Pain Contracts: Would You Sign One to Get Treatment?


One criticism was that the contracts put chronic sufferers, often in a weakened and vulnerable state, at the mercy of providers, shifting the balance in the patient-provider relationship.

Another concern is that the language could offend patients.

"They often conclude with a statement that if you do not abide by these conditions, you will be fired from our practice, and that language is inappropriate in a health care relationship," said Myra Christopher, president and CEO of the Center for Practical Bioethics.

"In a professional context, clinicians are bound to put the interests of the patient ahead of their own and frequently, when I see the locus of concern shift form the patient to the provider, then I have concerns. I'm a bit suspicious about what's going on and why," she said.

She also said that while she agreed with the need to take special precautions with opioids and carefully communicate the risks of these drugs, standardized forms are not the best way to accomplish that.

Doctors who use opioid agreements argue that the documents protect both patients and providers. According to the Substance Abuse and Mental Health Administration, 12.5 million Americans age 12 and older reported recreational use of prescription pain medications in 2009, an increase from 11 million in 2002. In addition, there have recently been a number of physicians prosecuted for overprescribing pain medications.

"My experience has shown that these agreements are necessary to protect patients from overuse and misuse and other consequences from opioid use," said Saper. "They also protect the doctor and show that we are taking due diligence. In the event there is an issue with a patient's misuse or overuse, we can say that we have signed these contracts."

"There's an exchange of information that is helpful to the patient, and I don't belive that the intention of these is to be punitive to anybody," said Gitlin.

Some patients have complained in online support groups and blogs that their doctors refused to continue treating them anymore after the patients received opioids or other drugs in emergency rooms, which violated the terms of their agreement.

Gitlin, however, said most agreements have special stipulations for medical emergencies.

"Usually, there's a provision in the agreement that speaks to the fact that whenever possible, opioid medications are to be prescribed by a single physican, but these agreements account for the fact that emergencies may occur and allow for treatment," he said.

While there's ongoing debate about the benefits of pain contracts among chronic pain sufferers and health professionals, Alison Goldsmith believes her agreement has served her well.

"If you haven't grown up with one or are tempted to sell or abuse medications, I can understand why people are opposed to them. But I think it's very important," she said, "and it's like a safeguard to me."

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