Winchester Health
1315 Bloomingdale Rd
Baltimore MD 21216
After Hours Emergency Phone Number:
(410) 624-7111
Guest Dosing
Winchester Health LLC welcomes patients visiting the area and in need of guest dosing services.
In preparation for guest dosing, each patient’s home clinic will need to contact us via phone / fax prior to arrival at Winchester Health.
Each patient’s home clinic MUST fax a signed copy of a guest dosing request form including the signature of the Medical Director. A minimum of 7 days advanced notice is required.
Please feel free to contact us for the required paperwork, fee, or if you have any aditional questions.
Revised May 2016
Welcome to our facility. Winchester Health is a private, outpatient clinic devoted to the treatment of chronic opioid dependence. Chronic opioid dependence is a long-term addiction to prescription opiates or heroin. Opiate addiction is a disease of the brain. It can be frightening for the individual and their loved ones. At Winchester Health, treating opiate addiction is our specialty. We have found that “medication assisted treatment”, using medications such as methadone and Suboxone, is a safe, proven, and effective treatment for opiate addiction.
Our Role & Your Role
Our treatment center will help you by providing a confidential, positive, respectful, and welcoming environment. We will give you medical, psychological, and social support, along with education and specific tools and skills to help you make life-long, healthy decisions and to manage the chronic disease of addiction. Yes, your work will be difficult—perhaps the most difficult work you’ve ever encountered—and present you with many challenges. Be assured that we will be there supporting you and your loved ones each and every step of this journey. You can regain your hope, faith, and health, so you can realize your potential and accomplish your life dreams.
You may be worried about the outcome of your treatment and the years ahead, which frankly you should be. It should come as no surprise that treatment of any chronic medical disease or condition is difficult. For example:
• 50% of adult-onset diabetes and high blood pressure is preventable; 80% of the blindness and amputations associated with adult-onset diabetes are preventable.
• Less than 30% of high blood pressure patients stick with the diet, exercise, and lifestyle recommendations of their doctors.
• Less than 30% of asthma patients and 60% of high blood pressure patients take their medication as prescribed.
What is a common theme regarding these poor treatment outcomes? Usually, such negative outcomes result from poor treatment compliance. Over time, there is a natural human tendency for people to not follow their treatment plans. There are similar results for addiction treatment:
• Less than 40% of addiction patients follow their treatment plan within 6 months of completing initial treatment.
• 50% to 60% of addiction patients relapse within 6 months of beginning treatment.
How can you (with our support) improve your chances to succeed? First, we are going to give you and your family support system a comprehensive, detailed assessment in order fully to understand your addiction, treatment history, medical and psychological status, support systems, occupational/school history, current status, and legal problems, if any. Then we will work with you to design an individualized initial treatment plan to address issues identified; this will help stabilize your addiction and assist you in working through problems in your life that are likely to sabotage your recovery and potentially result in relapse. We will provide you and your support system with important education about addiction and what helps and hurts your recovery. With your input, we will continue monitoring your progress during the initial treatment phase and work with you to adjust your treatment plan along the way. After initial treatment helps you to stabilize your symptoms, we will assess your ongoing progress to ensure that the stage is set for your life-long recovery.
Medication Assisted Treatment
Medication assisted treatment is often the beginning of change for an individual who has been suffering from opiate addiction. However, recovery will not occur with medication alone. Individual and group counseling are required and integral components of treatment. Additionally, our clinical staff provide referrals for additional services beyond the scope of our practice to ensure all individual needs are met. Each person choosing treatment with Winchester Health will be evaluated by our medical and clinical staff to ensure that they receive the best possible individualized treatment, as the length of time in treatment and program elements vary from person to person. Individuals are reevaluated frequently during the treatment process to ensure that the most appropriate level of care is provided.
