Section One—Intake Information INTAKE (Admission to our program) New Clients The “intake” process is an evaluation you will receive by the clinic representative and the medical director or staff physician.  You will be interviewed for necessary medical, psychiatric, substance abuse and psychosocial behavior.  You will also have a physical examination where blood will be collected for laboratory testing for metabolic and infectious diseases and a tuberculosis skin test.  A urine sample is requested of all patients at the time of admission in order to verify drug use. It is imperative that you give the nurse, counselor and the physician accurate and truthful answers during this interview process about your health habits, drug use and medical history. The counselor, physician and federal guidelines will all be taken into consideration to determine whether you are a candidate for methadone treatment.  Within the federal guidelines, the physician or other qualified person will evaluate your history to determine what dose will be appropriate to start. Transfer Clients Once you have decided that you would like to enter our program and leave your prior program, we require a medical authorization to be signed by you so that we may obtain your medical records from your previous program including but not limited to:  drug screen results, counseling notes, physical exam results, laboratory results, progress notes, medication type and dose and other information related to your treatment. All Clients There are a number of consent forms you are requested to sign before you complete admission into our program.  Many of these consents are required by federal and state authorities; the remainder is clinic policy.  PRIOR to signing any form, you are expected to read the consent form and ask questions about anything you do not understand.  Since this is a voluntary program (that is to say you wish to participate on your own free will), we require that you are making an informed decision about joining our program.  Methadone does cause physical dependence and you will have withdrawal symptoms if you abruptly discontinue its use. COUNSELING Upon admission you will meet with an intake counselor, who will assist you with the process of being admitted to our program.  You will be assigned a counselor based upon availability and your preferences.  We will make every effort to notify you of any changes in the assignment of your primary counselor in advance of this occurring. Within 30 days of admission a formal plan for your treatment will be developed with your primary counselor to begin addressing your treatment issues and goals.  You are expected to meet with your counselor a minimum of twice per month during the first year in treatment and once per month in the second year of treatment.  Assuming you are progressing as expected, starting the third year of treatment you may only be required to meet with your counselor every six months.  Your counselor may require you to meet with him/her more often than the minimum. All requests should first involve you primary counselor.  Your counselor should be made aware of any significant changes and problems in your life.  Please bring all your requests to your counselor first including a need to be seen by the physician.  You are expected to make and keep all appointments with your counselor.  If you are going to be late or need to reschedule, please call and inform us of the delays.  Any absence must be explained in your client record; please inform us of the reason for any missed appointments. As professionals, our staff of counselors, nurses and doctors is mandatory reporters.  The means in certain circumstances we will notify the proper authorities without your consent.   These situations include: 1.        If you verbalize an intent to do bodily harm to someone or yourself, 2.        If you admit to current child or elder abuse, and 3.        If you are diagnosed by us as having a reportable disease. CLIENT RIGHTS When you receive services in a substance abuse program, your rights are protected by the law; Code of Federal Regulations, chapter 20-4-9 and Department of Human Resources in chapter 290-4-12-7.  Below is a simplified outline of those rights.  The rules and regulations describe any limitations to these rights and other provisions, which may apply and should be consulted when there is a question regarding your rights.  Your rights include: The right to receive care suited to your needs, The right to receive services that respect your dignity, protect your health and safety, The right to be informed of the benefits and risks of your treatment, The right to participate in planning your own treatment, The right to be promptly and fully informed of any changes in the plan of treatment, The right to accept or refuse treatment, The right to prompt and confidential treatment, The right to exercise all civil, political and personal and property rights you are entitled as a citizen, The right to be free of physical or verbal abuse, and The right to file a complaint, without fear of discrimination or retaliation, if these rights have been restricted or denied and to have them investigated by the program within a reasonable time frame. NOTE:  Privileges, unlike patient rights, can be lost through violation of program rules or a failure to demonstrate progress in treatment. CONFIDENTIALITY The confidentiality of your records is protected by federal law.  You have the sole right to have this information released to whomever you wish or to have the release restricted at any time. We will require your signature before releasing confidential information.  Without a signed authorization, information about your enrollment in this program will not be made available to a significant other, employer, lawyer, insurance company, or another client.   