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Medication Agreements: An Educational Tool for Reducing Prescription Misuse and Abuse

| Jul 13, 2015
As previously run in WorkCompWire

A recent study in the April 2015 issue of Pain found that one in four patients using opioid analgesics for the treatment of chronic pain misuse their medication, whether by under using it, taking it erratically, or taking it inappropriately. The researchers concluded that this problem may be overcome by increasing patient education.

A medication agreement is one tool that can be used to increase patient education, and in doing so, promote medication adherence. Medication agreements are recommended by many nationally recognized guidelines, such as the American Academy or Pain Medicine and the Veterans Health Administration, for the treatment of pain to help ensure patients are aware of the risks and responsibilities of using medications. They serve as a detailed and well-documented informed consent associated with pain treatment. A medication agreement outlines the use of prescription pain medications and other adjunctive treatments, and is signed by both the patient and doctor to ensure both are on the same page regarding the proposed treatment plan and each others’ roles and responsibilities. They can promote awareness, create a dialogue between the patient and provider, and level-set expectations for both. This can help prevent situations that can lead to misuse or abuse.

Common Components of Medication Agreements

There are many formats used for medication agreements. Moreover, the content is also somewhat varied. This said, there are certain common components more frequently included, such as those   recommended by the American College of Occupational and Environmental Medicine (ACOEM). These include:
  • Patient Expectations – Taking medications as prescribed, compliance with the treatment plan, not sharing prescriptions with other
  • Unacceptable Patient Behaviors – Illegal substance use, using medications at higher frequencies than prescribed, diversion or unauthorized use of medication, use of more than one pharmacy, failure to show for scheduled appointments
  • Consequences – Reduction in quantity dispensed in future refills, immediate discontinuation of medication therapy, dismissal from physician’s care or practice, referral to rehabilitation program
While these components might sound punitive, for most patients, signing a medication agreement provides confidence that their doctor is looking out for their best interest and safety. They also provide reassurance for the doctor that the patient understands their treatment and how to properly follow their medication regimen.

The Payer's Role

Medication agreements help payers to gauge the injured worker’s level of understanding regarding their medication therapy regimen. The use of medication agreements can also signal the physician’s compliance with treatment guidelines, whether national, state-specific, or both, thus facilitating conversation and collaboration.

To incorporate medication agreements into your claim management process:

  • Create a sample medication agreement that could be used as a template
  • Contact the prescribing doctor to discuss the tool
  • Once in place, use the medication agreement as a go-to, living document with the injured worker and physician in follow up conversations and when checking on injury resolution

Medication agreements can benefit all parties involved in chronic pain treatment, providing an educational tool for understanding proper medication usage, as well as an understanding of the risks and expectations associated with medication therapy, particularly opioid analgesics. For more information and a sample medication agreement, read our white paper, Medication Agreements: Promoting Awareness, Dialogue, and Level Set Expectations.

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