It has been explained to me Buprenorphine or Suboxone is also a narcotic (opiate-based) drug, which can be harmful if taken without medical supervision. I further understand Buprenorphine or Suboxone is an opiate based (partial agonist) classified as an addictive medication and may, like other drugs used in medical practice, produce adverse results. The alternative methods of treatment, the possible risk involved, and the possibilities of complications have been explained to me, but I still desire to receive Buprenorphine or Suboxone due to the risk of my return to the use of opiates and /or opiods such as Heroin, Oxycontin, Morphine, or other such drugs of the narcotic (opiate) family.
The goal of Buprenorphine or Suboxone treatment is total rehabilitation of the patient. Eventual tapering and withdrawal from the use of all drugs, including Buprenorphine or Suboxone, is an appropriate trreatment goal. I realize for some patients Buprenorphine or Suboxone treatment may continue for relatively long periods of time but the periodic consideration shall be given concerning my prospects for tapering and complete withdrawal from Buprenorphine or
Iunderstand I may withdraw from the treatment program and discontinue the use of the drug at any time and I shall be
afforded tapering and cessation under medical supervision.
I agree that I shall inform any doctor who may treat me for any medical problem I am enrolled in a narcotic treatment program, since the use of other drugs in conjuction with Buprenorphine or Suboxone may cause me harm.
Ialso understand during the course of treatment, certain conditions may make it necessary to use additional or different
procedures than those explained to me. I understand these alternate procedures shall be used when the Program Medical Director's judgement is considered advisable.
I certify that no guarantee or assurance has been made as to the results that may be obtained from Buprenorphine or Suboxone treatment. With full knowledge of the potential benefits and possible risks involved. I consent to Buprenorphine or Suboxone treatment, since I realize I would otherwise continue to be dependent upon and abuse narcotic drugs.