Confidentiality is strictly enforced and your understanding in this area is greatly appreciated.  If you feel you have witnessed a breach of confidentiality of your or another client’s information, please inform the program director. In emergency situations where serious medical harm is potential, our staff is required to release only medically necessary information about you to emergency medical workers and/or facilities.  This will be limited to medical information necessary for you to receive appropriate emergency treatment. By reading and signing that you have read this handbook, you indicate that you understand that in certain circumstances our staff is legally required to report suspicion of child/elder abuse. Any crime committed against the clinic or in view of clinic staff, by law, nullifies the confidentiality of the person committing the crime.  Any theft of clinic or another’s personal property, destroying or damaging property, threat to or assault of staff or others, the sale or purchase of illicit substances will remove your right to the confidentiality of certain information.  In particular, name, address, date of birth, social security number, gender, hair color, eye color or other identifying information will be released to the proper authorities for prosecution. If your take-home medication is lost or stolen it must be reported to the police by you, especially if you wish it to be replaced. MEDICAL INFORMATION Methadone is a man-made (synthetic) opioid.  Opioids are opiate-like substances; that means they act much like opiates in the body.  At our program, you will receive the orally consumed form of methadone.  These products are made to interfere with a person’s ability to inject them.  Methadone produces physical dependence, blocks the effects of other opioid medications and prevents withdrawal symptoms when you stop using other opioids.  A properly prescribed methadone dose will decrease or stop the desire to use other opioids and does not cause excessive sleepiness or intoxication.  While in treatment for opioid dependence, your dosing needs may increase, decrease or remain constant depending upon various medical and environmental factors.  Abrupt discontinuation of methadone will produce withdrawal symptoms that may last from two (2) weeks to six (6) weeks. BIRTH CONTROL/PREGNANCY We encourage patients not to become pregnant during methadone treatment.  All women who could become pregnant will have a urine pregnancy test conducted at intake.   However, a woman who becomes pregnant while taking methadone should NOT discontinue methadone until after the baby is born.  Women who wish to prevent pregnancy should use an effective birth control method.  Our staff can meet with you to recommend places to receive birth control and family planning services. Drug abuse, physical illness and stress can all interfere with regular menstrual cycles, so you CANNOT count on menstruation to tell you if you may or may not be pregnant.  If you become pregnant or suspect you may be pregnant, please inform your primary counselor so that an appointment can be made to meet with our physician.  We will provide urine pregnancy tests at a minimal charge at your request.  The clinic does not furnish contraceptives, but we can direct you to where contraceptives may be obtained at reasonable costs.  If you become pregnant, you should meet with our medical director as soon as possible.  We will request that you sign a release of information so that we can verify that you are receiving prenatal care. No drug or medicine is absolutely safe during pregnancy, but through research methadone has been shown to be generally safe for the woman and unborn fetus.  Methadone treatment is the preferred treatment for women who are opioid dependent and become pregnant.  It can be extremely dangerous to withdraw from opioids during pregnancy including methadone.  Withdrawal from street opioids, prescription pain medications or methadone may cause harm to the fetus and miscarriage or premature delivery. If you become pregnant while on methadone, inform our program medical director as soon as possible.  Our physician will follow you closely during your pregnancy, helping with referrals to obstetrical services, providing information to your obstetrical services, providing information to your obstetrician about pregnancy and methadone, and monitoring your dose to make sure it remains adequate for your needs.  Our physician will require that you give consent to share information with your obstetrician so that your pregnancy treatment can be well coordinated.  In addition, our physician will want to communicate with the pediatrician that you choose for your child before you deliver.  There are issues regarding the breastfeeding of your infant and prenatal treatment with methadone that should be discussed by all of the involved doctors.  Pregnant women in the program may be required to have additional blood or urine testing to monitor their treatment if it is necessary for the mother or baby’s safety. As with any pregnancy, patients on methadone will be prescribed prenatal vitamins by their obstetricians and will be encouraged to avoid any medications not prescribed by a physician.  Avoiding any illicit drugs, keeping regular attendance for stable dosing of methadone and having early prenatal care are the best ways to maintain a healthy pregnancy. Because pregnancy can produce more emotional, social and financial stresses, a pregnant woman in treatment will be encouraged to meet more frequently with her counselor and develop strategies to cope with the life changes she is facing.  Goals leading towards a healthy pregnancy will be incorporated into the treatment plan.  