Evidence status: CURRENT PROFESSIONAL STANDARD, NOT A UNIVERSAL MANDATE. Iowa Administrative Code 481—655.2 governs physicians’ opioid treatment of chronic pain. The current rule tells physicians to consider pain-management agreements and says an agreement should be used after more than 90 days when there is concern for drug abuse or diversion.
Current rule language
Physicians treating chronic pain with opioids should consider implementing a pain-management agreement that outlines medication-use rules and consequences for misuse. The decision should be individualized based on risks and benefits of long-term opioid treatment.
More than 90 days
If opioid treatment exceeds 90 days for chronic pain and there is concern for drug abuse or diversion, the current rule says a pain-management agreement should be used.
Nonuse documentation
If the physician does not use a pain-management agreement, the current rule says the reasons should be documented in the patient’s medical record.
Hospice and nursing-home patients
The current rule states that pain-management agreements are not required for hospice or nursing-home patients.
What the rule does not do
The current 2026 rule does not say that every chronic-pain patient must sign a contract, does not impose one state form, and does not prescribe a universal set of agreement clauses. Individual clinics may add one-pharmacy rules, testing schedules, pill counts, refill restrictions, cannabis provisions, or discharge language, but those terms must be classified separately.
Primary source
Reviewed: October 4, 2026.
Evidence boundary: Iowa’s current physician rule contains a conditional professional expectation rather than the categorical agreement mandate that existed in the pre-May-21-2025 rule text.