TERMS OF PARTICIPATION

this is a sample of the treatment contract that all patients are required to sign and adhere to:

  1. You are being placed on a Methadone or Suboxone maintenance program for an indefinite period of time; or a withdrawal program for a maximum of ____ months.
  2. For safety reasons, the Methadone or Suboxone prescriber will contact the patient’s family physician in order to ensure that each physician is fully aware of the treatment being provided by the other.
  3. Patient’s attending a clinic for Methadone or Suboxone are encouraged to be receiving more than just Methadone or Suboxone. They are expected to be receiving counseling at the clinic, or from an alcohol and drug service provider, and/or receiving support from AA or NA.
  4. Methadone or Suboxone are a long acting narcotics, and as such, is a very dangerous drug which must be kept out of the hands of children and all non-tolerant persons.
  5. In order for Methadone or Suboxone to be effective, it must be ingested on a daily basis at the prescribed dosage level.
  6. The physician will adjust dosage levels, frequency of dispensing, location of dispensary, frequency of clinic visits, and frequency of urine screening as is seen fit in order to provide safe care.
  7. No person other than the patient may pick up methadone from the pharmacy - ONLY YOU CAN PICK UP YOUR DOSE!
  8. Failure to collect medication form the pharmacy for 2 successive days raises safety concerns, which require that the medication be withheld until the reason for non-attendance has been reviewed by the prescribing physician.
  9. There will be no replacement of any lost, stolen, or spilled medication.
  10. Medication may not be picked up early from the pharmacy.
  11. Urine samples will be collected by the office staff on a random basis as judge appropriate; Patient’s may be contacted through the pharmacist and given 24 hours to come to the clinic and provide a urine sample. Failure to provide a sample when requested will be considered the same as a urine sample that is positive for opiates, and will result in a return to daily witnessed ingestion (if on carries)
  12. Any cold urine samples will be treated as a serious program violation with the following consequences
    - If the patient is receiving carries, there will be an immediate return to daily witnessed ingestion until judged stable by the attending physician;
    - Random urine samples will be required as judged appropriate by the physician;
    - The physician may decide to increase the frequency of his contact with the patient until the patient is stable;
    - In some circumstances, the patient may be asked to leave the program.
  13. The ingestion of any mood-altering drug (ie: tranquilizers, sleeping medications, codeine, etc.) when prescribed by another physician, or OTC, will be discussed with that physician regarding its necessity considering the patient’s addicting disorder.
  14. Patients who are abusive towards staff will not be allowed to continue on the program. Depending on the seriousness of their behavior, they may be removed either over a 2 week period, or immediately.
  15. Patients may be removed for the program for a) failing to attend scheduled appointments with the physician or counselor; b) selling or giving methadone to another person; c) selling or distributing illicit drugs; d) any violent or abusive behavior; e) failure to pay clinic fees over time; or f) providing altered urine samples.
  16. The purpose of the methadone maintenance treatment is to facilitate the discontinuation of other more dangerous mood modifying drugs. When a patient’s behavior or urine samples show that the methadone maintenance treatment is not being effective in eliminating the use of the drugs, the methadone prescriber may decide to discontinue the methadone maintenance treatment.
  17. ***Patients who are pregnant, or are planning a pregnancy, must inform the Methadone or Suboxone at The Nanaimo Paint Clinic immediately so that safe care can be provided***