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CAPC Palliative Care Discussion Forum
Palliative Care Out-Patient Services

Next Reply: Re:opioid agreements
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Post opioid agreements
Author: Mary_Hubert
Date: Mar 8, 2011 9:44 pm
We are in the process of laying the foundation for a supportive care clinic in a cancer center and I am reviewing literature on the use of opioid agreements for cancer pain management in a palliative population and have not found much so far. What I see is that opening an ongoing dialogue is the primary benefit of these contracts, and I wonder if there use is standard in other programs and what forms might be suggested or shared? Thank you.
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Re:opioid agreements (by mrabow on 03/09/2011)
Currently, there is no clear standard in outpatient palliative care practices regarding the use of pain contracts. Also, any particular practice's population (ie actively dying, terminally ill, chronic non-malignant) may bear on these considerations.

Clearly, in primary care and pain management clinics they are widely used, but there is very limited data about the efficacy of contracts and/or random drug testing. There is also concern among many about the potential impacts of contracts on the clinician-patient relationship and trust.

Identifying patients with a history of chemical coping and prior difficulties with substance abuse may be the most useful approach as these patients are at much higher risk for misuse of medications prescribed for palliation.

Best,
Mike Rabow, MD
UCSF Palliative Care Leadership Center

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