OPIOID CONTRACTS AND PRIMARY CARE PHYSICIANS

Gagan Mahajan, MD 1 , Barth Wilsey, MD 1,2 , Sun Wong Jung, MD 1,3 and Scott M. Fishman, MD 11 Division of Pain Medicine, University of California, Davis 2 Northern California Veterans Administration Pain Clinics 3 Keimyung University, Taegu, Korea. Summary: The PCP was asked to collaborate with the pain specialist's decision to use opioids by cosigning an opioid contract, with the understanding the PCP would assume the refills once the opioid regimen had become stabilized. Preliminary analysis of the results strongly suggests the opioid contract may be an effective way to network specialty and primary care services in the delivery of chronic opioid therapy. Methods: We conducted a retrospective chart review of 81 patients with chronic non‐malignant pain who were seen at our university Pain Clinic from November 1999–September 2000. We asked those who signed the contract to deliver it to their PCP for review. In cases where the patient did not return the contract from the PCP, determining the reason(s) for this was attempted through a standardized questionnaire administered to the PCP via telephone. Results: Sixty‐nine of the 81 patients (85%) signed the contract. Forty‐five (56% of the 81 enrolled patients; 65% of the 69 signed contracts) were returned with the PCP's signature. None of the 45 patients with a completed contract encountered any difficulty in obtaining opioids upon discharge from the Pain Clinic. For the remaining 24 (35%) incomplete contracts, we were able to only contact 20 of the PCPs: 5 PCPs acknowledged receiving the contract, and 15 did not. Among the latter, all claimed they would have signed the contract had they received one. Discussion: Preliminary findings indicate many PCPs are willing to collaborate with pain specialists in prescribing opioids long‐term. A significant part of the failure in contracting resided with the patient. Reasons for unreturned contracts varied from patients not delivering it to their PCP, to patients or PCPs misunderstanding what to do with the contract after signing it. These data support the inclusion of the PCP in the contracting process as a practical and accepted management strategy, particularly during and after the transition from specialty to primary care.