Beginning Treatment
In the beginning stages of treatment, daily attendance is required. Regular daily medication appointments normally take 10 minutes or less. Early morning dosing hours are available so that patients can maintain employment and other activities of daily living. Appointments for individual counseling are conveniently scheduled and normally last 45 minutes. Group counseling sessions are offered in a variety of topics and psycho-educational areas to provide opportunity for personal growth and sober support development. As you progress in treatment, attendance requirements may be reduced through earning take home medication privileges.
You will be assigned a primary counselor who will meet with you to look at needs and define goals for your treatment. During this meeting, you and your counselor will create a personalized Treatment Plan. This plan will form the road map for your treatment process.
Our goal for you is to develop a program of recovery from the effects of opiate addiction. To this end, we expect you to dedicate yourself to this goal as well. One of the most important ways you demonstrate your commitment to recovery is by attending all program functions and appointments as scheduled.
This patient handbook has been designed to assist you in understanding our program and what is expected of each patient. Please take some time to review it. Your counselor will also review the handbook with you as a part of your orientation.
In order for the program to work best, all patients are expected to follow established rules and regulations.
Your Team
Your care is delivered using a multidisciplinary team approach. Your team meets weekly at a team conference, to discuss your treatment needs and goals. The team continues to meet every week to talk about your progress and to adjust your plan as necessary.
Your treatment team consists of the Medical Director, Medical Staff, Nursing Staff, Clinical Staff, and Administrative Staff who work at our facility. Any team member can be reached by calling our office at 410-484-8500.
Code of Ethics
Winchester Health has a written Code of Ethics which defines standards of conduct for personnel, business, marketing and professional ethics. A copy of the code is available upon request.
Dispensing Hours
Monday through Friday 6:00 am to 10:00 am
Sunday 6:00 am to 10:00 am
Saturday CLOSED
Holidays
The following holidays may be recognized by the clinic:
New Year’s Day
Martin Luther King Jr. Day
Memorial Day
Independence Day (July 4)
Labor Day
Columbus Day
Veterans Day
Thanksgiving Day
Christmas Day
Take-home doses will be provided to patients who are determined stable and where the benefits of take home medication outweigh the risks of diversion. The Winchester Health Medical Director will determine what patients are appropriate for holiday take homes.
Emergency Preparedness
Winchester Health has specific clinic plans and protocols that will be initiated and followed in the event of disaster. Diagram of the location of all exits, fire suppression equipment are located conspicuously throughout the clinic in public areas such as hallways, etc. In the event of a natural disaster emergency, please contact the after-hours emergency cell phone at (410)-624-7111 to determine whether our facility is open for medication dispensing.
Severe Weather
During winter months, the clinic MAY close when hazardous driving conditions are forecasted more than 24 hours in advance. In cases of closure, take home medication will be provided to all patients. The clinic answers its emergency phone 24-hours a day, seven days a week. If you are in doubt about the clinic being open, call the clinic. During severe weather, the clinic will likely reduce its hours.
Program Fees
All current fees are posted in the Business Office. The program fee is charged even if you fail to come to the clinic. Our fees are based on a weekly charge and include required counseling and testing. Only excused absences (incarceration & overnight hospital stays) will not be charged.
General Information about Medication Assisted Treatment:
Medication Assisted Treatment utilizes federally approved synthetic opioids. Synthetic opioids and similar opioids are addictive. Federally approved synthetic opioids eliminate the physical reasons for the continued use of illegal opioids for the following reasons:
1. Inhibits the sickness that results from the withdrawal of other opioids.
2. Reduces the craving for other opioids.
3. Effective from 24 to 36 hours and the medication is free of contaminated substances.
4. On the initial day of treatment, patient must sign consent forms authorizing Clinic staff to confer with any medical or psychiatric provider regarding appropriate medical care.
