Play 9: Reduce the risk of opioid-based treatment

Summary
It is clear that the long-term use of opioids legitimately prescribed for pain management increases the risk of a patient developing a substance use disorder. A fundamental and widespread approach to the mitigation of this risk is to ensure that (1) both the rescriber and the patient fully understand the consequences of taking the drug and (2) the physician and the patient have a clear and unequivocal understanding of the conditions under which the prescription will be continued.

In utilizing this strategy, the first step in reducing risk is to provide physicians and patients with the information they need. Literature, briefings to community groups and handouts in medical offices are all parts of an educational effort to ensure that every party is aware of the guidelines and constraints for using an opioid as a long-term medication. Some organizations are promoting the use of written doctor-patient agreements, which can be controversial.

Example: The NH Board of Medicine has published strict rules requiring the development of written doctor-patient
agreements. The NH Medical Society provides sample agreements.

Goals and Objectives
The goal of this strategy is to ensure that physicians and patients fully understand the risks and obligations each has in undertaking opioid-based treatment, and to make clear the conditions for its continuation. The objective is to document this understanding, so it is clear to the patient.

Theory of Change
Patients are less likely to develop opioid use disorders if they receive sufficient education and agree to a clear, written understanding as the basis for and conditions of treatment using opioids.