Evidence status: CURRENT PROFESSIONAL-SCOPE RECORD. Virginia’s chronic-pain treatment-agreement framework applies across more than one licensed prescriber category, but the controlling chapter depends on who is prescribing.

Board of Medicine practitioners

For physicians regulated under the Board of Medicine’s opioid-prescribing chapter, 18VAC85-21-90 requires the signed written treatment agreement for chronic pain.

Advanced practice registered nurses

18VAC90-40-210 contains a parallel requirement for APRNs with prescriptive authority. It requires informed consent and a signed written treatment agreement addressing treatment parameters, including behaviors that can result in higher-level referral, cessation, or dismissal. The agreement also covers Prescription Monitoring Program review, requested urine or serum testing, and consultation with other prescribers or pharmacists.

Licensed certified midwives

18VAC90-70-200 contains closely parallel chronic-pain treatment-agreement language for licensed certified midwives.

Dentists

Under 18VAC60-21-105, a dentist who treats chronic pain with an opioid must either refer the patient to a pain-management physician or comply with the Board of Medicine chronic-pain opioid regulations in 18VAC85-21-60 through 18VAC85-21-120.

Why scope matters

A clinic form may use one generic agreement across several prescribers, but the legal analysis should identify the license and governing professional chapter before describing a term as required by Virginia.

Primary sources

• 18VAC85-21-90
• 18VAC90-40-210
• 18VAC90-70-200
• 18VAC60-21-105

Reviewed: October 4, 2026.