Pregnancy:
Medication assisted treatment during pregnancy may result in unknown risks to the patient and unborn child. Female patients are oriented and educated to inform a clinic staff member immediately if she becomes pregnant, or suspects that she may be pregnant. Female patients of child bearing age may be pregnancy tested at admission and appropriate intervals during treatment, as clinically indicated. In addition, female patients will be pregnancy tested immediately prior to initiating a voluntary or involuntary medically supervised withdrawal. If the result of the pregnancy test is positive, the patient must have a physical examination by the clinic physician or designee within 14 calendar days. The clinic physician must certify that the patient may remain on the Maintenance Program, and if the patient is currently undergoing Suboxone treatment, the Clinic Physician will immediately transition her to Methadone treatment.
Medication:
1. Patient identification will be verified according to established clinic procedures before receiving the medication.
2. Initial dose of medication will be supervised by a Clinic Physician or appropriately designated medical staff. This information will be recorded in the patient's records.
3. Clinic Physician or appropriately designated medical staff will regulate the patient medication levels.
4. Medication must be swallowed under the direct observation of the clinic’s medical, nursing staff.
5. Medication may be withheld or dosages decreased if medical staff have appropriate evidence that the patient is intoxicated or under the influence of other drugs.
Nausea or Sickness:
If you are experiencing nausea (upset stomach) either before or after ingesting medication, we ask that you remain in the Clinic area for 30 minutes for observation and medical monitoring. If you vomit after taking medication, please notify a staff member. In this event, the medical staff has the option to re-medicate if deemed safe and appropriate. You may be required to have a medical examination. We cannot re-medicate patients if vomiting occurs after leaving the clinic grounds.
Drug Analysis Specimen Collection:
1. Specimens for drug analysis, urine, oral fluid, etc. will be provided upon request according to Policies and Procedures and State and Federal Regulations and will be collected by designated clinic staff.
2. Specimens will be analyzed for unapproved substances as defined by Policies and Procedures, and State and Federal Regulations. Positive test results and / or negative results for the medication administered or dispensed will be considered an unapproved analysis and may result in the loss of all / or some take home or other privileges.
3. Failure to provide an adequate specimen for drug analysis will be considered as an unapproved result and may affect take-home status or other privileges.
4. Attempts to alter a specimen for drug analysis may result in the removal of all / or some take-home or other privileges.
5. A specimen for drug analysis may be requested the day following an absence or at any time during treatment.
Patients have the option to elect, at their cost, to undergo an oral swab drug screening instead of a urine drug screening.
Frequency of Drug Analysis Specimen Testing:
Winchester Health does random urine drug testing monthly for all patients. Patients who consistently test positive for illicit drug use will be placed on weekly testing. These “extra urines” result in additional fees. To discontinue weekly UDS you must test free of illicit drugs three weeks in a row. If you are not able to submit a urine screen at time of request, mouth swabs will be given at a $25.00 fee for each, which is your responsibility to pay unless the request is made by Winchester Health staff.
If you refuse a requested monthly drug screen, it will be documented as positive and another urine screen will be scheduled within that same month.
Drug Analysis Specimen – Confirmation Request
False positives and false negatives are very rare, but do occur. For this reason it is essential that you obtain the results of your last urine screen as soon as they are available. If you question the results, the lab can run a confirmation test if there was sufficient urine in the sample provided. This request may only be requested under the following conditions:
1. The request is made within two weeks of sampling.
2. The patient is willing to pay a re-test fee of $25.00 in the event that the original results are confirmed. There is no charge in the event that the lab erred on the initial test.
Prescription/ Over the Counter Medication
It is your responsibility to report All Medications you are currently taking or that are prescribed at any time during your treatment. The purchase of any non-prescription medications at any time during your treatment must also be reported. This includes prescription medication that is prescribed by a physician, over-the-counter medications (these are medications you must purchase by obtaining from behind the counter at a pharmacy), and any non-prescription medications (such as cold medicines, cough syrups, herbal supplements, vitamins, etc…). All medications should be reported to nursing and to your counselor on the next visit to the clinic.
