An APA, also known as a patient scribe contract, opioid contract, or opioid contract, is a formal, written agreement between a patient and a healthcare provider that describes each participant`s responsibility during treatment with controlled substances, typically opioid painkillers. The AAE aims to improve the quality of patient care and reduce the potential for abuse and distraction of opioid analoid drugs.  EPAs vary, but most describe patients` responsibilities with respect to inappropriate use of controlled substances, refills, drug testing, a prescriptive/pharmacist rule, and the consequences of non-compliance with A.A. [8,9] Although the use of PDOs is increasing, there is limited evidence of the effectiveness of EPAs in preventing abuse.  A 2010 systematic review, which examined the effectiveness of PDOs in reducing opioid abuse, concluded that out of 11 studies that met the inclusion criteria for reconsideration, the evidence for efficacy was weak.  However, the authors found several limitations of the studies as part of the review, including multi-component interventions and poor definitions of outcomes.  Most GPs agreed that they would not use a PAA for an episode of acute pain requiring a single opioid prescription. In contrast, many patient focus group participants reported signing an ECA before receiving opioid drugs in the emergency department, even though opioid drugs did not have a replenishment. In many of these cases, the patient was in great pain when asked to sign the AAA. As one patient remarked, “I was in so much pain that I would sign everything.
Over the past decade, there has been an explosion in the use of opioid analgesydes in the United States. Prescriptions for opioid painkillers dispensed by retail pharmacies increased by 48% between 2000 and 2009, and the milligram per person using prescription opioids increased by 402%. [1,2] Opioids can cause serious adverse effects and, as a result of improved access, an increase in emergency room visits and deaths due to opioid-related drug overdoses have been reported. [1,3–5] To improve patient safety and information and reduce adverse events, evidence-based policies have been developed for the safe prescribing of opioids, including Patient Administration Agreements (PAAs). [6,7] Many organizations, including the American Pain Society, the American Society of Addiction Medicine, and the British Pain Society, encourage their members to use PPS when prescribing opioids to relieve chronic pain to prevent abuse and distraction. . . .