Family Care Clinic Medication Assisted Treatment
1. Q: If I call you or make an appointment will anyone else find out?
1. A: Keeping your information private and confidential is central to what we do. We will not disclose your participation in our program under any circumstances, unless you specifically direct us to do so in writing. There are federal laws that work to protect information about those who seek treatment. No one at your workplace, in law enforcement, or in your family is entitled to know that you are seeking treatment. You are welcome to call us anonymously to start a conversation.
2. Q: What happens at my first visit?
2. A: You should allow 45 minutes to an hour for your first visit. Our offices are set up just like any typical doctor's office. We are singular in our treatment, so the only other patients you will see will be here for the same addiction challenges that you are facing. You will check in with our staff and fill out intake forms. Feel free to download the forms ahead of time or fill them out and bring them with you. Please fill out the new patient forms for the Family Care Clinic as well. After you finish the forms, you will give a urine sample and then a medical assistant will take your vitals and ask you some questions about your history. At that point you are ready to see one of our providers. Your first appointment should take twenty to thirty minutes with the provider. During your appointment, your provider will determine what the best course of action will be. You will be assigned a case manager who will follow up with you in the next day or so.
3. Q: Do I need to be in withdrawal before I take my first dose of Suboxone or other buprenorphine medication?
3. A: Patients are recommended to be in "mild withdrawal" as defined by the Clinical Opiate Withdrawal Scale (COWS). If you are not experiencing mild withdrawal symptoms, you risk putting yourself into severe withdrawal when you take your first buprenorphine dose. This is called precipitated withdrawal. The amount of time you need to wait between your last opioid dose and your first buprenorphine dose is not just a function of time (hours or days), it is more a function of how long acting the last opioid you took is, and what dose you have been taking. For example, heroin and most pain pills are relatively short acting, but methadone is long acting and requires much more time to get out of your system. There is also a big difference between large and small doses; your tolerance will have a lot to do with how long you will need to wait to take your first dose of Suboxone (or other buprenorphine medication). Please be honest with your provider about your drug history so they can help you smoothly transition to buprenorphine.
4. Q: How often do I need to come in for doctor visits?
4. A: It's our goal to get patients to a monthly maintenance schedule. All patients, however, will be required to come in two weeks after their initial appointment to confirm that they are doing well. If you are stable and feeling good about your dosage, you will likely not have to come back for a month. Some patients struggle in the beginning and we ask to see them back at shorter intervals until they stabilize. If they cannot be stabilized inside of our program's structure, we will refer them to more intensive programs.
Almost all of our patients quickly find themselves visiting us monthly. For patients who need more intensive treatment, we will work with them to find a better match. Some patients leave FCCMAT for more intensive alternatives and come back to us once they are more stable.
5. Q: What about drug testing?
5. A: We collect a urine sample at each visit, and if you need a drug screen between appointments, we are happy to accommodate you. Patients have lots of questions on this topic. Below are some common questions and answers:
•On my initial visit, what if my urine is positive for drugs? We expect your first urine screen will be positive for whatever opioids that you are coming to address. After your initial appointment, we expect that your urine screens will be positive for buprenorphine and any other prescription medications that you are prescribed, and negative for everything else. •What if a drug test says that I am positive for something that I did not take? We do an initial point-of-care test in our office. Those tests are not as reliable as a licensed laboratory. All samples are sent to our lab for further screening and then all positive results are sent out to an independent confirmation laboratory. Lab results are always available for you to review. Ask your provider or our front desk staff and they can print them out for you •What happens if I relapse during treatment? Relapse is part of the disease of addiction so don’t be too hard on your yourself. Patients relapse for all kinds of reasons; a death in the family, loss of employment, a move, a fight with a significant other or family member, or any other type of stressor. What is most important about a relapse is that you get back into treatment as soon as possible. The risk of overdose and death during a relapse is highest. If you relapse call us immediately and we will help you get back into treatment whether that is with us or with a more intensive treatment facility.