We advise that you first check with our MD or nursing staff for any possible side-effects before purchasing any medications. Legitimate prescription medications present in urines are considered negative for illicit use. In order to be legitimate, documentation must be presented before the medication is taken stating the need for each prescription. Even with a prescription, the Medical Director reserves the right to disallow any prescription determined to be inappropriate, regardless of documentation provided. Misuse of prescription drugs is considered the same as illicit drug use.
Benzodiazepines
Benzodiazepine medications, such as Diazepam (valium), alprazolam (xanax), Clonazepam (klonopin), and Lorazepam (ativan), can interfere with methadone and have serious side effects, including accidental overdose or death. It is critical that all use of benzodiazepines be reported to the program staff so that we may monitor you to ensure an appropriate and safe dose of methadone.
In addition to prescription medication, you should report the use of any over-the-counter medication to the dosing nurses to ensure that the medication does not have any negative interaction with methadone or Suboxone.
Illness or Hospitalization
You are encouraged to report any illness to the clinic staff. When appropriate, an appointment will be made with the clinic physician. In the event of a medical emergency, staff will assist with any referrals necessary.
If you will be hospitalized for any reason, we encourage you to inform the Clinic staff in advance. In case of an emergency hospitalization, you should try to have a physician or hospital staff member contact the clinic for continuity of care. Upon discharge from the hospital, please be prepared to present discharge paperwork that includes diagnoses, treatments received, length of stay and medications administered and/or prescribed.
Confidentiality of Patient Records:
Federal and state laws protect the confidentiality of patient records maintained by each CTC Program. Staff will neither divulge nor confirm your status to any person or entity; neither will they disclose any information identifying you as having associated alcohol or drug abuse problems, unless:
1. You consent in writing.
2. The disclosure is mandated by a court order signed by a judge
3. The disclosure is made to medical personnel in a medical emergency or to qualified staff.
4. For research, audit or clinic evaluation purposes
5. Federal and state laws require “Duty to Report” information about suspected child abuse or neglect, and / or elder abuse and the clinic staff will adhere to these regulations. Suspected violations must be reported.
6. You present as a threat to yourself or others.
7. Federal laws and regulations do not protect information about a crime committed by a patient or any threat to commit such a crime.
See 42 U.S.C. 290dd-2 for federal laws and 42 CFR Part 2 for federal regulations.
Attendance
At Winchester Health, all patients are expected to arrive on time for all scheduled appointments including counseling and medication appointments. Any absence without prior permission is considered an unexcused absence.
Automobiles
Please ensure you park in designated parking areas.
Contraband Items
The following are examples of items considered contraband and are not permitted on the premises
• Drugs, both illicit and over-the-counter
• Liquor, beer or wine.
• Weapons of any kind...definition of "weapon" determined by staff, but is inclusive of pocket knives.
Dress Code
We expect that you will attend appointments in casual attire suitable for visiting a professional office. However, the following guidelines are enforced:
• Shirts and Shoes must be worn at all times.
• No pajama wear is permitted.
• Hats and sunglasses are not permitted inside the clinic.
• Any clothing judged by the staff as sexually suggestive, promoting drug culture, or other illegal activity may not be worn.
Pets
All pets, with the exception of service animals, are prohibited on facility grounds.
Smoking
Smoking is not permitted on the property at any time under any circumstance. PLEASE do not litter the outside areas with cigarette butts or other items.
Telephone Use
Patients are not permitted to use Winchester Health phones unless with a counselor in accomplishment of treatment goals. Please refrain from using your cell phone within the building.
Visitors
Due to the nature of our work, please do not bring visitors/guests to the building without an appointment. All individuals visiting our facility are required to sign the facility confidentiality log and agree to our confidentiality policies.
