Evidence status: CURRENT STATUTORY AND REGULATORY REQUIREMENT. Virginia law requires a signed chronic-pain treatment agreement, and the Board of Medicine’s current opioid regulations implement that requirement.
Statutory mandate
Virginia Code §54.1-2928.2 requires chronic-pain opioid regulations to include a treatment plan, a treatment agreement signed by the provider and patient that includes permission to obtain urine drug screens, and periodic review at specified intervals.
Board of Medicine rule
18VAC85-21-90 requires informed consent before opioids are initiated for chronic pain and a written treatment agreement signed by the patient in the medical record. The agreement must address treatment parameters, including behaviors that can result in referral to a higher level of care, cessation of treatment, or dismissal from care.
The agreement must also notify the patient that the practitioner will query the Prescription Monitoring Program and authorize requested urine drug screens or serum medication levels and consultation with other prescribers or dispensing pharmacists.
Related chronic-pain duties
18VAC85-21-100 requires review of the course of pain treatment at least every three months, documentation of continued benefit before ongoing opioid prescribing, Prescription Monitoring Program review at least every three months, and urine or serum monitoring at initiation and thereafter randomly at the practitioner’s discretion but at least once a year.
Primary sources
Reviewed: October 4, 2026.
Evidence boundary: Virginia requires the written agreement, but that does not make every clinic-created clause a separate statewide mandate.