SUBOXONE TREATMENT CONTRACT
GENERAL SUBOXONE INFORMATION
The Drug Addiction Treatment Act of 2000 made it legal to prescribe a narcotic for addiction treatment. A heroin or opioid /pain medication addicted patient may receive opioid medication for detox or maintenance in a regular office setting, rather than a Methadone treatment program. Suboxone is the only allowed medication.
The restrictions of this law require the physician to have training in opioid addiction treatment, be registered with the secretary of health and human services and be certified by the drug enforcement administration to prescribe scheduled drugs.
Suboxone is a Long acting opioid medication that binds for a long time to the narcotic receptor. Suboxone is taken sublingually under the tongue because it is not absorbed well by swallowing. The tablet or film also contains a small amount of naloxone (Narcan) which is a narcotic antagonist, or blocking/reversing agent, which will cause withdrawal if injected.
Suboxone has a ceiling which makes it safer in case of an accidental overdose. In large doses Suboxone does not suppress breathing to the point of death in the same way that heroin, methadone, and pain medications do.
These qualities make it safer to use outside of the strict confines of a methadone clinic. After stabilization, most patients are able to self manage Suboxone for up to four weeks at a time.
Suboxone is not equivalent to maintenance strength of methadone. In order to try Suboxone without going into major withdrawal, a methadone patient would have to taper down to 30mg or less of methadone.
Remember these tips: If you are offered Suboxone by a friend and you are taking opioids, the Suboxone will push the other opioids off the receptor and you may go into withdrawal and become sick. If you dissolve and inject the Suboxone tablet, it may induce severe withdrawal because of the naloxone in it. Naloxone is a pain/opioid receptor blocker (antagonist) and reverses narcotics effects by kicking opioids off of the receptor. Naloxone is not absorbed well sublingually and does not cause this when the medication is taken properly. If you are on methadone and want to switch to Suboxone, your dose must be at or below 30mg.
FDA Warning Concerning Buprenorphine and Tooth/Gum Decay: Patient is hereby informed to swish mouth with water 20 minutes after medication completely dissolves and to brush teeth one hour after it dissolves. Patient also informed to keep regular dental appointments.
SUBOXONE TREATMENT INFORMED CONSENT
Please read this information carefully. Suboxone (buprenorphine + naloxone) is an FDA approved medication for treatment of people with opioid (narcotic) dependence. It can be used for detoxification or for maintenance therapy when prescribed by qualified physicians. Suboxone itself is a weak opioid (partial opioid agonist) and reverses actions of other opioids! It can cause a withdrawal reaction from standard narcotics or methadone while at the same time having a mild narcotic pain relieving effect from the Suboxone.
The use of Suboxone can result in physical dependence of the buprenorphine, but withdrawal is much milder and slower than with heroin or methadone. If Suboxone is suddenly discontinued, patients will have mild
Symptoms such as muscle aches, stomach cramps, or diarrhea lasting several days. To minimize the possibility of opioid withdrawal, Suboxone may be discontinued gradually, usually over several weeks or more.
Because of its narcotic-reversing effect, if you are dependent on opioids, you should be in as much withdrawal as possible when you take the first dose of Suboxone. If you are not in withdrawal at the time of your 1st visit, you may not be given Suboxone, as it can cause severe opioid withdrawal while you are still experiencing the effect of other narcotics. A prescription of Suboxone can be filled at the pharmacy of your choice.
Some patients find that it takes several days to get used to the transition from the opioid they had been using. After stabilization on Suboxone, other opioids will have virtually no effect. Attempts to override the Suboxone by taking more opioids could result in an opioid overdose. Do not take any other medication without discussing it with your physician first.
Combining Suboxone with ALCOHOL or some other medications may also be hazardous. THE COMBINATION OF SUBOXONE WITH MEDICATIONS SUCH AS XANAX, VALIUM, ATIVAN, KLONOPIN, OR LIBRIUM HAS RESULTED IN DEATHS.
The form of Suboxone in this program is a combination of buprenorphine with a short acting opioid blocker, naloxone. If the suboxone tablet was dissolved and injected by someone taking heroin or another strong opioid it would cause severe opioid withdrawal.