When indicated, female patients anticipating detoxification from methadone should receive a pregnancy test before starting voluntary detoxification. BLOOD TESTS Upon acceptance into our program and each year thereafter, you are required to have a blood test and routine medical examination.  You will be asked to meet with a physician or other qualified staff if your laboratory results are abnormal.  A copy of any blood work can be sent to your primary care doctor with your written authorization.  You will be charged for all blood work required for general medical care.  We do not routinely test for exposure to the human immunodeficiency virus (HIV) or for exposure to hepatitis but this testing is available upon request, additional cost maybe incurred. GENERAL MEDICAL CARE Your primary care provider should continue to provide general medical care.  However, if you have a need to see our clinic physician, please make an appointment.  When you make an appointment the time is reserved for you and it is important to keep that appointment or call at least 24 hours in advance to reschedule the appointment. HOSPITALIZATION Your daily dose may be provided to you if you require hospitalization.  Notify the hospital physician caring for you that you are a client at Metro Treatment Center.  The hospital may require you to authorize the release of information of your medication from our program.  If authorization is not able to be obtained we will make every effort to verify the person contacting us is genuinely involved in your care at the hospital before releasing information about your medication.  Upon discharge from the hospital, you will need to provide documentation of your hospital stay and evidence of the last day that methadone was provided to you from the hospital.  Documentation of controlled substances provided to you from the hospital will also be required to verify positive drug screen results. Section Two—Dosing Policies NEW CLIENTS—First Month Orientation Once you enter our program, you will be provided your first dose of methadone by our staff.  The dose will be ordered by a physician or other qualified staff which is medically safe and in compliance with federal guidelines.  After your first dose, you are asked to remain in the clinic for half-an-hour to see that no serious adverse reactions occur.  You will be asked frequently in the first month of treatment about how your dose is affecting you.  You will be able to request medication changes of up to 5mg per day until you reach 60mg per day total.  Once at 60mg/day you will be required to meet with a counselor who will submit a form for the physician to review and approve/deny medication changes.   Once your first 30 days in treatment has ended you will not be allowed to make request medication changes except via your counselor. You should know what to look for regarding overmedication and under-medication.  Signs you are overmedicated include feeling sleepy, sedated, or short-of-air.  These are serious signs of overmedication and you should notify the clinic as soon as possible.  Signs of under-medication include frequent opioid cravings, achiness, diarrhea, and restless sleep.   Typically the best indicator of appropriate dosing is your ability to sleep through the night. TRANSFER CLIENTS If you transfer from another methadone program, your dose level and attendance schedule will be transferred with you.  We are required to verify this information with the clinic you are leaving.  We will attempt to make the transition as seamless as possible.  You will be required to be seen by our physician within 14 days of your transfer. CHILD CARE We do not encourage bringing children to the clinic during dosing hours.  However, if it necessary to bring your children to the clinic, you must NOT leave your children in the car without adult supervision.  Inside the clinic, your children must accompany you and be supervised by you at all times.  We will not assume responsibility for your children while at the clinic. DOSING RULES Our clinic has specific time during which you may enter the facility for medication.  These dosing hours are 5:30AM-9:30AM and 12Noon-1:30PM, Monday through Friday, 5: 30AM-9:00AM Saturday.  The clinic is closed all Sundays and many state holidays.  We will notify you of any holiday or special closing at least 30 days prior to the closing.  If you are late to the clinic, even by a few seconds, you will not be allowed into the facility.  If you have an ongoing problem with regular dosing hours because of travel or employment, special arrangements may be considered, please discuss the problem with your counselor.   Documentation of your circumstances and illicit-substance free drug screen(s) will be required for state and federal approval for additional take-home medication. You must return all take-home bottles when you return to receive more take-home doses.   This is a part of our diversion control plan required by the Drug Enforcement Administration.  If you attend the clinic without your take-home bottles, you will NOT receive take-home medication.  It is your responsibility to keep track of these bottles so that they may be returned appropriately. Also as a part of our diversion control plan, any client with regular take-home doses may be contacted and required to return for a check of the take-home medication.  If you are contacted, even just leaving a message on a phone number you have provided, you will have 24 hours to return to the clinic with your remaining take-home doses.  A drug screen will also be performed at this time to verify methadone and methadone metabolite are in your system.  If you fail to return within the 24 hour window, you will loose your take- home status and will have to progress in the program again to regain that level of take- home doses. When you are at the dosing window, appropriate behavior is expected.  