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Tools for Opioid Prescribing & Pain Management Agreements

This section of the toolkit is designed for providers who are prescribing opioid medications to their patients based on the patient’s functional goals in addition to the failure of non-pharmacologic or non-opioid treatment options. This section will walk you through the Michigan legal requirements of informed consent and establishing a bona fide patient-provider relationship using a pain management agreement.

Establishing a “Bona Fide” Patient-Provider Relationship

 

As required by Public Act 247 of 2017, Michigan prescribers must be in a bona fide prescriber-patient relationship prior to prescribing Schedule 2-5 controlled substances for more than 7 days. As stated in the Public Act 101 of 2018, the effective date for the bona fide prescriber-patient relationship is required by 3/31/19.

Please refer to the Public Act 249 of 2017 for sanctions for failing to comply with the new MAPS usage mandates, failure to establish bona fide prescriber-patient relationships, and failure to inform patients regarding the risks associated with prescription opioid drugs.

Patient-Provider Pain Management Agreement

A pain management agreement is designed to establish a bona fide patient-provider relationship. This agreement can be used for ongoing use of opiate (Narcotic) medication(s) aimed to protect the patient’s access to controlled substances and protect the physician’s ability to prescribe.

Download a Michigan specific sample Word template now:

Sample Pain Management Agreement

  • Edit this sample agreement as needed to use in your clinical practice.

 

FAQs About Pain Management Agreements and Informed Consent

Michigan Automated Prescription System (MAPS)

Please refer to the Department of Licensing and Regulatory Affairs (LARA) website on MAPS for the most up-to-date information on Michigan safety opioid prescribing laws.

MI Automated Prescription System (MAPS)

  • Click here to access Michigan’s prescription monitoring program , a tool used by prescribers and dispensers to assess patient risk and prevent drug abuse and diversion by tracking scheduled 2-5 controlled substances.
  • Create an account or log in to MAPS

Informed Consent

Opioid Start Talking Form (MUST BE INCLUDED IN A PATIENT’S MEDICAL RECORD)

Nonopioid Directives

LARA: Nonopioid Directives

Additional Resources

Please see below for additional sample patient-provider agreement templates that can be used to establish a patient-provider bona fide relationship.

How Should a Physician Respond to a Patient’s Pain When New Opioid Prescribing Laws Limit Shared Decision Making?

  • This commentary responds to a case and examines pragmatic concerns about operating a busy outpatient practice in compliance with new laws that regulate opioid prescribing.

Patient-Provider Agreement for On-Going Use of Controlled Medication

  • Download this patient-provider agreement to better inform your patient on their medication, getting help, and obtaining prescriptions.

NIDA: Model Opioid Patient Agreement 

  • Download this example patient agreement from the National Institute on Drug Abuse (NIDA) to use to educate patients about lowering risks when prescribed opioid medications.

Ottawa Personal Decision Guide

  • Download this sample personal decision guide to be completed between the patient and provider to explore treatment decisions based on the patient’s knowledge, values, and certainty–Available in French, Swedish, Dutch, Danish, Norwegian, Spanish, German, Japanese, and Mandarin Chinese.

Sample Opioid Treatment Agreement

  • Download this sample opioid treatment agreement form to be used with patients prescribed ongoing use of an opioid (narcotic) medication.