OBJECTIVE Hydrocodone is one of the most frequently prescribed medications in the United States. Chronic users of hydrocodone are high-risk patients who consume valuable time and resources within a Family Medicine Residency Program. A narcotic agreement is a tool to help providers define patient expectations regarding chronic medication use. Objectives of this project were to classify hydrocodone utilizers by frequency of use, determine use of narcotic agreements in chronic users, and evaluate patients' ad- herence to agreement parameters. METHODS A report was created for all hydrocodone prescriptions generated between January and June 2013. Patients were classified as acute, episodic or chronic users. Clinic records were reviewed to determine if chronic users had an existing narcotic agreement with the Family Medical Clinic (FMC). Adherence to agreement criteria was assessed by reviewing the Arkansas Prescription Monitoring Program. RESULTS A total of 371 patients received hydrocodone prescriptions; forty-eight percent (N = 177) were chronic users. Chronic users accounted for 85% (N = 44,693) of the 52,478 hydrocodone units prescribed. Forty-four percent (N = 78) of chronic users had a narcotic agreement; 37% (N = 29) were completely compliant with the terms. CONCLUSIONS The majority of hydrocodone prescribed within our FMC during the study period was for chronic users, most of whom did not have narcotic agreements. A minority of patients with agreements were adherent to all parameters. Identifying chronic utilizers in a timely manner, standardizing implementation of narcotic agreements, and integrating prescription database monitoring into routine care would permit pro- viders to more appropriately manage these high risk patients.