This includes not talking on cell phones or wearing sunglasses.  When taking a dose of medication observed by our staff, you must speak to the medicating nurse prior to leaving the dosing window.   So that we are assured the dose has been swallowed.  All cups used for medication may not leave the dosing window.  If you require a cup of water to be able to provide a urine drug screen, you need to speak with a counselor; we can provide you with a non- medicating cup.  Following consuming your dose at the medicating window, please do not wait or socialize at the dosing window. FIT FOR DOSING All clients are required to be “fit for dosing”.  This includes but is not limited to zero signs/symptoms of intoxication from alcohol or other substances.  You may be asked to provide a drug screen based on clinical observation of intoxication.  Failure to provide drug screen samples upon request may jeopardize your enrollment in our program.  By federal law, we may medicate you at half your dose for signs of intoxication.  We reserve the right to refuse to medicate any client who appears to be under the influence of any substance (prescribed or illicit). ALERT FLAGS Our computer system has “alert flags” so that the medicating nurse may notify you which specific staff member needs to see you PRIOR to dosing.  Please cooperate with clinic staff at all times during this process.  We will do our best to speak with you prior to reaching the medicating nurse and removing the alert.  Please do not speak rudely to the medicating nurse if the alert was not removed appropriately, they are not capable of removing the alert.  Another staff member will have to do this for the nurse. DOSE CHANGES After medication changes please allow 72 hours to completely feel the effects of the new level (increase or decrease).  Do not expect a dose change to be effective during the first day.  Methadone blood level tend to be consistent for 24-36 hours, which is why it can be dosed only once per day. When to increase:  Moderate to severe physical withdrawal experienced 4-16 hours after the observed dose. When to remain:  Comfortable during the first 2-8 hours after dosing with mild withdrawal such as simple anxiety and insomnia for the remainder of the 24 hours.  You may experience even moderate withdrawal towards the end of the 24 hours (in this case more time in treatment, not more medication is indicated). When to reduce dose:  Any sensation, no matter how mild, of being sedated, high or loaded during the first seven days after a medication increase.  Remember the dose response/effect will be more pronounced after the next dose, assuming a steady state has not been reached yet. Vomiting your dose:  We may not be able to replace a vomited dose due to federal regulations.  At a minimum the vomitus must be observed by a staff member inside the building such that we can verify the appearance of methadone in it.  You may be asked to wait half-an-hour prior to being remedicated to partially determine the possibility of methadone previously ingested being absorbed.  If you are nauseated consult with a pharmacist, nurse or physician before dosing.  Doses vomited at home cannot be replaced.  Talk to the physician or a pharmacist for what anti-nausea medication you might use if this is an ongoing problem. DRUG TESTING Each client is expected to submit a drug screen specimen when requested.  According to state standards, we will collect a minimum of one drug screen per month.  If a urine drug screen is to be observed, you may substitute an oral drug screen at additional cost to you.   Otherwise, a same sex staff member may be required to observe the collection of a urine drug screen specimen. NOTE:  Failure to provide a drug screen specimen upon request is considered a serious infraction of our rules which seriously jeopardizes your enrollment in our program.  Failure to provide a drug screen upon request may result in your ineligibility to medicate or it may even result in discharge from our program for repeated infractions.   MISSED DOSES Metro discourages missing any dose which you are scheduled to take.  It is our position that continued and consistent dosing is a necessary part of your treatment.  This is why when you are absent; you must be evaluated by a staff member prior to dosing.  A regular pattern of missed dosing will require evaluation by the physician or other qualified personnel. After missing several consecutive days, your dose may be reduced as medically indicated in order to protect your health and well-being.  Any day that you miss your dose, we request that you contact the clinic to notify us of the reason for missing (this is a courtesy).   Missed dosing from our facility when you can verify you received the methadone at the hospital or while incarcerated will not count against you.  After fourteen days of continuous, unexcused absences from dosing, you will have to be evaluated for continued participation in our program. TAKE HOME MEDICATION Take home medication is a PRIVILEGE that must be earned.  This is done by demonstrating to the program that you can safely handle the take home dose.  This is accomplished through providing drug screen free from illicit substances and positive progress in treatment.  The recommendation for additional take home doses originates with your primary counselor but must be approved by the physician.  The physician will determine your eligibility based upon federal criteria.  A requirement of getting take home medication is that you must have a lock box when you pick up the take home medication as well as your previous/empty take home bottles. TAKE HOME BOTTLES ALL empty bottle used for take home medication MUST be returned to the clinic with the proper label when you return to take more take home doses.  