Suboxone tablets must be held under the tongue until completely dissolved. It is then absorbed from the tissue under the tongue over the next 30 minutes – 2 hours. If swallowed, Suboxone is not well absorbed from the stomach and the desired benefit will not be experienced. All Suboxone must be purchased at private pharmacies. We do not supply any Suboxone.
We do not prescribe , under any circumstances, narcotics, Methadone, or sedatives (Xanax or Klonopin) for patients desiring detoxification or maintenance from narcotics. All Suboxone must be purchased at private pharmacies (if you have insurance, it may cover it). We will not supply any Suboxone.
SUBOXONE PATIENT – TREATMENT CONTRACT
As a participant in treatment (Suboxone sublingual film, Suboxone sublingual tablets) for Opioid dependence and addiction, I freely and voluntarily agree to accept this treatment contract as follows:
I agree to keep and be on time for all appointments. I also understand that if I fail to show for an appointment without 24 hour notice, this may result in not receiving medication til the next appointment.
I agree not to sell, share, or give any of my medication to another person. I understand that Buprenorphine and Naloxone film/tablet is a controlled substance, that mishandling of my medication (dealing, selling, trading, etc.) is a serious violation of the agreement, and would result in my treatment being terminated without any recourse for appeal.
I agree not to alter the prescription in any way.
I agree to conduct myself in a courteous manner while in the program.
I understand that if dealing or stealing or if any illegal or disruptive activities are observed or suspected by employees of the pharmacy where my prescription is filled, that the behavior will be reported to NAS Clinic and could result in termination without any recourse for appeal.
I agree to store medication properly. Medication may be harmful to children, household members, guests, and pets. The pills should be stored in a safe place, out of reach of children. If anyone besides the patients ingest the medication, the patient must call Poison Control or 911 immediately.
I agree to take the medication only as the Provider or staff have instructed and not to alter the way I take my medication without first consulting my provider or staff.
I understand that I must notify other healthcare providers that I am using a controlled substance for the treatment of opioid addiction to help prevent drug-drug interactions.
I agree to provide urine samples for each visit if indicated. Urine testing is a mandatory part of the program. With each visit, the patient must be prepared (drink plenty of water before appointment) to give a urine sample and be prepared to show the bottle for a pill count.
I understand that I may be asked to provide a urine sample to an independent lab for a more definitive analysis. I understand that there is a cost to this test and that my insurance company will likely pay the fee. I further understand that if I don’t have insurance, I may be billed directly by the independent lab.
I understand that if my drug screen is positive for illicit drugs, I will be given a verbal warning on the first occurrence, potentially a written warning on the 2 nd occurrence, and that my treatment at National Addiction Specialists may be terminated after the 3 rd occurrence.
I agree to make and prepay (if uninsured) for another appointment in case of a lost or stolen medication.
I understand the financial responsibilities as outlined.
I have the phone number of the clinic and understand the hours I can call or text the number.
I understand that I am required to abide by the rules of the program to remain on Suboxone treatment.
I understand that my participation in an ongoing outpatient drug addiction treatment/counseling program, either through National Addiction Specialists or elsewhere is recommended while on a controlled substance for the treatment of opioid addiction – at the discretion of my provider.
I agree to abstain from alcohol, opioids, cocaine, methamphetamine, or other addictive substances (except nicotine/tobacco).
I agree to read the manufacturer’s Medication Guide and consult my doctor should I have any questions or experience any adverse events or side effects.
I understand that the Providers at National Addiction Specialists are NOT my primary care physician (s) and that we only provide treatment services related to my opioid dependence only.
I understand that if I am taking any controlled substance prescribed by another physician, I may be asked to provide a letter signed by the prescribing physician, verifying my prescription. I further understand that I can show my prescription bottle to my provider at National Addiction Specialists with current prescription information.
Note: Many insurance companies are now REQUIRING addiction counseling if they are expected to pay for the medication.
I understand that National Addiction Specialists are now periodically reviewing my controlled substance prescriptions through the Tennessee Department of Public Health Prescription Drug Monitoring Program/Controlled Substance Monitoring Database (CSMD).
I agree to notify the clinic in case of relapse to drug abuse. Relapse to opioid drug abuse can result in the need to go to a rehab program and potentially being removed from the program. The physician should be informed of narcotic usage prior to finding out from the urine drug screen.
