These contracts have become more important through enhanced regulatory oversight and allow physicians to provide patients with a documented means of what they can expect if they are in their care for pain management. They exist to help both the patient and the supplier comply with controlled substance laws and regulations. While this is a precondition for prescribing controlled substances, the requirements for informed consent vary from state to state. Michigan, for example, will bring into effect a new law that will come into effect on June 1, 2018, with specific guidelines for a state-mandated form. The CDC has also compiled a set of standard patient agreement forms, which should help promote open communication between the patient and the physician. Controlled substances can reduce pain and other symptoms to improve quality of life. What happens if a patient breaks a deal? Depending on the criteria set by the doctor or practice, a patient may be weaned from his or her regulated substances or even released from the office. Each of them refers to the same contractual document: an agreement signed between a prescriber and a patient that clearly defines the guidelines and responsibilities between these two parties with regard to the behaviours and expectations regarding the prescribing of opioid drugs. In talking to our clients, however, we found that there was some deviation in the information contained in these contracts and the consequences for non-compliance. Individual states, either public authorities or state medical companies have published models of agreements, some that we have found useful: Texas Minnesota Oregon. In addition, several national medical organizations have also published standard treatment agreements: AAFP AAPM ASAM. As the opioid epidemic persists, private payers such as Aetna Better Health – Kentucky have introduced requirements where a signed treatment agreement must be submitted as part of the opioid pre-authorization process. This trend is becoming more and more common among payers.