Client who fails to return take home bottles may have to attend the clinic more frequently until the missing bottle(s) is returned.  You may be denied addition take home medication until the bottle(s) is returned.  The label must be intact and legible on the bottle including your name and the appropriate date which it was given to you. LOST OR STOLEN DOSES Methadone is a Schedule II narcotic and should be considered dangerous.  It can be fatal if consumed by a child or someone not tolerant to opioids.  Your take home medication is a privilege and should be considered a trust given to you in your treatment.  Methadone and all medicines should be stored under lock and key so unauthorized persons will not have access. If your take home medication is lost or stolen, it must be reported to the police.  A police report must be filed and a copy provided to us.  Since methadone is a state and federally regulated narcotic and your bottle is labeled with your name, a lost bottle could result in a loss of confidentiality about your treatment.  Lost, stolen or spilled take home doses cannot be replaced by our program and could result in the loss of regular take home privileges. Regular take home medication will be permitted if: 1.        Amount of time in treatment (see below) 2.        Drug screen results which must show methadone, methadone metabolite and only approved prescription medications 3.        Attendance is per your approved schedule 4.        No serious behavior problems or known criminal activity 5.        Medication is not suspected to be sold or transferred to another person especially not children 6.        No illicit alcohol or other drug abuse 7.        Stability in home environment and social relationships 8.        Transfer records, if applicable, are on file and meet with all other requirements 9.        Intake/admission process has been completed 10.      All other rules of the program are followed including payment of account to no more than one week’s worth in the arrears. Maximum number of take home doses permitted by federal law is based upon time in treatment.  We are permitted to provide take home doses for days that the clinic is closed such as state holidays and Sunday.  Therefore, according to federal law the maximum number of take home doses is: Level                Number of take home doses                        Time in treatment needed Phase 1:        Sunday only per week                                   Available upon intake Phase 1A:     Sunday plus one (1) other day per week        Minimum 14 days Phase 2:        Sunday plus two (2) other days per week      Minimum 3 months Phase 3:        Sunday plus three (3) other days per week    Minimum 6 months Phase 4:        Sunday plus five (5) other days per week      Minimum 9 months Phase 5:        Maximum thirteen (13) at a time                    Minimum 12 months Phase 6:        Maximum twenty-seven (27) at a time           Minimum 24 months If you transfer from another clinic, you get to keep your time in treatment from your previous program. Special take home doses or emergency doses may be approved by the physician, the state methadone authority and the Center for Substance Abuse Treatment (CSAT).  You must have a recent illicit substance free drug screen prior to being able to apply for special take home doses.  Reasons that would be considered for special take home doses would include but not limited to personal/family crisis, travel, employment or other exceptional circumstances.  Generally, a request for special take home doses will need to be made a week in advance. METHADONE MAINTENANCE Methadone maintenance is intended to do three things for our clients. 1.        Keep the client out of withdrawal. 2.        Keep the client comfortable and free from craving/using other opioids. 3.        Prevent criminal behavior related to substance abuse. Section Four—Individual dose reduction (IDR) or tapering In accordance with the program’s goals and federal consent for treatment, the goal of opioid treatment is total rehabilitation of the client.  The eventual withdrawal from the use of ALL drugs is an appropriate treatment goal.  This includes methadone. Every client is evaluated for the feasibility of methadone tapering at regular intervals as well as upon request.  The decision to begin methadone tapering is a serious and important decision.  It will depend upon: 1.        Your progress in counseling. 2.        The absence of any non-prescribed drug use for a minimum of three (3) months prior to beginning the tapering. 3.        You are gainfully employed or have stable income and stable relationships. 4.        Additional items may be identified after completing the Tapering/Detoxification checklist. We expect that a medically supervised tapering schedule will last at a minimum six (6) months to be most successful. Voluntary Tapering:  The client determines that the have successfully completed his/her treatment.  And client believes that he/she has reached his/her goals and objectives and is ready to begin a medically supervised tapering schedule from the methadone.  The dose changes and the pace of the tapering are individually determined with the assistance of the medical director.  During medically supervised tapering, you (the client) retain the option of asking for a dose change with in the boundaries of the schedule or to return to maintenance status at anytime.  It is imperative that you, your counselor and the physician take your journey of tapering together. Administrative/Against-medical-advice Tapering:  The client will not be provided an opportunity to return to maintenance or adjust the tapering schedule.  Once discharged for this type of tapering the client will have to wait a minimum of thirty (30) days before reapplying to the program. Withdrawal symptoms also called discontinuation syndromes may or may not occur in a gradual tapering schedule.  