Violation of Program Rules
Violating the rules and expectations of the program creates problems for the staff as well as other patients. Each patient is reminded that the road to recovery begins with compliance, which can mean many things. While in treatment with Winchester Health, compliance begins with following program rules and expectations, and it is your responsibility to know what these are.
Discharge Planning
Discharge planning begins as soon as you enter treatment to facilitate thinking toward long-term goals as you settle in to the daily structure to revamp your life. During treatment, skills are taught to increase your ability to manage life’s challenges and joys without the use of alcohol or drugs. Your primary counselor will meet with you to help plan for discharge. Lists of community resources that may be helpful are also made available.
Discharge Against Medical Advice (AMA)
No one will be forced to remain in the program. However, should you determine that you wish to leave the program before a time the staff has determined is appropriate, you MUST see the physician before any taper will begin.
Involuntary Termination:
The following can result in involuntary termination from the Clinic:
1. Registration in more than one program *
2. Misuse or sale of medication
3. Selling drugs on clinic premises
4. Abuse of drugs or intoxication
5. Possession of alcohol on clinic premises
6. Violence or threats of violence to clinic staff and / or patients *
7. Possession of weapons on clinic premises
8. Consistent loitering on clinic premises
9. Alteration of specimens for drug analysis
10. Non-payment of fees
* Violations 1 and 6 can result in immediate discharge from the treatment program.
Patient Fair Hearing Procedure:
Every patient who has received a notice of involuntary termination from the Clinic has the right to request a Fair Hearing. If, at any time during your treatment, you desire a Fair Hearing, a written request for a hearing must be submitted to the Executive Director / designee within 48 hours of receiving a notice of termination. A Fair Hearing request form may be obtained from the clinic staff. Your treatment will continue uninterrupted pending the outcome of the Fair Hearing decision.
Hearings will be held within seven (7) business days from the time you request a hearing. The Executive Director / designee and treatment team will conduct the hearing. At the hearing, you may be represented by a lawyer or other person of your choice. You may call witnesses on your behalf and may question witnesses presented by the Clinic. In such instances the you have the right to use an Advocate (National Alliance of Methadone Advocates - “NAMA”) or other representatives and witnesses. The clinic will provide treatment information upon request to you or your representative with appropriate signed consent. This information will be provided 48 hours prior to the hearing. You must present a signed consent for release of information. The treatment information to be released needs to have the approval of the clinic physician and/or Executive Director.
In order to terminate a patient, the Fair Hearing Panel must conclude that the reason for termination is true and accurate and coincides with the reason for termination given in the notice to the patient. The Fair Hearing panel's decision will be rendered no later than one (1) working day following the hearing. The decision will be in writing and a copy of the decision, as well as, the record of the proceedings will be maintained in the designated clinic administrative records and made available to the patient upon request.
Patient Responsibilities:
While you are a patient at Winchester Health, it is your responsibility to:
• Provide accurate and complete information about your past illnesses, hospitalizations, medications and other matters relating to your health.
• Tell staff members if you do not understand your treatment or what you are expected to do.
• Tell staff members if there is a change in your condition or if problems arise during your treatment.
• Be courteous and considerate of other patients and of clinic staff.
• Keep your emergency contact information up to date so that staff may contact you if necessary.
Patient Rights
We would like to assure you that we will do everything possible to make your treatment experience as comfortable and productive as possible. To this end, we have adopted a Patient’s Bill of Rights. You can expect that you will always be treated with dignity and respect by all of those who work at this clinic and you may be assured that your human rights will be protected.
Winchester Health values advocating for and protecting the rights of patients and will adhere to all applicable Federal and State Regulations regarding the rights of the patients. We do not discriminate in the provision of services on the basis of age, gender status, race, creed, sex, ethnicity, color, national origin, marital status, sexual orientation, handicap, or religion. You will be informed, in writing, at the time of admission of the following rights in a language you understand. A copy of these rights is being provided to you in this patient handbook. These rights will be discussed during orientation and will be posted in the clinic, and read as follows:
As a recipient of services at Winchester Health, I have the right:
1. To be informed of my rights during admission or orientation to treatment, whenever the agency makes a change to my rights, and upon verbal or written request.
