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WCB Manitoba Opioid Treatment Agreement (OTA)

WCB Manitoba requires this one-page agreement between an injured worker and the prescribing doctor before it will consider paying for opioid medication. The worker confirms they were told about common side effects and risks, including dependence, and agrees to nine conditions on prescribing, dispensing, use and follow-up. The WCB says the agreement follows best practice recommended by the National Opioid Use Guideline Group (April 2010).

Who completes it

The prescribing doctor's name goes in the first condition and the worker names the single pharmacy they will use; both the worker and the doctor sign and date the agreement. The worker's name and WCB claim number go at the top.

Submitting and payment

How to submit it
Send a copy to the WCB with the Initial Opioid Management Report, which asks whether the agreement was completed; the agreement prints the WCB fax number at the bottom.
Who pays
WCB Manitoba's fee schedules list no separate code for the agreement; the prescriber bills the initial opioid management report under 8114 (physician) or 0020 (nurse practitioner).

Good to know

  • The worker agrees to get opioids from one prescriber and one named pharmacy only, and not to give, share or sell them.
  • If medication runs out early because it was lost, stolen or overused, the doctor will not prescribe extra; the worker waits for the next scheduled prescription.
  • The worker agrees not to use over-the-counter opioids, recreational drugs or alcohol while on prescribed opioids, and to tell the doctor before using other medication.
  • If the worker breaks any condition, the doctor may stop prescribing opioids and the WCB may stop paying for them.

Get the official form

Download the current version from the source each time; forms change without notice.

Opioid treatment agreement

Entente de traitement aux opioïdes

Official pagePDF

Fill it with Vero

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Is the opioid treatment agreement mandatory for WCB Manitoba?

It is if the WCB is to pay. The form states that WCB Manitoba requires the agreement between the injured worker and the prescribing doctor to be completed before payment for opioid medication will be considered. The Initial Opioid Management Report then asks whether it was completed and for a copy.

What does the worker agree to in the WCB opioid agreement?

Nine conditions: one prescriber, taking opioids only as prescribed, no sharing or selling, one named pharmacy, no over-the-counter opioids, recreational drugs or alcohol, safe storage, no early replacement of lost or overused medication, attending all appointments, and taking part in recommended treatment or rehabilitation programs.

Is the WCB opioid treatment agreement available in French?

WCB Manitoba's French resources page lists it as Entente de traitement aux opioïdes, but it links to the same English PDF. The one-page form carries OTA beside its title and has signature and date lines for both the worker and the doctor.