{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:40:57Z","timestamp":1787013657145,"version":"build-2736575974"},"reference-count":108,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>Opioid treatment agreements (OTAs) are controversial because of the lack of evidence that their use reduces opioid\u2010related harms and the potential risks they pose of stigmatizing patients and undermining the clinician\u2013patient relationship.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Even so, their use is now required in most jurisdictions, and their use is influencing the outcomes of civil and criminal lawsuits.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>More research is needed to evaluate how OTAs are implemented given existing requirements. If additional research does not resolve the current level of uncertainty regarding OTA benefits, then policymakers in jurisdictions where they are required should consider eliminating OTA mandates or providing flexibility in the legal requirements to make room for clinicians and health care institutions to implement best practices.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids\u2019 risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in which the law permits flexibility for clinicians and health care institutions to adopt best practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions\u2019 requirements for OTA use are triggered at least in part by long\u2010term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts\u2019 reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician\u2013patient relationships and patient care within the bounds of relevant legal requirements and risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.12699","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T03:24:10Z","timestamp":1715311450000},"page":"632-668","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Legal Landscape for Opioid Treatment Agreements"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9114-0735","authenticated-orcid":false,"given":"LARISA","family":"SVIRSKY","sequence":"first","affiliation":[{"name":"Centre for Ethics University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DANA","family":"HOWARD","sequence":"additional","affiliation":[{"name":"Centre for Ethics University of Toronto"},{"name":"Center for Bioethics, College of Medicine The Ohio State University"},{"name":"College of Arts and Sciences The Ohio State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MARTIN","family":"FRIED","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, College of Medicine The Ohio State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NATHAN","family":"RICHARDS","sequence":"additional","affiliation":[{"name":"Office of Responsible Research Practices The Ohio State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NICOLE","family":"THOMAS","sequence":"additional","affiliation":[{"name":"Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research The Ohio State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PATRICIA J.","family":"ZETTLER","sequence":"additional","affiliation":[{"name":"Moritz College of Law The Ohio State University"},{"name":"Drug Enforcement and Policy Center The Ohio State University"},{"name":"The James Comprehensive Cancer Center The Ohio State University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468\u20100009.12602"},{"key":"e_1_2_9_3_1","unstructured":"National Center for Health Statistics.U.S. overdose deaths in 2021 increased half as much as in 2020 \u2010 but are still up 15%. 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