2. A receipt of this information shall be documented by my signature and filed in my clinical record. If I am unwilling or unable to sign it will be recorded.
3. To be provided services in the least restrictive environment. To know the recommended level of care for my treatment and as indicated by my presenting problems and to be provided a referral to alternate treatment services when indicated.
4. To not be discriminated against in the provision of services on the basis of age, gender status, race, creed, sex, ethnicity, color, national origin, marital status, sexual orientation, handicap, religion or source of payment. In addition, to exercise my rights without fear of restraint, interference, discrimination and reprisal.
5. To be informed in a language that I understand.
6. To be informed about what to expect in the treatment process, and to refuse any treatment, procedure, or medications, to the extent permitted by law and to be advised of the potential risks and impact on my treatment process.
7. To be informed of the cost of services rendered to me and to my family as soon as the information is available.
8. To receive a copy of the patient handbook, which contains the guidelines for treatment including program rules, services provided patient rights, etc.
9. To take an active part in the planning of my individualized treatment plan and aftercare activities as well as consider referrals to other services if I am inappropriate or ineligible for treatment at the present level of care. I may refuse treatment or any procedures or specific medication that is unusual, hazardous or experimental.
10. To request a review of my treatment plan at any time during treatment and to obtain the opinion of a qualified outside consultant regarding my treatment at my own expense if I so desire.
11. To know the benefits, risks and side effects of all medications and treatment procedures that may be prescribed and to be appraised of alternative treatment procedures.
12. To have competent, qualified, experienced clinical associates to supervise and carry out my treatment and the opportunity to select a counselor of my choice, to the extent possible.
13. To expect confidentiality from all staff and associates with respect to my identity, diagnosis, prognosis and treatment.
14. To not be requested to perform services for Winchester Health, which are not stated as part of my treatment plan. I understand I will not be allowed to perform services in lieu of treatment fees.
15. To obtain copies of all consents that I sign. Either the counselor or the Executive Director will honor verbal requests for copies of consents within 24 hours.
16. To protection from harassment by any outside agency or person while on the premises. Winchester Health will exercise confidentiality laws to the fullest extent.
17. To air grievances and initiate appeals. I have been informed of the patient appeals procedures. I understand that the grievance procedures will be posted within the clinic. I will receive decisions to my grievances in writing and have the right to appeal the findings to unbiased sources.
18. To inspect my records subject to the limitations outlined in policy titled “Patients right to record access.”
19. To not be restrained or secluded; however, in the event my behavior becomes unruly or a threat to the health of other patients or associates, proper authorities may be contacted to remove me from the clinic. I will not be deprived of any civil right solely by reason of treatment.
20. To NOT be subjected to:
o Physical abuse, sexual abuse, or harassment and physical punishment
o Psychological abuse, including humiliating, threatening and, exploitive actions
o Financial exploitation
21. To receive services in accordance with standards of professional practice appropriate to my needs.
22. To be afforded reasonable opportunity to improve my condition.
23. To receive humane care and protection from harm.
24. To exercise my constitutional, statutory, and civil rights that have been denied or limited by an adjudication or finding of mental incompetence in a guardianship or other civil proceeding. [This does not validate the otherwise viable act of an individual who was: (1) Mentally incompetent at the time of the act; and (2) not judicially declared to be mentally incompetent.]
25. Before being asked to consent to participate in a research project, to be informed of the following:
o The benefits to be expected;
o The potential discomforts and risks;
o Alternative services that might benefit them;
o The procedures to be followed, especially those that are experimental in nature;
o Their right to refuse to participate in any research project without compromising their access to the agencies services;
o The treatment being proposed;
o Elements of the proposed treatment that are considered experimental research or a clinical trial;
o Methods of addressing privacy, confidentiality and safety;
Right to File a Grievance
Should you feel that your rights have been violated or that the clinic has in someway treated you unfairly, you have the right to file a grievance.
