Opioid contracts in chronic nonmalignant pain management: objectives and uncertainties

Am J Med. 2006 Apr;119(4):292-6. doi: 10.1016/j.amjmed.2005.09.019.


In this article, we review the principal objectives and ideal elements of opioid contracts, as articulated by proponents of the practice. We examine the limited empirical evidence for the effectiveness of opioid contracts in achieving their intended objectives and identify areas of uncertainty and of ethical concern regarding their implementation. We argue that the challenge in deciding about implementing opioid contracts in clinical practice relates to the multiplicity of potential objectives they might serve, to a lack of empirical evidence regarding their effectiveness, and to ethical concerns over their implementation. Specialty and primary care clinicians contemplating the use of opioid contracts in treating patients with chronic nonmalignant pain need to be sensitive to these considerations, and further debate and research is necessary to establish the proper objectives, elements, effectiveness, and ethical justifications of opioid contracts in clinical practice.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects*
  • Chronic Disease
  • Humans
  • Informed Consent* / legislation & jurisprudence
  • Opioid-Related Disorders / prevention & control*
  • Pain / drug therapy*
  • Pain / etiology
  • Patient Compliance*
  • Physician-Patient Relations
  • Practice Patterns, Physicians'
  • Stereotyping
  • Trust
  • United States


  • Analgesics, Opioid