Evidence status: CURRENT WORKERS’ COMPENSATION CLINICAL GUIDELINE. Massachusetts Department of Industrial Accidents’ Chronic Pain Treatment Guideline, revised October 2024, recommends a written informed patient-physician agreement for all injured workers receiving long-term opioid therapy.

Agreement recommendation

The workers’ compensation guideline states that all patients on long-term opioids should have a written informed agreement.

Recommended subjects

The agreement should address opioid side effects, pregnancy risks, lost or missing medication, withdrawal symptoms, random drug testing, pill counts, tapering, and reasons prescriptions may be terminated. It also states that physician responsibilities should be included and that the agreement should not be unilateral.

No abandonment

The guideline explicitly states that abandonment must not be a consequence of agreement violation.

Monitoring recommendations

The guideline recommends one prescriber and one pharmacy when possible, PDMP review, recurring follow-up, baseline drug screening, random screening generally two to four times per year depending on risk, and specialist input in defined higher-risk situations.

Guideline, not universal statute

The Department of Industrial Accidents states that its treatment guidelines are used to evaluate whether proposed workers’ compensation treatment is medically reasonable and necessary and are not mandates. The Department notes that deviations may be appropriate.

Why this matters

The workers’ compensation agreement recommendation is broader than M.G.L. c.94C §18A. It should not be misclassified as a statewide statutory contract requirement for every Massachusetts chronic-pain patient.

Sources

Reviewed: October 4, 2026.

Evidence boundary: This is a workers’ compensation clinical guideline and utilization-review framework, not the statewide statutory agreement mandate.