

establish the proper objectives, elements, effectiveness, and ethical

justifications of opioid contracts in clinical practice.