The role of the patient–provider agreement (PPA) is to set forth respective roles and responsibilities for opioid therapy with the goal of improving outcomes, reducing risks, and improving patient education. The Food and Drug Administration (FDA) Safe Use Initiative Opioid PPA Working Group convened to develop a PPA and test it for acceptability as an educational and shared decision-making tool in opioid therapy. This multicentre study evaluated the utility of the PPA, how readily patients understood it, its ability to educate patients in an unbiased way about opioid treatment and the feasibility of incorporating a PPA in clinical practice. A total of 117 patients and 14 providers at urban centres were included (mean patient age: 56 years) with 85% of patients treated for pain for >3 months. Most patients reported the PPA to be ‘somewhat helpful’ or ‘very helpful’ in deciding a course of treatment (96%) and ‘easy to understand’ (97%). Both patients and prescribers (89% and 92%, respectively) found the PPA was neutral in terms of presenting opioid therapy. Most centres found the PPA could be administered in ≤10 min and 72% of prescribers said this PPA could be readily incorporated into their practice. This PPA was perceived by both patients and prescribers as helpful in deciding a course of treatment and unbiased in terms of presentation of the risks and benefits of opioid therapy.