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The Legal Landscape for Opioid Treatment Agreements.
Larisa Svirsky1, Dana Howard1,2,3, Martin Fried4
1Centre for Ethics, University of Toronto.
The Milbank Quarterly
|May 10, 2024
Summary
Opioid treatment agreements (OTAs) are now required in most states, influencing legal outcomes despite limited evidence of their effectiveness in reducing harm. Policymakers should consider eliminating mandates or allowing flexibility in OTA requirements.
Area of Science:
- Legal Medicine
- Public Health Policy
- Clinical Practice
Background:
- Opioid treatment agreements (OTAs) are increasingly mandated, yet their efficacy in mitigating opioid-related harms remains unproven.
- Concerns exist regarding patient stigmatization and potential damage to the clinician-patient relationship due to OTA use.
- Existing requirements for OTAs are influencing civil and criminal legal proceedings.
Purpose of the Study:
- To identify jurisdictions mandating Opioid treatment agreements (OTAs).
- To analyze how OTAs impact litigation outcomes in cases involving opioid prescriptions.
- To explore legal flexibility for clinicians and institutions in implementing OTAs.
Main Methods:
- A comprehensive survey of laws and regulations across all 50 U.S. states and the District of Columbia was conducted.
- Analysis included identifying mandatory OTA usage circumstances and required terms.
- A review of civil and criminal judicial decisions was performed to assess the influence of OTAs on litigation.
Main Results:
- A majority of jurisdictions (27) now mandate OTAs, primarily for long-term opioid prescribing.
- Significant variation exists in OTA requirements across states, with some flexibility noted.
- OTAs can inform court decisions and may offer legal protection to clinicians, though not consistently.
Conclusions:
- Opioid treatment agreement (OTA) usage is closely linked with legal obligations and risks.
- Clinicians and healthcare institutions must navigate legal requirements while seeking to optimize patient care and relationships through OTAs.
- Further research is needed to clarify OTA benefits and inform potential policy adjustments regarding mandates.
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