The Controlled Substance Agreement

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doctors from the cleveland clinic have created a controlled substance agreement for opioids

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 in its tracks.”

I know it’s something we’ve all felt at one time or another, but what can one person do?  Well, two industry professionals have carved out a strategy they say has proven helpful in their practices – The Controlled Substance Agreement.

doctors from the cleveland clinic have created a controlled substance agreement for opioids

What is the Controlled Substance Agreement?

This Agreement, at its most basic, is a simple contract between the doctor and patient on how to best manage the patient’s pain during treatment for whatever the main ailment might be.  All too often, that is something not given sufficient consideration at the outset as both parties concentrate more on how to solve the immediate issue of pain, without much concern for how it might unintentionally lead to addiction.

Doctors often err on the side of relieving pain by giving too many pills – and patients then either use them up, or save them for a rainy day, making them 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.

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 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, it relies on something much more important – the force of “will” – keeping both the patient and doctor mindful of the potential consequences.

How Can the Controlled Substance Agreement Help?

These contracts are useful because they can allow a doctor to demand such things as urine tests or other procedures, if he/she should fear that the patient is abusing their medication.

It also outlines 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.”

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, “I provide them more thoughtfully…(The Agreement) forces me to be more deliberate about risks and benefits for my patients.”


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