This section provides some more detailed information on treatment agreements and consent for UDT…
Treatment Agreements (consent to HARMS Program)
Current Canadian guidelines (2017) note that evidence on treatment agreements is of low-quality and shows limited benefits, with equivocal effects on opioid misuse1. Despite the lack of high quality evidence, treatment agreements can be utilized as a method of gaining informed consent on opioid use and clarifying expectations for both the patient and physician. Written agreements can delineate the terms and goals of an opioid trial, points of termination, and alternative treatments in the event of a failed trial1. The use of treatment agreements is optional and can be modified to reflect physician prescribing.
Consent to Urine Drug Testing
The primary goal of urine drug testing (UDT) is to improve the safety and efficacy of opioid therapy by monitoring adherence. UDT provides clinicians with an objective measure to support decision making during opioid prescribing.3 Expert opinion strongly recommends urine drug testing be utilized as a universal precaution.3
As part of the HARMS program, patients are randomized to complete urine drug testing according to their risk level. Each time a patient is requested to complete UDT, they should consent. Click the image on the right for an example of a consent outlining the risks and benefits of urine drug testing.
Cases
Case 1
43 year old male coming in for a refill of his oxycodone/acetaminophen 6 tabs/day. He is new to your clinic. You do your intake history and physical and inform him of the HARMS Program. He signs the treatment agreement but is skeptical to sign the urine drug testing consent. He is a truck driver and voices concern over the possibility of his test results being shared with his employer. You reinforce laws surrounding confidentiality and that the results would not be shared with his employer. You inform him that you would discuss any concerns with his safety to drive with him prior to any action, and if any action was required, it would involve reporting to the ministry.
Chapter Pearls
- Use of treatment agreements is optional. Low quality evidence shows limited benefits, with equivocal effects on opioid misuse.
REFERENCES:
- Busse J. The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain. Cancer Pain. 2017:105.
- Rx Files. Informed Consent/ Agreement for the Use of Opioid Medication in Chronic Pain. https://www.rxfiles.ca/rxfiles/uploads/documents/Opiod-Informed-Consent-And-Agreement.pdf. Accessed August 15, 2019.
- Argoff CE, Alford DP, Fudin J, et al. Rational Urine Drug Monitoring in Patients Receiving Opioids for Chronic Pain: Consensus Recommendations. Pain Med Malden Mass. 2018;19(1):97-117. doi:10.1093/pm/pnx285