Opiate contracts would typically include documentation of which pharmacy the patient agrees to use, the intervals between picking up the medication and an understanding that lost or stolen medication will not be replaced.

Dr Rupert Backhouse, General Practitioner, Mandurah

The use of such a contact can ensure the doctor is compliant with the health department, sets clear boundaries for the patient, protects the doctor from demands by the patient and facilitates continuity of care between doctors in the same practice if the main prescriber is not available.

Despite such benefits opiate contracts are not commonly used outside an opiate substitution program. Reasons for this will include the time needed to complete the contract, patient resistance, a sense that the doctor does not trust the patient and thus impair the doctor/patient relationship, the resistance by the doctor for more paperwork and a belief that an opiate contract is ‘just a piece of paper’.

The health department rarely demand an opiate contract for people unless there has been evidence of medication misuse or is on a high dose of opiates. In these circumstances having an opiate contract not only satisfies the demands of the authorisation to prescribe but makes it much easier to implement tighter control if addictive behaviours emerge. A simple therapeutic relationship can be maintained (despite such contracts) if the doctor tries to provide whole person care and not focus on the opiate alone.

We are increasingly inundated by forms from multiple agencies (e.g. hospitals, Centrelink, housing agencies, employers etc). To then take time to complete a contract for someone well known to the GP and who has never exhibited any drug seeking or addictive behaviours, can seem a waste of time and the contract becomes ‘just a piece of (unwanted) paper’. Fortunately, this such patients are common in General Practice.

However, if a patient does begin to show such behaviours, a contract helps the patient and protects the doctor. Giving a patient a drug of addiction, without boundary setting as part of the overall care, is colluding with the patient’s illness. If the patient is unwilling to accept the conditions the doctor can be confident of having tried their best to help the patient.

Opiate contracts are usually of no use but occasionally can be very useful, like so many pieces of paper.

Author competing interests: nil relevant.

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