The clinical pathways (standards of care) for pain management here in the US states that the PCP or the prescribing provider must have a contract with the patient if they are prescribed narcotics or certain other pain medications i.e. Tramadol long-term (generally more than 30 days). The contract outlines the expectations of both patient and prescriber and includes things like they will only get the meds Rx'd by that provider, that they will get the Rx filled at only one pharmacy, there will be no early refills, and that urine drug screens can and will occur both regularly and randomly. If you have anything other that what you have been Rx'd for show up in the drug screen OR if you don't have the Rx'd med show up you can be or will be "fired" by your provider. This is the standard for practice in the civilian sector as well as through the VA. The VA follows the Federal laws which still have marijuana listed as a Schedule I controlled substance, so even if you live in a state where medical marijuana is legal and you have a card, it doesn't matter -- it is still considered to be illegal. It isn't that the medical providers will report you to the law, they just won't prescribe for you any longer because you are out of compliance with the long-term opioid drug contract you presumably agree to and have signed.