Managing Addictions

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6 “Preamble” Elements of an Opioid Agreement for #ptsafety

by Dr. Mike on

Prescription opioids are not the only controlled substance with a risk for abuse, misuse, and diversion; but they have a readily achievable threshold for lethal toxicity. They are the source of widespread patient safety problems like addiction and overdose, excess resource utilization, and disability.

(Related topics are covered in my recent free report “5 Lethal Mistakes Medical Directors Can Eliminate in Their Group” You can download that report by clicking on the link.)

Communication is one of the keys to patient safety

Communication is one of the keys to patient safety

Providers who treat chronic illness with medications prone to abuse struggle to balance patient safety with issues of care management efficiency, and other issues that can leave providers feeling emotionally depleted. I find that if “it takes a village” to raise kids, it takes a well aligned organization (not just the physician) to achieve outcomes of provider satisfaction, care efficiency, and patient safety.  Communicating norms and expectations can be challenging for many providers, in spite of wanting to do so. In other cases, communicating medication limits or agreements can result in a patient feeling “singled out” or misinterpreting the purpose of the discussion. For this reason I support universal delivery of pain agreements, with companion video narration, so that key points can be meaningfully identified, efficiently delivered, and universally understood (with opportunity for questions).

As I have detailed in previous posts, Washington State has specific rules relating to opioid agreements in chronic pain. The agreement I use has a one page pre-amble to introduce the agreement. The agreement itself (not included here) has 4 sections covering 15 separate points.  I include the six pre-amble elements here.

Working together. This agreement is to keep your care safe and avoid confusion. Talk with your provider if you have questions before signing it. The medications you are prescribed are sometimes not used properly. This can cause serious problems. Pain medications (“opioids”), anxiety medicines, and medicines for Attention Deficit Disorder are all considered high risk.

What problems could develop?: Sometimes when patients use these medications for months or years, they find the medicine is less effective. Taking more than is instructed on the bottle can place you at risk for overdose, and other problems.  Dependence means having withdrawal symptoms if you stop taking the medication. If a person can’t control how much they take, or is constantly thinking about the medication, this is addiction. To avoid bad problems, never take more than the maximum daily dose in any 24 hour period. Also, pain medication can cause sleepiness, fractures, or death. Pain medications used over time, can lead to worse pain when you try to stop.

High Risk! Thousands of people die each year from a prescription overdose.  Combining pain medications with anxiety medications, sleeping pills, cold medicine, or alcohol; increases the chance of death.  Do not mix or overuse these in any way not directed by your provider. These medications also can make driving more dangerous.

You must sign the form. You need to follow this agreement to be a safe candidate for the medications. There may  be other issues that leads your provider to recommend safer alternatives. Signing the form doesn’t mean the provider will necessarily prescribe you the medications. However, avoiding the agreement is not an option if you have been asked to do sign in order to receive these medications. Your provider may recommend weaning off. If dependence is interfering with your care, they may recommend treatments for dependence. Any violations of this agreement will impact your provider’s care plan.

We might share this agreement. By signing this, you are giving us permission to share this agreement with ER’s, Urgent Care Centers, and other providers.

If my care changes as a result of this agreement, and I disagree with that, what do I do next? If you feel you have been impacted by this agreement, and would like reconsideration, we invite you to submit a written appeal explaining your circumstances. Any appeal will be reviewed by at least two staff and  may take up to 3-7 days for a response.

These six elements fit nicely on one page, and I recommend placing them behind a plastic sheet protector, because the agreement itself (not included here) fits on one double sided page. The patient is prompted during a short video presentation to initial each of the four main sections as they are explained, and sign the agreement. 

Interested in patient safety and process improvement? Download my free report for more information. (Link -Click here)


Free Report for Clinical Leaders Focused on Patient Safety

Free Report for Clinical Leaders Focused on Patient Safety


About Dr. Mike

Michael Schiesser MD is a physician, speaker, consultant and expert in addictions. View all posts by Dr. Mike →