Controlled-substance treatment agreement for patients receiving buprenorphine (Suboxone/Subutex), methadone, or naltrexone for opioid use disorder or alcohol use disorder, covering drug screening, single-prescriber policy, diversion, and recovery expectations.
The Medication-Assisted Treatment (MAT) Agreement is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, addiction medicine, mat, buprenorphine, suboxone, methadone. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Medication-Assisted Treatment (MAT) Agreement > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Provider / Practice:** ___________ **Patient Name:** ___________ **Date of Birth:** ___________ **Medical Record Number:** ___________ --- ## 1. Purpose of This Agreement Medication-Assisted Treatment (MAT) combines FDA-approved medications with counseling and behavioral therapies to treat substance use disorders. MAT is evidence-based medicine — not a substitute for recovery, but a critical tool that reduces cravings, prevents withdrawal, lowers the risk of relapse, and dramatically reduces overdose mortality. Because MAT medications are controlled substances (buprenorphine, methadone) or require clinical oversight (naltrexone), this Treatment Agreement establishes the mutual obligations of the patient and the prescribing practice. Both parties must follow these terms to maintain safe, effective, legally compliant treatment. --- ## 2. Diagnosis and Medication Prescribed **Primary Diagnosis:** ___________ **MAT Medication:** ___________ **Dose / Formulation:** ___________ **Prescribing / Treating Clinician:** ___________ **Dispensing Pharmacy (if applicable):** ___________ --- ## 3. What This Medication Does ### Buprenorphine (Suboxone, Subutex, Sublocade, Probuphine)