Treatment agreements for patients on opioids for chronic pain

January 01, 0001

Treatment agreements for patients on opioids for chronic pain

The purpose of this systematic review by US authors was to synthesize studies of the association of treatment agreements and urine drug testing with opioid misuse outcomes in outpatients with chronic noncancer pain. They included original studies addressing opioid medications, chronic pain, and treatment agreements or urine drug testing, with a sample size of 50 participants or more and published in English, Spanish, or French.

They found: "Of 102 eligible studies, 11 met inclusion criteria; 6 were in pain clinics and 5 were in primary care settings. Four primary care studies examined multicomponent strategies that included interdisciplinary support. All studies were observational and rated as poor to fair quality. In 4 studies with comparison groups, opioid misuse was modestly reduced (7% to 23%) after treatment agreements with or without urine drug testing. In the other 7 studies, the proportion of patients with opioid misuse after treatment agreements, urine drug testing, or both varied widely (3% to 43%)."

The authors concluded: "Relatively weak evidence supports the effectiveness of opioid treatment agreements and urine drug testing in reducing opioid misuse by patients with chronic pain. Further research on effective ways to monitor and reduce opioid misuse is needed, especially in primary care settings."

Well-designed studies on this topic are sorely needed.

For the full abstract, click here.

Annals of Internal Medicine 152(11):712-720, 1 June 2010
© 2010 to the American College of Physicians
Systematic Review: Treatment Agreements and Urine Drug Testing to Reduce Opioid Misuse in Patients With Chronic Pain. Joanna L. Starrels, William C. Becker, Daniel P. Alford, Alok Kapoor, Arthur Robinson Williams, Barbara J. Turner. Correspondence to Dr. Turner: [email protected]

Category: HSR. Health Services Research. Keywords: chronic pain, noncancer pain, opioids, narcotics, treatment agreements, urine drug testing, systematic review of observational studies, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 22 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.