Evidence status: CURRENTLY LINKED BY THE PRACTICE. Lake Washington Pain Management’s live patient page currently identifies its Opioid Treatment Agreement as required reading and signature material for patients who wish to use opioids in pain management.

What the agreement adds

  • Immediate termination language for specified staff-conduct violations.
  • No replacement of lost or stolen opioid medication under any circumstances.
  • Random or scheduled pill counts with a 12-hour response deadline.
  • Single-pharmacy use and communication with pharmacists and other treating providers.
  • Psychiatric, addiction, and sleep-apnea assessment requirements when deemed necessary.
  • Prohibitions on alcohol, dextromethorphan, kratom, akuamma, benzodiazepines and other listed sedatives while opioids are prescribed.
  • Random drug testing with a one-hour specimen-submission requirement and immediate-discharge language for noncompliance.
  • No-show fees and discharge provisions.
  • A return-to-work participation requirement for certain patients.
  • A clinic dose ceiling stated as 120 mg morphine per day, or equivalent.

State rule versus clinic policy

Washington’s state rule does require a written agreement, testing cooperation, a lost/early-refill protocol, single prescriber/clinic, single pharmacy when possible, substance restrictions, secure storage, and discontinuation language. The clinic’s specific time limits, fees, conduct rules, cannabis language, work requirement, dose ceiling, and automatic-discharge provisions are additional practice terms unless another authority independently requires them.

Current-rule safeguard

Washington’s current WAC 246-919-920 states that biological specimen testing should not be used punitively and that physicians should not dismiss a patient from care based on a specimen-test result alone. That state rule should be read alongside, not replaced by, a clinic’s broader agreement language.

Sources

← Washington Contract-for-Care Evidence Library

Reviewed: October 4, 2026.