What is a controlled substance agreement?

‍A controlled substance agreement (also known as a contract or opioid agreement) is a written agreement between a patient using ontrolled substances like opioids and their prescriber. These agreements usually cover the risks and expectations of their medication, and are signed by the patient and the provider. Common sections of a well-designed controlled substance agreement include:

• the risks of opioids/other substances
• alternate therapies
• expectations to follow provider instruction
• proper storage and disposal of medications
• illicit drug use
  
• notification of abuse prevention tools (i.e. PDMP, UDT, Pill Counts)
• naloxone use and expectations

Why do I need one?

Controlled agreements are not about punishing patients or doctors suspecting abuse. Put simply, these agreements exist to keep patients safe. Controlled substances are risky, and agreements help patients fully understand the risks, options, and safeguards that are essential for responsible substance use.

Similarly, controlled substance agreements are a powerful tool to keep providers protected and compliant.

In some states, like Delaware, providers are legally REQUIRED to have a controlled substance agreement for many opioid prescriptions.

Even when not required by law, providers are always required to sufficiently warn patients of the risks of pharmaceutical treatment. (Failure to Warn is one of the three most common reasons for opioid-related malpractice suits, alongside Failure to Monitor and Improper Prescribing).

In the case of adverse events, notes are often not enough. Agreements, where the patient actively understands and agrees to follow protocols, are far more powerful to prove sufficient "warning."