The grievance procedure is as follows:
1. The patient is encouraged to first talk with the counselor.
2. If not resolved, the patient may request, in writing, a meeting with the Clinical Supervisor and/ or Program Director
3. This meeting must occur within three (3) working days; the Clinical Supervisor must respond, in writing, within 24 hours.
4. If not fully resolved the patient may then file a written formal grievance and submit a signed copy to the Executive Director.
5. The Executive Director must meet with the patient to review the grievance within two (2) working days. The Executive Director must respond, in writing, within 24 hours.
6. Patients have the right to bring witnesses or Patient Advocates to the meeting with the Executive Director.
7. If the patient is not satisfied after this step, (the grievance remains unresolved) the patient may elect to forward the grievance to the Vice President of Operations.
8. The Vice President will review grievance documentation with one week of receiving a grievance. Members may elect to make a decision based on documents reviewed or may elect to interview you in person or by telephone. The Vice President will render their decision within one week of reviewing the grievance.
9. Decisions of the Vice President are final.
10. If you filed a grievance at the clinic and still would like additional assistance, the state patient advocate is available to assist with any possible grievances.
11. All patients have the right to fair and equal treatment without discrimination. Patients are informed of their right to take any complaint that they may have to a counselor or to the program’s Executive Director without fear of any negative consequences. Should you find it difficult to file a complaint, you can ask for assistance from any Winchester Health employee or advocate (NAMA or ARM) or other person who will further explain the process to you and/or will help you file my your grievance. You may also contact the human rights advocate.
National Alliance of Methadone Advocates (NAMA)
435 Second Avenue, New York, NY 10010
212-595-NAMA
www.methadone.org
Advocates For Recovery Through Medicine (ARM)
P.O. Box 90337, Burton, MI 48509
Patient Input
We include input from those we serve by keeping a SUGGESTION BOX in the lobby and by regularly soliciting feedback through SATISFACTION SURVEYS. Please use the Suggestion Box without fear of reprisal or other negative consequences. We also hope you will provide critical feedback on each SATISFACTION SURVEY.
Take Home Policy
Take-home privileges are only permitted when they provide rehabilitative benefit to the patient, either by allowing the patient to more easily attend school or maintain employment or to serve as incentive to continued work in treatment. Patients must have attended the clinic for a minimum of three consecutive months before consideration of take-home status.
Based on counselor recommendation, take home doses can be less than the maximum number approved for a phase. Negative UDS must be consecutive time frames.
Take-home medication will only be given when the following 8 point criterion is met:
• There is an absence of recent abuse of drugs, including alcohol as evidenced by three consecutive (3) urine screens;
• Expected attendance of counseling per month has been documented;
• There have been no incidences of behavioral problems for a minimum of 91 consecutive days at the clinic;
• There is no record of recent criminal activity;
• There is stability in the patient’s home environment and social relationships;
• Patient has been continuously in treatment for the prescribed lengths of time.
• There is assurance that take-home medication can be safely stored at the patient’s home; and
• The patient’s counselor determines that the rehabilitative benefit to the patient from take-home status outweighs daily attendance at the clinic and that there is minimal risk of diversion.
Orientation - 4 groups
****Required contacts are based on individual patient needs and can be increased at any time.
Take Home Medication and Lock Boxes
Be sure that you have a locked box to use for any take home medication doses you receive from our facility. Patients are not permitted to share lockboxes; this can result in the removal of take home privileges. If an accidental poisoning occurs, call the POISON HOTLINE at 1-800-222-1222. This hotline will give directions on what to do if an accidental taking of the medicine occurs.
