Evidence status: CURRENT STATE STATUTE. Massachusetts General Laws c.94C §18A requires a written pain-management treatment agreement in a defined category of long-term opioid treatment.
When the statewide agreement mandate applies
If a practitioner registered under c.94C §7 recommends an extended-release or long-acting opioid during the course of long-term pain management, the practitioner must enter into a written pain-management treatment agreement with the patient.
Agreement purpose
The agreement must appropriately address the benefits of the prescribed substance as well as risk factors for abuse or misuse under guidelines published by the Department of Public Health.
Medical-record requirement
The agreement must be filed in the patient’s medical record or included in the patient’s electronic health record.
Related first-prescription requirement
Before issuing an extended-release long-acting opioid in a non-abuse-deterrent form for outpatient use for the first time, the practitioner must evaluate the patient’s condition, risk factors, substance-use history and current medications, and must document that the medication is an appropriate treatment based on the patient’s medical need.
Important scope limit
Section 18A is not a universal pain-contract law for every opioid prescription or every patient receiving long-term immediate-release opioids. The statutory agreement mandate is tied to the use of extended-release or long-acting opioids in long-term pain management.
Primary source
Reviewed: October 4, 2026.
Evidence boundary: Broader clinical guidelines, workers’ compensation rules, payer policies, or professional-board rules may use treatment agreements in additional circumstances. Those are separate evidence layers.