Controlled substances are those that are closely controlled by local, state, and federal government.
I understand that the long-term use of such substances as sedatives (Ambien, Lunesta), benzodiazepines(Xanax, Klonopin), and stimulants (Adderall, Ritalin) is controversial because it is not certain whether they help patients over the long-term. Patients who are prescribed these drugs have some risk of developing an addictive disorder or suffering a relapse of a prior addiction. The extent of this risk is not certain.
I understand that dependence is not the same as addiction. Many people who take controlled substances daily will become dependent on them. Dependence is when your body adapts to the medication and then experiences withdrawal if the medication is stopped or lowered too quickly. Withdrawal symptoms can include moodiness, ache, and pains, sweating, diarrhea, abdominal pain and even seizures.
I understand that addiction is not the same as dependence. While many people become dependent on daily opioids, only a small percentage of these people will become addicted. Addiction is characterized by behaviors such as loss of control of drug use, compulsive use, and craving, and continued use despite harm or risk to the person.
I understand that if I am prescribed controlled substances, I should not increase the dose or stop the medication unless asked to do so by their provider or their covering associate.I understand that I must follow through on appointments and other non-medication recommendations.These may include counseling and other mental health practices and use of positive airway pressure.Consistent failure to keep these appointments and therapies may result in the stopping of the controlled substance medications or possibly discharge from the practice. No refills will be given during holidays, at night or on weekends.
I understand that early refills will not be given unless approved by my provider.
I understand that I will not tamper with or change a written prescription and understand that is a felony to do so.
I understand I will not share, exchange, or sell my controlled substance medications, as the law prohibits those actions. I understand that my provider will report serious concerns of drug misuse to authorities for investigation.
I understand that I take another person’s-controlled substance (prescribed either by Pacific SleepProgram or another providers office), I will be discharged from Pacific Sleep Program and may be reported to the authorities for investigation.
I understand I will not use illegal/street drugs when using controlled substance prescribed by PacificSleep Program. Patient will not use other controlled substance medications for sleep unless prescribed by the provider.
I agree to provide samples for random drug testing when asked. If I fail to provide the sample when asked or is the results are unsatisfactory, I may forfeit the right to continue receiving the medication and possibly be discharged from the practice.
If my provider is concerned that I might have a substance abuse problem, I must agree to an evaluation by a specialist in abuse/addiction. If the evaluation suggests I have a drug abuse problem, my provider may stop my medication in a way that does not cause withdrawal symptoms.
I recognize that controlled substances by themselves, in combination with alcohol or in combination with other medications can result in unclear thinking and loss of coordination. I agree to contact my provider if these symptoms arise. I should not drive or operate equipment if I have these side effects.
It is my responsibility to keep my medication safe. If controlled substance medications are lost, damaged or stolen, the medication may or may not be refilled early. Each case will be looked at individually. If the medication is stolen, I must file a police report and submit the number for verification to my provider’s office. Again, stolen medications may or may not be refilled. If a refill is given, it will be given only once.