I agree that my medication/prescription can only be given to me after an appointment. I understand that no medications will be prescribed by phone by calling the office or staff and asking for a prescription or on weekends. A missed visit may result in my not being able to get my medication/prescription until the next scheduled visit and may cause me to go into withdrawal.
I agree to make another appointment in case of a lost prescription or stolen medication.
I understand that, if I am a female and of reproductive age, I will obtain a Urine Pregnancy Test, prior to starting the treatment with Suboxone (Buprenorphine and Naloxone) or any controlled substance to confirm I am not pregnant. If I engage in sexual activity and could potentially become pregnant, I confirm that I will obtain a Urine Pregnancy Test to rule out being pregnant while on any controlled substances.
I understand that mixing Buprenorphine and Naloxone film or tablets with other medications/substances, especially alcohol or benzodiazepines such as Valium(Diazepam), Xanax (Alprazolam), Klonopin (Clonazepam), Ativan (Lorazepam), Librium (Chlordiazepoxide), Restoril (Temazepam), and Halcion (Triazolam) can have a combined effect on the respiratory drive causing me to stop breathing. I am aware that several deaths have occurred by persons mixing buprenorphine and benzodiazepines, especially if taken outside the care of a physician, using routes of administration other than under the tongue (sublingual) or in higher than recommended therapeutic doses.
Suboxone Treatment May Be Discontinued For Several Reasons
Suboxone controls withdrawal symptoms and is an excellent maintenance treatment for many patients. If you are unable to stop your substance/heroin abuse, or if you continue to feel like using narcotics, even at the top doses of Suboxone, a rehab facility may be recommended or we may stop treatment with Suboxone and recommend seeking help elsewhere.
There are certain rules and patient agreements that are part of the Suboxone treatment. All patients are required to read and acknowledge these agreements by signature upon admission to the treatment panel. If you do not abide by these agreements you may be discharged from the Suboxone program.
Prompt payment of clinic fees is also part of the program. If your account does not remain current, appointments cannot be scheduled. If appointments cannot be kept as agreed, status as an active patient will be canceled.
In the very rare case of an allergic reaction to the medication, Suboxone must be discontinued.
Dangerous or inappropriate behavior or being intoxicated with narcotics, xanax or similar medications may result in suboxone stoppage.
Office Procedures
If you are in need of an accommodation, please contact the main office. Accommodations are granted on a case by case basis and in concordance with your care team (i.e. medical provider and counselor)
Patients may be discharged based on patient preference to discontinue treatment or change providers. Patients may also be discharged by the provider if they consistently break the rules of the program or are deemed to not be responsive to treatment and counseling.
Discharged patients will be advised to follow-up with the appropriate medical provider based on each individual patient’s circumstances.
Discharged patients may be provided with appropriate medication to allow appropriate detoxification based on each individual patient’s circumstances.
If an existing patient requires a transfer to a different clinic or service, the case manager and clinical staff will document the reason and assist in document transfer with the entirety of the NAS care team.
If a member exhibits risk factors determined by member’s provider that deem that member a poor candidate for teleMAT (i.e.: concern for diversion or repeated failed drug screens), NAS provider may determine based on risk: benefit ratio that member may best be suited from an option other than teleMAT including but not limited to: clinic dismissal, elevation to an ASAM higher level of care such as IOP or residential rehab, or referral to a different clinic.
Members may return to NAS after discharge on a case by case basis, reviewed by the NAS care team.
It is the policy of NAS to ensure that the emergency medical and mental health needs of all patients are addressed twenty-four hours a day, seven days a week. The organization will maintain an “on-call” system when staff is not available at the clinic to cover the emergency medical and mental health needs of all clients. Please contact 615-994-1000 for after hours services outside of business hours (Monday through Friday from 8:30am to 4:30pm Central Standard Time.)
Patients that are deemed an immediate or emergent high relapse risk will be dealt with on an individual basis and potential provider actions may include: calling 911, referral to a hospital, referral to a higher level of care such as IOP, residential rehab facility, or an acute psychiatric facility.
All NAS Staff will adhere to professional and ethical codes of conduct.
Should a patient find it necessary to report an individual, they may contact the Intake Coordinator who will send the information to the admin team. Reports will be reviewed on a case by case basis and documented.
