Having a Controlled Substance Contract in Place is NOT Enough

Controlled substance prescribing is innately subjective. Every provider should have a contract.. and then some.

Controlled substance prescribing always has a subjective component, whether it is opioids for chronic pain, benzodiazepines for anxiety, or stimulants for ADHD. Distinguishing between a patient who has a legitimate need for a controlled substance versus a patient who may be inclined to use these drugs for addiction is one of the most challenging positions prescribers face.

Practices prescribing controlled substances have traditionally been expected to have controlled substance contracts or agreements between the practice and the patient. Recently, more prescribers are expected to have a contract, including pediatricians and general practitioners, when initiating and maintaining patients on controlled substances. These contracts are necessary when prescribing medications for insomnia, muscle spasms, chronic pain, anxiety, and ADHD.

Clear communication and understanding are vital when prescribing controlled substances for patients. Although controlled substance contracts are intended to convey certain treatment guidelines, some patients feel judged or forced into signing them, feeling overwhelmed and intimidated.  For example, some patients claim to feel criminalized when required to abide by the contract, and a simple conversation may improve the communication process. The intention of a controlled substance contract is to facilitate patient and provider communication while enhancing compliance and understanding of their roles and responsibilities regarding treatment with controlled substances.

Sample controlled substance contracts are available from NIDA at the NIH and FDA, while many practices decide to compose a custom contract fit for their practice and patients.

Having a controlled substance agreement in place goes beyond documenting patient and prescriber understanding, as this is required by some state medical boards and several insurance companies to approve a chronic controlled substance. The American Medical Association (AMA) states that informed consent goes beyond simply getting a patient signature, and this written document acts as a process of communication between the patient and the prescriber. The contract between a patient and the provider must be documented with a timestamp in the chart to efficiently retrieve this data in the case of an audit. To demonstrate concrete understanding, practices often require the patient to initial each line of the contract to confirm comprehension.

Scriptulate provides the framework to save this vital information securely and integrates alert functions for reminders when a contract may be expiring. We strongly feel that it is crucial to offer as much communication necessary to allow the patient to comprehend and apply the content in the agreement ultimately. The patient and the provider should have as much clarity as possible regarding the potential risks of taking controlled substances while aiming to improve the patient’s quality of life safely.

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