Controlled Substance Policy
Controlled substance use by prescription: This office uses prescribed controlled substances for the treatment of various mental health diagnoses. Most commonly prescribed controlled substances are stimulants for ADHD which are categorized as a schedule 2 controlled substance by the federal government, meaning they present risk for abuse and dependence. This Practice generally avoids prescribing benzodiazepines, which are schedule 4 controlled substances, although this Practice may occasionally use benzodiazepines for intermittent treatment of specific situations that bring on high anxiety, i.e. needle phobias or intense fear of flying. This Practice prescribes controlled substances with great care, and will only prescribe these medications to patients who adhere strictly to the below policy. The Practice shall only prescribe controlled substances in accordance with applicable laws, regulations, and rules including, without limitation, those provisions of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 applicable to health care providers.
Signature of this form indicates that you agree to the following contract for the administration of and treatment with controlled substances, should those be prescribed to you.
I agree to only take my medication(s) as prescribed. This includes how often I take the medication(s) and what dose I take.
I have disclosed all of my medications, supplements, and vitamins to my provider. I am responsible for updating my provider with any changes to this list.
I understand that the medications that I am being prescribed have abuse potential – and that being prescribed this medication puts me at risk for developing a substance abuse problem. I also understand that this medication may cause physiological dependence, tolerance and withdrawal.
I understand that the Practice may require random drug testing while under their care. Results that are inconsistent with my medical history or medications prescribed or results suggesting that I may have a substance problem (for example testing positive for illegal drugs or medications that I am not prescribed), may be grounds for termination of care at my provider’s discretion.
I understand that I always have the right to refuse or stop taking my medication(s), but that doing so may result in withdrawal symptoms (with potentially severe medical consequences including, in the case of benzodiazepines, seizures and, in rare cases, death). If I decide to stop a medication or decrease my dose without direct supervision from my provider, he/she/they are not responsible for any serious adverse reaction or consequences (including seizure and/or death).
If there is concern for medication abuse, diversion (giving or selling the medication to others) or “doctor shopping” (obtaining similar medications from multiple prescribers), my care will be terminated at my provider’s discretion. Signing this form gives my provider permission to share my medical record (including drug screens) with any law enforcement agency, medical provider and pharmacy if my provider has a concern. The Practice and its providers are not responsible for any legal repercussions that I incur, should this occur.
The Practice may contact all of my current and previous providers and pharmacies at their discretion. Reasons include (but are not limited to) notifying them of this contract.
The Practice may require periodic and/or random drug testing for those prescribed controlled medications.
Refill policy – There are no early refills allowed on prescriptions for controlled substances. Should you have your medication stolen, a valid police report must be presented to your prescriber in order for a refill to be considered. There are no early refills for lost or damaged medications.
As a general rule, the Practice avoids prescribing benzodiazepines, as they have been shown to potentially increase the risk of Alzheimer’s, can be addictive, and can reinforce anxiety. Potential exceptions to this general rule include prescriptions for detox purposes, very infrequent use (e.g., once per month for fear of flying), and other rare circumstances.
If I am not adherent to this contract, honest about my medications and/or doses, do not take medications as prescribed, am not honest with my provider about a history of substance abuse or dependence, or do not notify my prescriber should I have concern that I am developing a substance abuse problem, I am solely responsible for any adverse outcomes.