We describe the creation and implementation of a formal treatment agreement between patients suffering from chronic nonmalignant pain and the pain management team at our institution. Key features of the agreement include acknowledgement that previous treatment strategies have been inadequate, use of extensive written explanations of the side effects and risks of opioid therapy (including the potential for addiction), outlining of the conditions under which therapy will be conducted, creation of a broad support structure of fully informed health professionals to monitor closely and protect the patient, and emphasis on the importance of pain relief coupled to enhanced function via the active continuation of other therapy. All patients carry a Medical Alert card identifying them as participants in the program. During the past 3 years, a total of 67 patients with refractory nonmalignant pain have been successfully treated with oral opioids using the agreement as a basis for therapy. The treatment agreement provides the necessary structure to formalize this therapeutic approach and emphasizes the mutual responsibilities of the patient and the pain management team.