Do Patients Know They Are on Pain Medication Agreements? Results from a Sample of High-Risk Patients on Chronic Opioid Therapy


  • Conflict of Interest: The authors have no conflicts of interest to report.

  • Funding Sources: This study was funded a grant R01DA022550 from the National Institute on Drug Abuse and R01MH54907 from the National Institute of Mental Health. The Tenderloin Center for Clinical Research was supported by the University of California, San Francisco (UCSF), Clinical and Translational Institute grant, NIH/NCRR UCSF-CTSI UL1 RR024131. The funders had no role in the design or conduct of the study or the preparation of the article.

Margot Kushel, MD, Division of General Internal Medicine/San Francisco General Hospital, University of California, Box 1364, San Francisco, CA 94143-1364, USA. Tel: 415-206-8655; Fax: 415-206-5586; E-mail:


Objective.  Pain medicine agreements are frequently recommended for use with high-risk patients on chronic opioid therapy. We assessed how consistently pain medicine agreements were used and whether patients were aware that they had signed a pain medicine agreement in a sample of HIV-infected adults prescribed chronic opioid treatment.

Design.  We recruited patients from a longitudinal cohort of community-based HIV-infected adults and recruited the patients' primary care providers (PCPs). The patients completed in-person interviews and PCPs completed mail-based questionnaires about the patients' use of pain medicine agreements. Among patients prescribed chronic opioid therapy, we analyzed the prevalence of pain medicine agreement use, patient factors associated with their use, and agreement between patient and clinician reports of pain agreements.

Results.  We had 84 patient–clinician dyads, representing 38 PCPs. A total of 72.8% of patients fit the diagnostic criteria for a lifetime substance use disorder. PCPs reported using pain medicine agreements with 42.9% of patients. Patients with pain medicine agreements were more likely to be smokers (91.7% vs 58.3%; P = 0.001) and had higher mean scores on the Screener and Opioid Assessment for Patients with Pain (µ = 26.0 [standard deviation, SD] = 9.7) vs µ = 19.5 [SD = 9.3]; P =  0.003). Patients reported having a pain medicine agreement with a sensitivity of 61.1% and a specificity of 64.6%.

Conclusions.  In a high-risk sample, clinicians were using agreements at a low rate, but were more likely to use them with patients at highest risk of misuse. Patients exhibited low awareness of whether they signed a pain medicine agreement.