Communicating our Opioid Treatment Policies to Patients
A member of the counseling staff will review the policies in person with each patient, making sure that patients understand them and will offer an opportunity for questions.
A member of the counseling staff will present a written agreement between provider and patient that explains policies and expectations of the patient.
The patient and provider must sign the written agreement.
A member of the counseling staff will review the policies with the patient again at the 2nd appointment.
Our practice will update policies as needed according to patients’ needs and behavior as outlined below.
Policies for Opioid Treatment Appointments
All patients must complete an initial evaluation to determine eligibility for Office Based Opioid Treatment (OBOT) in order to ensure appropriateness for level of care and ability of patient to engage in treatment recommendations. An evaluation does not guarantee a prescription will be provided.
Late for Appointments:
Patients who are more than 1 hour late for appointments must be rescheduled.
Review these policies with the patient each time they are late for an appointment.
Missed Appointments:
24 hour notice is required for cancellations. Later notice is considered a missed appointment.
Patients may miss 1 appointment without penalty. Staff will call to check on patient's status and reschedule.
A member of the counseling staff will review these policies with patients each time they miss an appointment.
Patient/Provider Contact
To reach your provider or a designated representative, please call our phone service at (803) 615-0001 and describe the nature of your problem. For all emergencies call 911.
Payment of Fees
Payment is accepted in the form of cash, credit or debit card.
The following are charges for initial and follow-up office visits for uninsured patients: $250 month.
Patients who have insurances we are out of network with will be expected to pay $250 a month, staff can provide a superbill that you can present to your insurance for a possible reimbursement if your policy has an out of network benefit (patient would be responsible for contacting their insurance company to find out if their plan offers an out of network benefit).
We do accept the following insurances: BlueChoice Medicaid, First Choice Medicaid, Wellcare Medicaid, Molina Medicaid, BCBS of South Carolina (includes the following plans: BCBS, Blue Choice, Planned Administrators, Federal BCBS), Tricare and Out of State BCBS plans (patients with out of state BCBS plans will have their monthly fee reduced to $150 a month).
We do not accept the following insurances: Medicare, United Healthcare and Cigna (Patients who have insurances we are out of network with will be expected to pay $250 a month, staff can provide a superbill that you can present to your insurance for a possible reimbursement if your policy has an out of network benefit (patient would be responsible for contacting their insurance company to find out if their plan offers an out of network benefit).
Prescription Policies
Office visits are required for renewal of prescriptions. Thereafter, prescriptions may be renewed regularly as long as patients attend scheduled follow-up appointments.
If your prescription is set up electronically on a day in which your assigned prescriber isn’t in the office, your assigned prescriber has up to 48 hours to send your prescription to your designated pharmacy.
Early renewal of prescriptions are permitted twice a year for travel purposes only.
Lost prescriptions or medications will not be replaced.
Requests for extra pills will not be honored.
Patients are limited to using one pharmacy for their buprenorphine prescriptions, we require that you select one pharmacy to fill all of your controlled medication prescriptions.
Patients who use more than one pharmacy will be warned for first instance. Further use of more than one pharmacy will result in discontinued treatment.
The patient is limited to one prescribing provider.
The Prescription Drug Monitoring Program will be checked for each patient at least monthly and more often for patients who have been non-compliant.
Patients who obtain buprenorphine from another provider/clinic will have their treatment at this clinic discontinued.
It may take up to 72 hours for Prior Authorizations when required. Please plan accordingly.
Treatment Policies and Expectations of Patients
This section describes policies for office based opioid treatment in this practice.
Patients are expected to adhere to the following expectations. Non-compliance will result in the consequences described below:
Treatment Goal: The outcome of treatment for most patients in this practice will be long term maintenance on buprenorphine.
Potential Benefits and Risks of Office-Based Opioid Treatment (OBT)
The potential benefits and disadvantages and risks that must be discussed with each patient include the following:
Potential Benefits:
1. Control of withdrawal symptoms when quitting opioid use.
2. Supports patients with opioid use disorder in quitting other opioid use.
3. Treatment can be conducted in an office-based setting (vs a methadone clinic).
Potential Disadvantages and Risks:
1. Patients become physically dependent on buprenorphine.
2. May experience some opioid-related side effects including constipation and, particularly when increasing dosage, mild sedation.
3. Potential drug interactions with other substances, especially sedating drugs and alcohol.
Substance Use
Patients will be instructed to stop taking other opioid medications unless specifically instructed to take it.
Patients are required to disclose the use of any psychoactive substance(s) to the provider.