Treating these temporary symptoms with other prescription medications and counseling is a part of your treatment in our program. As a part of your ongoing success, we offer free counseling services up to one year for those clients who successfully complete a medically supervised tapering schedule or up to one month for those client who complete an administrative/against-medical-advice tapering schedule.  We recommend that as a part of this clients submit drug screens (at the cost of the client) to demonstrate to themselves that they have been successful. Section Five—Drug interaction and abuse PRESCRIPTION AND OTHER DRUGS Methadone can interact with other prescription and non-prescription medications and herbals.  Every prescription medication and over-the-counter medication or herbal should be discussed with medical staff and counseling staff.  This is for your safety.  We will not take prescriptions from you if brought into the facility.  However, we may make copies of the bottle while you are waiting nearby.  Copies of controlled substance prescriptions must be supplied to the program every two months at a minimum.  Generally, if you provide a copy of all prescriptions each time you fill a new prescription; we will receive the proper information. It is not acceptable to take anyone else’s (relative, friend, etc.) prescription medication.  In some cases, the physician who provides you with the prescription may have to be contacted in order to assure appropriate medical care and information regarding your treatment.  You will be expected to authorize the release of information to another treating physician if this is necessary.  If you refuse to comply with this request, you may jeopardize your enrollment in the program. Combining methadone and anti-tuberculosis or anti-seizure medications may cause some unpleasant side effects.  Let all physicians and pharmacists know if you are taking these substances at the same time. Using certain types of medications may precipitate serious withdrawal symptoms when taking methadone, some of these include naloxone (Narcan®), naltrexone (ReVia®), butorphanol (Stadol®), pentazocine (Talwin®), nalbuphine (Nubain®), tramadol (Ultram®) or buprenorphine (Buprenex®).  Do not accept these medications while on methadone except in the case of an overdose. Methadone in combination with any of the following may cause serious injury up to and including death:  other opioids, tranquilizers, sleeping pills and alcohol.  Our medical staff will be glad to discuss any prescription medications as they pertain to methadone. DRUG ABUSE Methadone is a synthetic opioid analgesic with multiple actions and side effects similar to other opioid compounds (such as Dilaudid®, heroin, morphine, codeine, Darvon®, Demerol®, Percodan®, etc.), the most prominent of which involve the central nervous system (the brain and spinal cord) and the structures composed of smooth muscle (intestines).  Although the potencies and specific adverse side effects of various opioids differ, the overall effect upon the brain and its vital centers, such as breathing, is as a depressant. Methadone alone or combined with other opioids or benzodiazepines may cause SEVERE SEDATION, RESPIRATORY DEPRESSION, WHICH CAN LEAD TO RESPIRATORY ARREST, CIRCULATORY COLLAPSE AND CARDIAC ARREST.  Fortunately, the absorption of methadone and other oral opioids via the gastrointestinal tract occurs over a few hours providing a warning period of impending respiratory problems such as an increasing shortness of breath or air hunger.  If you experience ANY BREATHING DIFFICULTY or if others notice you are overly sedated such as abnormal snoring, you MUST visit an emergency room for evaluation immediately.   Contact emergency service personnel and explain the situation, this may be LIFE THREATENING!  The treatment is use of naloxone (Narcan®), this will induce withdrawal symptoms but it may save your life. Oxycodone (OxyContin®) is a long acting narcotic.  Methadone is also a long acting narcotic.  Combining these two may be fatal.  Do NOT combine these substances for your own safety.  If you receive a prescription for this medication, you will be required to sign an authorization to release information to and receive from the prescribing practitioner.   Use of OxyContin® may result in the loss of take home doses and potentially a reduction in your dose of methadone until the clinic is convinced that your OxyContin® use has been discontinued. A positive drug screen for cocaine will lead us to assume cocaine was used.  Drug such as Lidocaine®, Benzocaine®, and Procaine®, do not cause drug testing to show positive for cocaine. An illicit drug screen result can potentially result in the loss of take home privileges and may result in six days per week attendance.  Continued illicit drug screens may indicate treatment failure and lead to administrative tapering or discharge from our program.  If you are unable to demonstrate a reduction in the harmful side effects of substance abuse within a reasonable time frame, you may be administratively discharged.  We will make every effort to assist you in preventing this outcome. Drugs that are generally detectable by drug screen used in our program are listed below.   