Controlled Substance Agreement

Controlled Substance Agreement

Each prescription you fill for a controlled substance is monitored by state agencies who create a "risk score" based on how your prescriptions are handled. In order for us to prescribe controlled substances to you, we need you to agree to follow the terms below. Following these terms will also help keep your risk score low in the state database: 1. No early refills. Controlled substances cannot be filled early even if the pills are lost or stolen. Do not take more than prescribed or allow others to use your medication. 2. Only receive and change controlled prescriptions at office visits. I will keep regular office visits and only receive refills at the office. In rare cases when I am unable to keep an office visit I will provide one week notice for refills of controlled substances to allow time to check the state database. If I think I need to increase or change a controlled prescription, I will schedule an office visit rather than trying to make changes on my own or by phone. 3. Do not obtain from other providers. When other doctors refill controlled substances that we started, or prescribe controlled substances that are similar to what we prescribe, it raises your risk score (unless it is part of a hospital stay). Examples of controlled substances are below. 4. Refill limitations. Controlled scripts and their refills expire six months after they are written. We can usually renew them if you have an upcoming appointment, just call us to clarify the situation. 5. Drug testing and family input. In order to prescribe controls to you, we may require random drug screening and/or input from a family member or friend to make sure the drugs are not affecting you negatively. 6. Work drug screens and out-of-state pharmacies. If your work requires drug screens, warn them in advance as your controlled substance will show up on there (showing them the prescription bottle usually works). When travelling, keep in mind some states may not honor out-of-state prescriptions for controlled substances. For stimulant medications (e.g. Adderall, Methylphenidate, Vyvanse) 1. Three month limit. For stimulants, the maximum amount that can be written at each office visit is 3 months. 2. Pharmacy regulations. The pharmacy will require the person picking up the bottle to show a government-issued photo ID (you can designate someone else to pick up the prescription).

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Benzodiazepines: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clobazam (Onfi), clorazepate (Tranxene), diazepam (Valium), estazolam (ProSom), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), oxazepam (Serax), quazepam (Doral), temazepam (Restoril). Stimulants: methylphenidate (Ritalin, Concerta, Metadate, Methylin, Daytrana), dexmethylphenidate (Focalin), amphetamine-salts (Adderall, Evekeo), dextroamphetamine (Dexedrine, Vyvanse, Zenzedi). Sleep Medicines: eszopiclone (Lunesta), zaleplon (Sonata), zolpidem (Ambien, Edluar, Intermezzo), suvorexant (Belsomra), lumborexant. Opioids*: buprenorphine, codeine, hydrocodone, hydromorphone, fentanyl, meperidine, morphine, tramadol, oxycodone, oxycontin. Other: modafinil (Provigil, Nuvigil), pregabalin (Lyrica), dronabinol (Marinol)*, gamma hydroxybutyric acid (Xyrem)*, barbiturates*. *Not prescribed at the Mood Treatment Center