This means the use of consciousness altering drugs including alcohol, narcotics, euphoriants, hallucinogens, marijuana, designer drugs whether illicit or licit.
If patients are discovered to have not disclosed the use of psychoactive substances:
Remind patients of the policy for the first instance and increase frequency of UDTs/alcohol tests.
Discontinue treatment if there is a second instance of non-disclosure of use of psychoactive substance.
Patients are required to avoid use of substances that may cause an adverse interaction with prescribed medications.
This includes psychoactive substances.
If patients are discovered to have used substance(s) with adverse interactions:
Remind patients of the policy for the first instance and increase frequency of UDTs/alcohol tests.
Discontinue treatment if there is a second instance with referral to a higher level of care.
Urine Drug Screening Policies
Baseline urine drug tests (UDTs) are required for all patients in the opioid treatment program.
Monthly UDTs are required for all patients.
Initially during the stabilization period, UDTs may be checked up to twice a month.
After stabilization, monthly UDTs will be performed throughout treatment for each patient in random fashion.
UDTs may be scheduled or unannounced.
The consequences of problematic UDT results include (*positive results of cocaine, heroin and fentanyl will result in immediate discharge with a recommendation to a higher level of care):
Staff will discuss the problem with the patient.
Patient will be placed on a behavioral contract for a period of 30 days.
Patient will be seen on a weekly basis by a member of the counseling staff, patient will have weekly urine drug screens and will receive prescriptions on a weekly basis.
Should a patient test positive for an illicit pain med, benzo or one of the ADHD stimulant medications, a member of the counseling staff will complete the appropriate screening tool to further determine if patient has any additional treatment needs that warrant further assessment by their assigned prescriber or referral to an outside provider.
Patients will be evaluated during the 4th week of their behavioral contract period to determine the following: if patient’s identified issues/symptoms have stabilized to support ending the behavioral contract; extending the behavioral contract for an additional 30 days for further evaluation/monitoring; referral to a higher level of care is needed.
Taking Medication as Instructed
Patients are required to take medication as instructed by the provider, for example, they may not crush or inject the medication.
If patients take medication other than as instructed:
Discuss the problem with the patient for the first episode.
Discontinue treatment with 2nd episode.
Patient dose changes are not permitted without consulting the provider.
If patients change their dosage on their own:
Remind the patient of the policy for the first episode.
Discontinue treatment if there is a 2nd episode.
Safe Storage and Non-Sharing of Medications
Patients must agree to safe storage and non-sharing of medications.
Patients who share medications will have treatment discontinued immediately.
Patients who lose medication due to unsafe storage will be reminded of the policy for first instance, and have treatment discontinued if there is a second instance.
Mandatory Follow-up Visits
Patients must return for follow-up visits as scheduled.
After the dose is stabilized, follow-up visits will be at the very least monthly.
Criteria for Considering Treatment Successful
1. No intoxication from any substance use
2. Physical, psychosocial, and work-related functioning improved
3. No suffering from withdrawal
4. No experience of drug cravings
5. Following treatment protocol
6. Adherence to treatment agreement
7. Adherence to the treatment agreement and treatment plan
Relapse Policies
Relapse to using opioids will not be grounds for stopping treatment the first time, but treatment structure will be increased, including more frequent appointments.
A second episode of using opioids will result in the addition of further additional treatment structure, such as involving a third, responsible party.
A pattern of non-compliance with treatment plus continued use will result in discontinued treatment.
If patients stop taking buprenorphine, they can have reinduction after an office visit where a revised treatment agreement is signed.
Patients who have been dismissed from treatment and return with new motivation can be re-tried at provider discretion with increased treatment structure.
Pill Counts
Periodic pill counts are required of patients who are described as high risk at the initial or subsequent appointments.
Schedule of pill counts: Twice per year, unannounced.
Please bring buprenorphine medication bottle with you to each office visit.
If the results of the pill count are problematic or if the patient fails to comply:
Discuss the problem with the patient for the 1st episode.
Discontinue treatment if there is a 2nd episode.
Counseling and Other Treatments
Counseling and other treatment participation is required as part of Office Based Opioid Treatment.
Alternative options for counseling:
Patients can attend 12-step or Celebrate Recovery meetings within their community.
Patient Conduct
Behaviors that will result in permanent dismissal from treatment include threatening language or behaviors, illegal activity including: diversion, or carrying weapons.
Other behavior that will not be tolerated:
Arriving intoxicated for appointments
Disruptive behavior
Sustained payment problems
Consequences for these behaviors include the following:
The patient will not be seen until the next regularly schedule appointment for the first episode.
Discontinue treatment at 2nd instance.