Pain management contracts: a guide for Veterans

Before your appointment

For Veterans receiving care through both VA and community providers, the practical details matter. Who handles a new prescription after dental work? What happens if the pharmacy is out of stock? Those questions deserve answers before a problem arises.

Is an agreement the same as informed consent?

They serve related purposes. Informed consent concerns the expected benefits, risks, alternatives, and your decision about treatment. An agreement describes how treatment will be managed. The Indian Health Service explains both separately; its guidance is a useful example, not a statement of every clinic's rules. Read the informed-consent and agreement guidance.

VA's September 2026 announcement states that signature informed consent is already required for long-term opioid treatment. It also describes additional requirements scheduled to start in 2027. Ask your VA team which forms and current procedures apply to your care. VA's informed-consent announcement.

What should I ask before signing?

Read the agreement with the clinician rather than trying to resolve every question at the front desk. Useful questions include:

• What improvement are we aiming for in pain, sleep, or daily activities?
• Which clinician and pharmacy should I use, and what happens during an emergency or a pharmacy shortage?
• How far ahead should I request a prescription, and who covers absences?
• What should I do if medication is lost, a dose is missed, or I run short?
• What monitoring is planned, and how will you discuss the results with me?
• If the plan changes, who will continue my pain care?

Bring up transportation, work shifts, hearing or vision needs, and trouble using the patient portal. For example, if a clinic expects frequent visits and you live two hours away, ask how follow-up will work before leaving the appointment.

Why does pain management involve drug testing?

Testing can provide information about prescribed and other substances that may affect medication safety. The CDC says toxicology testing should support care, not punish patients. Clinicians should explain the purpose, discuss unexpected results without judgment, and consider confirmation when needed. They should not dismiss a patient from care solely because of a test result. CDC guidance, Recommendation 10.

There is no single testing schedule for every patient. Ask your team what it recommends, what the test can and cannot show, and how you will receive the results. A screening result needs clinical interpretation; it is not a stand-alone diagnosis of addiction.

Your clinician may also review a prescription drug monitoring database. The CDC recommends confirming information with the patient and using it alongside the medical history, examination, and other findings. Tell the team about prescriptions from dentists, emergency departments, and community clinicians. CDC information on prescription monitoring.

What happens if there is a problem with the agreement?

The response depends on the situation and the clinic's process. Contact the prescribing team promptly, explain what happened, and ask what to do next. Ask for the reason behind any proposed treatment change and a clear follow-up plan. Don't abruptly stop or change your dose on your own. CDC guidance on continuing opioid therapy.

In her 2017 lecture, Anna Lembke, MD, criticizes a staged encounter in which a patient is abruptly dismissed. That continued-care principle is useful. This guide follows current nonpunitive monitoring guidance rather than the lecture's later punishment-based examples. Watch the discussion around 32:58.

If concerns about VA care remain unresolved after speaking with your team, a patient advocate can help you seek a resolution. How to get help at a VA health facility.

An agreement should sit within a broader pain plan. Use the Veteran chronic pain care guide to prepare questions about other treatment options. Valor's program inquiry links below are for chronic pain program information; your prescribing team manages medication agreements and changes.

About this guide

Prepared from the complete available automatic captions, including Q&A, and selected visuals from Understanding and Managing Chronic Pain in Patients with Substance Use Disorder, part 1. Presented May 11, 2017; published by Health Improvement Partnership SCC on June 22, 2017. Veteran appointment questions are editorial additions, supported by the sources linked above. Educational guide; no clinical sign-off recorded.