Evidence status: CURRENT OFFICIAL AGENCY SAMPLE. The Michigan Workers’ Disability Compensation Agency currently publishes a Sample Opioid Treatment Agreement as a resource for workers’ compensation opioid treatment.
What the sample contains
The sample agreement includes patient responsibilities involving taking medication only as prescribed, participation in return-to-work and functional-improvement efforts, obtaining opioid or other pain medication through the treating provider, disclosure of other medications, use of one pharmacy when possible, protection of medication, participation in assessments when necessary, and restrictions involving illegal drugs or alcohol.
Monitoring and access provisions
The sample also addresses random drug testing and pill counts, prescription-monitoring-program review, scheduled appointments, emergency communication, and circumstances under which the provider may stop prescribing opioids or change the treatment plan.
Six-month renewal
The agency sample tells providers to keep a signed copy, provide a copy to the patient, and renew the agreement every six months.
Sample versus mandatory wording
The agency describes these materials as samples and resources. A public evidence record should therefore distinguish the binding minimum requirements of R 418.101008a from additional language that appears in the sample form or in a private provider’s version.
Primary sources
Reviewed: October 5, 2026.