The opioid contract in the management of chronic pain

Scott M. Fishman, Tara B. Bandman, Annabel Edwards, David Borsook

Research output: Contribution to journalArticlepeer-review

122 Scopus citations


Although the 'opioid contract' is widely used in the administration of chronic opioid therapy, its use has not been well defined and there are few guidelines for developing or revising such tools. We reviewed opioid contracts from 39 major academic pain centers and analyzed every statement for its core meaning. These statements were grouped into general categories and then into specific statement groups. Substantial diversity in the content of the 39 contracts was found. Statements could be grouped into 12 general categories, 43 statement groups, and 125 individual statements. Each of the 39 contracts reviewed contained 22.5 % ± 10.9% of the entire list of 125 statements and 32.6% ± 11.2% of the 43 statement categories. Contract length averaged less than 3 pages (range: 1 to 1 mean 2.2). We describe frequent and infrequent themes that may be well suited for inclusion in any given contract. While there are many significant issues related to the usage of a formal contract in chronic opioid therapy, there was substantial consistency among the contracts in their universal attempts to improve care through dissemination of information, facilitate a mutually agreed-upon course, or enhance compliance. This study serves as an initial step in considering the risks and benefits of an opioid contract as well as its ideal content and presentation.

Original languageEnglish (US)
Pages (from-to)27-37
Number of pages11
JournalJournal of Pain and Symptom Management
Issue number1
StatePublished - Jul 1999
Externally publishedYes


  • Chronic opioid therapy
  • Contract
  • Opioids

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Neurology
  • Nursing(all)


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