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Research Summary

Effectiveness of Opioid-Treatment Agreements and Urine Testing in Reducing Opioid Misuse among Patients with Chronic Noncancer Pain

Chronic noncancer pain is one of the most common reasons patients visit physicians. Despite a paucity of data demonstrating effectiveness, opioid therapy is frequently prescribed. To offset potential risks associated with opioid prescribing, consensus guidelines suggest the use of risk-reduction strategies including opioid-treatment agreements (OTAs) and urine drug testing (UDT). This systematic review assessed the effectiveness of OTAs and UDT in reducing opioid misuse in outpatients prescribed opioids for chronic noncancer pain.

  • Eleven of 102 eligible studies met inclusion criteria (6 in pain clinics and 5 in primary care): 3 evaluated OTAs alone, 1 evaluated UDT alone, and 7 evaluated both.
  • All studies were observational and of poor-to-fair quality based on multiple assessment criteria.
  • In the 4 studies with a comparison group, there was a 7–23% absolute-risk reduction in opioid misuse; however, the multicomponent interventions described were not representative of common clinical practice.


Few studies have examined the effectiveness of risk-reduction strategies for patients prescribed opioids. Of those published, none have examined opioid abuse, dependence, overdose, or death. As stated by the authors, weak evidence currently exists to support OTAs and UDT for such patients, since poor study quality, lack of generalizability, and variation in practice settings and interventions limit the findings and preclude meta-analysis. Jeanette M. Tetrault, MD


Starrels JL, Becker WC, Alford DP, et al. Systematic review: treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. 2010;152(11):712–720.