6. Q: Am I trading one addiction for another?
6. A: The simple answer is no, but it requires a few definitions. Physical dependence is your body craving opioids to avoid withdrawal. Addiction is dependence plus uncontrolled behavior. The active ingredient in Suboxone is buprenorphine. Buprenorphine is an opioid, but it's what is called a "partial agonist". The partial part is what is important. Taken as prescribed, it does not get you high and allows you to avoid withdrawal and cravings while at the same time allowing you to lead a normal, functional, responsible life. For as long as you are taking buprenorphine, you will remain dependent on opioids. When it's time for you to taper off completely, you will need lots of support and we are here to do whatever we can to help.
We like to think about buprenorphine as a bridge. It's a bridge between using opioids to get high and being completely free of all opioids. For some period of time (and it depends on the patient), buprenorphine allows patients to get their lives back in order. Eventually, with the help of counseling, patients may be ready to take the final step and completely stop use of their replacement therapy.
7. Q: What is the difference between Methadone and Suboxone?
7. A: Methadone was the first opioid replacement therapy to be employed in addiction treatment. The biggest difference between the two is that some patients report a "high" from their use of methadone, while Suboxone patients do not. The two share a fundamental objective, which is to move people from the dangerous addiction habits they have when they are taking opioids toward a life of independence.
Methadone and Suboxone are also prescribed differently. Methadone clinics generally require patients to report daily to take their medication. Suboxone can be prescribed so that patients can administer their doses in the privacy of their own homes.
Methadone can also be effective at higher dosages than Suboxone. For some long-term opioid users who have built up a very high tolerance, Suboxone may not be enough to ward off their withdrawal symptoms and cravings. Methadone, when properly prescribed, is as effective as Suboxone in treating opioid use disorder, and more effective for those whose tolerance is highly elevated.
8. Q: Are all patients a good fit for FCCMAT?
8. A: FCCMAT is designed to provide medication assisted treatment services for patients who are independent and can be responsible for their own day-to-day living. Family Care Clinic is not designed to support patients with severe mental illnesses that co-occur with their addiction. We can assist in referring such patients to facilities that are better able to address their illness.
In addition, it's important to note that FCCMAT is set up to move patients to monthly maintenance visits with a doctor or other provider as quickly as possible. Our patients appreciate the independence that provides. People at different stages of recovery may require different levels of intervention. If you have any concern that you may not be able to stick to a regimen on your own, please let us know and we will refer you to a more intensive treatment provider.
Our doctors and healthcare providers are always on the lookout for signs that our program may not be working and will address this with you if you are not compliant. There should be no shame in this, it's only important to find patients the best place for them at each stage of their recovery.
9. Q: What do I do if I need help between visits?
9. A: We answer the phone (972.875.6790) Monday through Friday and are also available by email at firstname.lastname@example.org Please never hesitate to call or email us if you are experiencing discomfort or have questions. If you are having a health emergency, please call 911 immediately.
You should also make sure that you develop a relationship with a mental health or an addictions counselor. You are free to find your own counselor or allow us to guide you to an appropriate match. If you are not satisfied with your current counselor, please let us know and we will work to find you a better fit. Your counselor will be able to provide additional support at times of stress or concern.
10. Q: What are the side effects of the medications?
10. A: Each of the medications can have slightly different side effects, so please visit the websites for whichever medicine you are prescribed. For Suboxone, the side effects are typically mild, but can be exacerbated by combining your use of Suboxone with other substances. We are available to answer any questions that you might have.
11. Q: Should can I carry my medication with me?
11. A: Ideally, our patients leave their medication at home in a secure (preferably locked) place. If you need take your medication with you, please take the fewest amount that you can. Always bring the original box or bottle with your printed prescription and leave the remaining medication at home. Suboxone and other buprenorphine products are Type III controlled substances and law enforcement works hard to control the illegal diversion (selling) of prescription medications. As long as you have your printed prescription, there should never be a problem.