Take Home Bottle Return
When take home medication is dispensed, we require that all bottles are returned next appointment day. Take home bottles should be returned to the facility utilizing your lockbox. While we recognize this is an inconvenience, it is one of the ways we assure federal and state authorities that we prevent diversion. Failure to bring your empty bottles may result in your being sent home to retrieve them. Additionally, failure to return take home bottles may result in a loss of take home privileges.
Take Home Call Back Policy:
The following call-back procedures have been implemented for those patients receiving take home medication.
1. Patients who receive 2 or more take homes per week on a regular basis will be randomly called at least two times per year. Please Note: It is the patient’s responsibility to ensure Winchester Health has the most up to date contact information. Patients will be held responsible for callbacks that are failed due to inability to be reached via phone or voicemail.
2. Upon receiving a call back, patients must return to the facility with all bottles intact and accounted for within 24 hours. A patient may also be requested to provide a urine drug screen, oral fluid screen, and/or breathalyzer during the call back procedure.
3. In the event of a failed call back, patients should schedule a meeting with their counselor within 5 business days to process the failed callback. Out of respect for other patients and clinic operations, please do not attempt to process call back failure with nursing staff.
Failed call backs are classified in two different categories, and can result in the loss of take home privileges as follows:
1. Diversion: manipulating medication, tampering with bottles in any way, drinking bottle before coming in and/or altering bottle with other substance
a. 90 days
2. Not returning a message left by staff or the patient did not update contact information
a. 30 days the first occurrence
b. 60 days the second occurrence
The Winchester Health treatment team reviews all patients who receive take home medication on a regular basis. Issues related to drug or alcohol use, current employment and educational status, compliance with fee payments, attendance and participation in counseling sessions, safety of his/her home environment, criminal involvement, involvement with drug users, stability of home life, etc., are examined at this time. If there are significant concerns with any of the above criteria or if there are any other elements of concern, take home privileges can be suspended or revoked as appropriate based upon your need.
For Exceptional Take Home Privileges
1. If you are certified to have a physical disability found to interfere with your ability to conform to the applicable mandatory schedule, a temporary or permanent reduced schedule of attendance may be granted.
2. In cases of exceptional circumstances, such as illness, personal or family crisis, travel, or other hardship found to interfere with applicable mandatory schedule, a temporary reduced schedule of clinic attendance may be granted.
In both cases, the rationale for an exception to a mandatory schedule, based on the reasonable clinical judgment of the program physician, must be entered into the record. In order to be certain take-home medication is needed and is handled responsibly, we will require that the need for each take-home dose be fully documented. Failure to adequately document the need for an exceptional take-home dose will jeopardize future requests. Travel related doses will be documented with gas, restaurant, hotel and similar receipts; work related doses by pay stub, etc.
Requests for vacation and other travel related take out medication must be presented to the counselor AT LEAST TWO WEEKS IN ADVANCE.
Common Causes To Restrict Take Home Medication Privileges:
1. Patients who submit a specimen that has tested positive for illicit drugs and/or negative for the opioid medication administered or dispensed by the program may lose take home privileges.
2. Unexcused absences from, or missed scheduled appointments or sessions with, the program
3. Unexcused clinic absences.
4. Sharing, giving away, selling or trading the medication administered by the program.
5. Incarceration
6. Attempts to register in another opioid treatment program
7. Attempts to alter a test or analysis for illicit drug use.
8. Unacceptable clinic behavior may result in the loss of take-home medication privileges and / or discharge from the program.
Reinstatements
Foremost, there MUST be a negative UDS before any take-home privileges can be returned
If you lose all take homes due to noncompliance with 8 point criteria, you must wait 30 days before being able to be presented for re-evaluation of take-home privileges. In those 30 days, you must demonstrate compliance with all criteria including negative UDS and counseling compliance. Patient reinstatement of Phase levels will be based on treatment team recommendation and state and federal regulations
***Although these are guidelines, the treatment team has final discretion on rescinding and reinstating take home privileges.