ABSTRACT
Opioid contracts are widely used to manage opioid prescribing in the treatment of pain conditions, but they are not well studied. A notable gap in our knowledge of opioid contracts involves the factors that determine their use. As an initial inquiry, this study evaluated the responses of a Web-based survey of trainees and faculty in an academic medical training context to determine correlates of opioid contract use. All paid faculty, third- and fourth-year medical students, and residents in The University of Oklahoma College of Medicine were invited via email to participate in a Web-based survey of their attitudes and prescribing practices related to controlled prescription drugs. Respondents composing a subgroup of those who replied to the survey were identified by their prescription of opioids and by their designation that pain was the most likely diagnosis for which they would prescribe a controlled drug. Chi-square analysis was used to determine any correlation between contract use and respondents' demographic variables and categorical survey responses. Analysis of variance was used to determine any correlation between contract use and survey responses that involved continuous variables. Our results showed that opioid contract use was significantly associated with resident status, primary care specialty, participant estimation of alcohol and illicit drug abuse by patients, and the participant's assessment of the risks in general of prescribing controlled drugs. A majority of contract users reported that the use of this tool increased their sense of mastery and comfort with prescribing controlled drugs. The factors associated with opioid contract use found in this study suggest there are significant prescriber-specific determinants of the use of the tool, including training level, medical specialty, and risk appraisals. Opioid contracts' effects on mastery and comfort of the physician with prescribing opioids suggest that they may play an important role in facilitating appropriate pain management with opioids. Further study is needed to elucidate environmental and patient-specific factors that may influence opioid contract use.