Many of these substances interact with methadone and may cause serious, possibly even fatal, reactions. OPIOIDS                                 Bancap         Lortab                           Hycotuss           Percocet         Tussionex Codeine        Fiorinal w/ codeine        Methadone        Percodan        Tylenol w/ codeine Darvon         Heroin                           Novihistine DH  Propoxyphene Tylox Demerol        Hycodan                       Nubain              Robitussin AC  Ultram Dilaudid        Hycomine                      Opium               Roxanol           Vicodin Donnagel PGHydrocodone                Oxycodone        Stadol         Fentanyl        Hydrocet                      OxyContin         Talwin                              BARBITURATES                                 Amytal (amobarbital)       Dannatal      Nembutal        Seconal (secobarbital)         Butisol (butabarbital)        Fiorinal        Phenobarbital                                      BENZODIAZEPINES                                 Ativan            Dalmane       Serax            Valium         Klonopin        Halcion        Tranxene        Xanax                              STIMULANTS                                 Adderall                Cocaine         Cylert            Exstacy (MDMA)        Ritalin Amphetamine        Concerta        Desoxyn        Methamphetamine         WARNING:  Over the counter stimulants (white crosses, ephdra, ephedrine, etc.) may result in a positive drug screen for amphetamines and will be counted as illicit.  Certain herbals may test positive as benzodiazepines, these will also be counted as illicit. The use of any of the aforementioned substances will influence your take home status. Section Six—Clinic policies and Client expectations PROBLEM RESOLUTION The program director is the person responsible for the day to day operations of the clinic.   If you have a problem with any of the policies or procedures or any staff member of the program, you are encouraged to speak with the program director to resolve any misunderstanding or problem.  All conversations with the program director will be kept confidential up to the point where disclosure is necessary to conduct an investigation of allegations.  Problems concerning your treatment should first be addressed with your counselor, before being brought to the program director.   If a formal complaint is being made, this must be done in writing.  This should be directed to the program director but may be directed to the program sponsor who is ultimately responsible for all of the activities of the program.  This process can be initiated with any staff member if you desire assistance in completing the required form. We also encourage all clients to offer suggestions and recommendations on how we can better serve you and our community.  We provide a suggestion box with paper and pens for anonymous comments.  We also conduct semi-annual satisfaction surveys at which time comments are requested. TOBACCO Absolutely no smoking or any other use of tobacco is permitted inside the facility.  You may be asked to step outside to finish with a tobacco product.  We expect your cooperation with these requests. FEES Metro Treatment Center, Inc. is a privately owned treatment program.  We do not receive direct public funding.  Our program remains open only through client payments. All accounts are expected to be kept paid current.  Clients are allowed to maintain a balance of owing up to one week’s worth of medication.  Each billing and payment is recorded in the Client Management System.  You may request a balance history and review this with a counselor should you have any questions. All fees must be paid at the time of services. Fees as of August 1, 2006 are as follows: Intake/Admission fee for a new client:            $30.00 Admission fee for a transferring client               FREE Dosing fee per day until Phase 4                   $10.00 Dosing fee per day after Phase 4                     $9.00 Gas Chromatography/Mass Spectroscopy     $15.00 Pregnancy Test                                                $5.00 Onsite Drug Screen                                         $5.00 Extra laboratory drug screen                            $5.50 Delinquent accounts will be expected to be paid even if you as the client leave our program, voluntarily or involuntarily.  Past due bills may be handed over to a collection agency at our discretion.  An important aspect of your recovery is to accept the responsibility for paying for your own treatment in a timely manner. Only the program director may approve any variation to the normal payment/fee schedule.   Please do NOT discuss financial arrangements at the dosing window. MISCONDUCT Our program’s goal is to treat our clients with dignity and respect and help them to feel accepted.  In return we expect our clients to treat each other and our staff with respect as well.  Loitering, abusive language, threatening language, arguing with staff or with any client at the clinic will not be tolerated.  You are an adult, we expect you to act like it.  Be respectful of others at all times. Physical threats, assault, carrying or concealing any weapons WILL result in immediate dismissal (administrative discharge).  Any and all violations will be reported to the police department.  Charges will be filed if appropriate. Suspected or confirmed selling or distributing drugs to anyone around the facility will result in administrative discharge.  Selling, loaning, or providing methadone or any other controlled substance to anyone other than the client for which it is intended will also result in administrative discharge. Committing a crime on our premises or against staff or other clients will nullify your confidentiality with respect to providing demographic information to the police. If you are administratively discharged from our program for any of the above violations of conduct, readmission to our program at a later date may be denied at the discretion of the program director. PARKING Please be sure that you park in the appropriate parking spaces in front of the building.   Some spaces are reserved for neighboring businesses; please do not park in these spaces despite the time of day.   