Controlled Substance Policy Patient Attestation

Controlled substance medications can be clinically useful but also have the potential for misuse. Controlled substances include (this is not a comprehensive list):

Benzodiazepines: potent anxiety-reducing medications such as Valium (diazepam), Ativan (lorazepam), Xanax (alprazolam), and Klonopin (clonazepam), among others.
Stimulants: potent medications often used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), and include Adderall and Dexedrine (amphetamine); Vyvanse (lisdexamfetamine); and Focalin, Concerta, Ritalin, and Metadate (methylphenidate).
Opioid analgesics such as hydrocodone and oxycodone.
Buprenorphine: an FDA-approved medication for treatment of opioid use disorder, and which may be used for detoxification or for maintenance therapy.

At CARMAhealth, PLLC our prescribers strive to provide quality, individualized care that best addresses client concerns and offers the highest chance at successful treatment. While we acknowledge the efficacy and appropriateness of long-term use of some controlled substances in some patients, we also take into consideration the risk for misuse, abuse, and diversion of these medications.

Controlled Substance Early and Bridge Refills: 
 
CARMAhealth providers generally will not provide partial or bridge prescriptions for controlled substances without a visit with and authorization from your provider. If a patient is unable to make an appointment and this results in a lapse in your medication prescription, your medication will not be renewed or refilled without first having a provider visit. Controlled substances include buprenorphine, stimulants, benzodiazepines, and some pain medications. 

At each appointment, your doctor, nurse practitioner, or physician assistant advises both you and our staff of the timing of your next follow up appointment.  It is your responsibility to ensure that a follow up appointment is made within that time frame.  Follow up appointments should be scheduled on the same day that you see your doctor or nurse practitioner.

In order to best protect your health and safety, by signing below you agree to the following:

If you are transferring into our services and are currently on long-term benzodiazepine therapy, we will carefully review your history and plan of care and propose reasonable and evidence-based alternatives to benzodiazepine therapy when clinically indicated. If you are new to our services, you can expect that all other alternatives will be thoroughly exhausted before benzodiazepine therapy is considered as a plan of care.

If you are transferring into our services and are currently on long-term stimulant therapy, we will continue your therapy once you have provided documentation of the diagnosis and of a stable dosing regimen for at least 12 months. If you are new to our services, you can expect that all other alternatives will be thoroughly exhausted before stimulant therapy is considered as a plan of care or if there is evidence from collateral and neuropsychological testing confirming the diagnosis.

If you are prescribed opioid analgesia, you understand that the lowest dose and shortest course clinically indicated will be prescribed, and any refills will be issued only after a face-to-face follow up with your prescriber.

If you are prescribed buprenorphine, you agree to adhere to the office policies regarding buprenorphine prescribing as outlined in the buprenorphine attestation and consent document.

If, after careful review and exhaustion of reasonable alternatives, our plan of care recommends discontinuation of a controlled substance we will collaborate on a discontinuation plan. If you do not agree with a reasonable discontinuation plan, we will work with you to find another provider.

If you are prescribed any controlled substance, you understand that you are responsible for the controlled substance medications prescribed to you. If your medication is lost, spilled, misplaced, misused, or stolen you understand that you will not receive a refill until the next scheduled refill date or after a face-to-face appointment with my prescriber. You understand that early and bridge refills are not part of our standard practice and will require a provider visit and authorization. You agree to comply with random toxicology screens, and consent to random or scheduled medication counts. If called for a random medication count, you must present to the clinic or your pharmacist within 24- hours. You agree to have all prescriptions for controlled substances filled at the same pharmacy, and should the need arise to change pharmacies, the practice will be notified. You agree to comply with your prescriber’s recommendations for additional counseling or other supportive services.