The opioid contract in the management of chronic pain

Although the "opioid contract" is widely used in the administration of chro nic opioid therapy, its use has not been well defined and there are few gui delines for developing or revising such tools. We reviewed opioid contracts from 39 major academic pain centers and analyzed every statement for its c ore meaning. These statements were grouped into general categories and then into specific statement groups. Substantial diversity in the content of th e 39 contracts was found. Statements could be grouped into 12 general categ ories, 43 statement groups, and 125 individual statements. Each of the 39 c ontracts reviewed contained 22.5% +/- 10.9% of the entire list of 125 state ments and 32.6% +/- 11.2% of the 43 statement categories. Contract length a ve-aged less than 3 pages (range: 1 to 1 mean 2.2). We describe frequent an d infrequent themes that may be well suited for inclusion in any given cont ract. While there are many significant issues related to the usage of a for mal contract in chronic opioid therapy there was substantial consistency am ong the contracts in their universal attempts to improve care through disse mination of information, facilitate a mutually agreed-upon course, or enhan ce compliance. This study serves as an initial step in considering the risk s and benefits of an opioid contract as well as its ideal content and prese ntation J Pain Symptom Manage 1999;18:27-37. (C) U.S. Cancer Pain Relief Co mmittee, 1999.