Clinic form
Opioid treatment agreement
An opioid treatment agreement is a clinic policy document, not a court order and not a moral test. It sets how this practice will prescribe an opioid: one prescriber (or a named group), one pharmacy, monitoring, storage, and what happens if prescriptions are lost or urine screens are unexpected. Colleges expect a plan. The PDF is yours or your group’s. There is no single Canadian government opioid-agreement form.
What the agreement is for
You are documenting shared expectations so the next refill is not an argument in the hallway. Typical elements: indication, dose, pharmacy, no early fills without a conversation, naloxone in the house, and that driving or safety-sensitive work may be affected. It does not replace a diagnosis, a taper plan, or a chart note.
Use your clinic’s current version. If you inherited a 2014 pad that still says “narcotic contract” and threatens automatic discharge in bold, replace it with the version your group actually follows. Patients sign after they have read it, not while you are already printing the script.
Unexpected urine is a clinical event
The agreement should say you will talk about unexpected screens, not that you will punish them in the waiting room. Diversion, extra prescribers, and missed monitoring are safety issues. Shame is not a monitoring strategy.
Who completes and who signs
- The prescriber (physician or nurse practitioner) who will write the opioid.
- The patient, after an explanation they can actually understand — language, literacy, and time.
- A substitute decision-maker only if they have authority for this treatment.
- Do not have a medical office assistant “get the contract signed” without you available for questions.
What to put on the form
- Indication in clinical terms (post-op, cancer pain, palliative, carefully selected chronic pain) — not a lecture.
- Drug, strength, and that changes go through this clinic.
- One pharmacy, named if you have it.
- How lost or stolen doses will be handled (usually no automatic replacement).
- Monitoring: prescription database where your province has one, urine or other tests as your policy states, visit interval.
- Naloxone kit offered; storage away from children and guests.
- Other sedatives (benzodiazepines, alcohol) as a safety discussion, not a character judgment.
- What will trigger a pause, a taper, or a specialist referral.
If this is opioid agonist treatment (methadone, buprenorphine), use that program’s forms and exemptions. A chronic-pain agreement is not a methadone carry agreement.
Worked example (fictional)
Clinic opioid agreement — post-laminectomy pain, family practice
Fictional 61-year-old. Do not copy into a real agreement.
Indication: post-laminectomy neuropathic pain, failed gabapentin trial, hydromorphone IR as needed after a documented function goal (walk 20 min). Pharmacy: one community pharmacy on the form. No other opioid prescriber. Early fills only if I document a reason. Monitoring: provincial prescription check each fill; UDS as discussed; review in 4 weeks. Naloxone dispensed today. Not to drive if drowsy. If unexpected UDS or extra prescriber: appointment before the next fill — not an automatic public confrontation. I am the FP. Patient signed after reading. This is not OAT.
Why these documents fail in a complaint
- Unsigned, or signed years ago with a different drug and dose.
- Threatening language you do not actually follow.
- No indication and no monitoring plan.
- Using a pain agreement for methadone carries.
- Never offering naloxone on a form that claims you always do.
Draft the opioid agreement from this visit
In Scribeberry, open Forms, search for opioid treatment agreement, or upload your clinic’s current PDF. Generate from the encounter and your notes, then review every field before anyone signs. Scribeberry does not pre-map this form. You still review and sign. Scribeberry does not file with a college or a pharmacy.
Frequently asked questions
Is this legally required?
Colleges expect a documented plan for opioid prescribing. Your clinic policy and the current standards in your province decide the format. An agreement does not replace informed consent or the chart.
What if the patient refuses to sign?
You can still decline to prescribe, taper, or refer. Document the discussion. Do not sneak a signature onto a form they did not see.
Does this authorize me to look at a prescription database?
Database access follows provincial rules, not this PDF. Mention monitoring in the agreement only if you actually do it.
Does Scribeberry store this as a legal contract?
No. Scribeberry helps you complete the PDF. You keep the signed copy in the chart under your usual records rules.
Forms
