FORM-Buprenorphine Agreement

Because Buprenorphine is a potent controlled medication used to treat addiction, we require that you notify us prior to taking any medications in addition to your dispensed medication at CEH. This includes prescription and over-the-counter medication. We want to ensure that the medications you take with buprenorphine do not cause unwanted or risky interactions. Our intent is to keep you safe with this policy.

Buprenorphine – While we know that sometimes it may be necessary for you to take short-acting pills while on buprenorphine/buprenorphine-naloxone, (for example if you have surgery or a dental procedure) we ask that you let us know before any hospital admission or any medical procedure. It is imperative that you notify the doctor performing the procedure that you are taking buprenorphine. The CEH provider, along with the doctor performing the procedure will need to determine the best course of action for your pain management through the course of the procedure and its aftermath. After the procedure, the client will be required to bring records of procedure/hospitalization for the provider’s review.

Records needed:

• Discharge paperwork which should contain admission and discharge dates
• Medications given under medical care
• Medications prescribed
• Final prognosis

Clients may be required to see the provider to re-induce onto buprenorphine/buprenorphine-naloxone depending on how long the client missed dosing and other factors.

We do check with the North Carolina and South Carolina systems that track all prescribed controlled substances, and if we later find out you have been getting prescriptions for addictive medications that you did not tell us about, we may lower you back to level 1 where you have to come to the office once a week until you are stable again. In extreme situations (for example, if a patient is getting buprenorphine/buprenorphine-naloxone from another source) it may, unfortunately, be necessary to discharge a patient from our facility.

Thank you for keeping us informed of all your health concerns and medications; we can give you better care if we know all of the other medications you are taking.

Thank you,
CEH Footprints Team