When leaving the facility, please do not “car hop” or visit with friends in the parking lot.   This is discouraged because it gives the impression of loitering to our business neighbors and it detracts from the professional atmosphere we are trying to maintain.  Furthermore, in the treatment community in particular, methadone treatment program such as ours have difficulty being accepted as well as our clients.  To help reduce the stigma of this type of treatment, please cooperate with our expectations of your behavior in and around our facility. DRESS CODE Please respect other as well as yourself and dress appropriately.  A general policy is “NO SHIRT, NO SHOES, NO DOSE”.  If you have questions regarding the appropriateness of an outfit, please don’t wear it.  Please refrain from wearing clothing with statements or implications about the acceptability of using drugs or alcohol.  This type of clothing may be counter-productive for some of our clients.  Please wear clothing that covers the important parts of your body to not be overly revealing.  Think “casual, yet professional”.  Shoes are important; the area around of the facility may have sharp objects such as glass or needles on the ground. TRANSFERRING If you are transferring from another clinic, we will need certain medical and counseling records from the previous program.  You will be expected to sign an authorization for the release of this information prior to beginning the intake process.  Not every client who requests to transfer into our program may be eligible based upon the previous programs rules. If you wish to transfer from our program to another clinic, we will cooperate to the best of our ability assuming you have not violated any of our rules.  We expect that you will have discussed this transition with your primary counselor prior to requesting the information be sent to a new clinic.  As a part of this process we expect you to participate in an exit interview so that we may learn better how to serve our clients.  All accounts must be paid to zero, prior to your records being released.  After leaving our program, if you request copies of your records, to get these copies, your account must be paid to zero before any copies will be made. TRANSIENT DOSING If you are enrolled in an opioid treatment program elsewhere and are going to dose as a guest at our facility on a temporary basis, all of these rules will apply to you as well.  Your eligibility for take-home doses will depend upon the information we receive from your home clinic. TRAVEL DOSING At your request, we will make appropriate dosing arrangements at a clinic near your destination.  Any request for travel mediation should be made at least a week in advance to allow for physician, state and federal approvals. Section Seven—For your information LEGAL OBLIGATIONS Parole, probation, pending cases, outstanding charges, etc. should be discussed with your counselor and/or the physician.  Information will not be release to any attorney, judge or court officer without your written consent or court order.  Since many probation/parole agreements require you to have weekly counseling, all such clients should anticipate seeing their counselor on a more frequent basis.  A judge may issue a court order for drug treatment; this does not include methadone treatment under most circumstances. RELAPSE Re-using after being drug free can be a temporary slip this is called relapse.  During treatment in our program, it is possible to learn skills and strategies to prevent temporary return to substance abuse.  For each client this experience will be unique.  Our counselors will work with you to prevent the spiral down that may start with relapse.  Your responsibility is to notify us honestly when you begin to think excessively about using illicit substances. DRIVING If you drive or have a job that requires good reflexes or precision, your abilities should not be impaired by your proper use of prescribed methadone.  Your methadone dose when take appropriately, will not affect motor control or motor skills, vigilance, concentration or thinking. FAMILY Your family has probably suffered as a result of your addiction.  At the same time, your family may be the most help for you in recovery.  The quality of your relationship with your family, especially your children, and the behavior you display towards them strongly influences the type of person they will be in the future. Studies confirm that the children of parents who drink alcohol and use drugs are at an increased risk of abusing alcohol and drugs themselves.  Therefore, it is important that you involve your family in your treatment since they may perhaps desire help learning to adjust to your new “recovery” behavior.  Your family is your emotional support system and important to your recovery.  This would be an excellent time to get your family involved in drug prevention. SEXUALITY Loving, caring relationships begin and grow once recovery begins.  Self-esteem and self- image are in a state of flux and are central to how you relate to your significant others.  No one likes to talk openly about a problem with intimacy, physical and mental abuse or sexual functioning, but trying to ignore the problem is a serious threat to recovery.  Methadone may have a side effect with both men and women that may negatively affect their ability to enjoy sexual relationships.  We encourage you to discuss any unsatisfactory aspects of intimate relationships with your counselor, your partner and/or our physician.  In many situations, these problems have solutions that our organization can help you with.  If you wish, we can also make a referral to an outside organization to help you investigate these problems as well. Thank you for allowing us to provide these services for you. BEST OF LUCK IN YOUR RECOVERY