Pre-enrollment
The following steps must be completed before you are considered a patient of Bluewater Methadone Clinic.
1. Our staff physicians must complete a 2-part assessment. Blood work, a chest X-ray and possibly an EKG are required. Some of these tests can be done at BMC, the others can be done at a facility of your choice.
2. Patients being transferred from another clinic must sign a release form to allow their current clinic to provide us with a clinical summary of the treatment to date.
3. The College of Physicians and Surgeons of Ontario (CPSO) requires that all methadone patients are registered with only one clinic. BMC staff will complete the paperwork but the CPSO must approve your registration with BMC for you to start/continue receiving methadone from BMC.
4. You have read these Policies
and Procedures and signed the document accepting these policies as a treatment
contract. You have read and understood and signed the Consent to Treatment Form.
General Policies
1. You agree to be a patient of Bluewater Methadone Clinic, not of an individual physician staff member. You may not choose to see a specific physician at this clinic.
2. You agree to allow BMC staff to photograph you. This image will be kept on the computer at the clinic to identify you when you provide a urine sample. It may also be on the computer at your pharmacy to identify you when you receive your methadone. It will not be shared with any other agencies.
3. Bluewater Methadone Clinic is not a medical clinic. We provide Methadone Maintenance Treatment (MMT) as defined by the CPSO guidelines for MMT. We do not provide general medical or psychiatric care nor do we manage chronic pain. We encourage you to retain your family doctor. If you do not have one you should attempt to secure one. If you cannot you may access medical care at the local walk-in clinic or the emergency department as appropriate or required.
4. Our staff will provide you with phone numbers of other addiction related services and community resources in the community that you may access as you require.
5. Bluewater Methadone Clinic is open during the day (check with the reception staff for exact hours) Monday, Tuesday, Thursday and Friday. If you miss an appointment you should call as soon as possible to arrange another in order to ensure you have a prescription for methadone at the pharmacy. There is no after hours treatment available. We do not make house calls nor give telephone advice. Patients must agree to not contact us at home. We will not provide methadone through the emergency department.
6. You understand that the continued operation of Bluewater Methadone Clinic depends, in part, on good relations with the landlord, neighbors and the city. You agree to be respectful, discrete and considerate in and around the clinic. Violent, threatening and abusive language or behavior directed towards staff or patients in or around the clinic will not be tolerated.
7. No illegal activity is allowed in or around the clinic.
8. Breaching policies 5, 6 or 7 is grounds for immediate and permanent dismissal from the Bluewater Methadone Clinic.
9. Patients should be aware that only certain pharmacists prescribe methadone and these pharmacists are an integral part of MMT. The pharmacy options in Sarnia are limited therefore you must mind your behavior in the pharmacy - if a patient becomes banned and is therefore unable to access pharmacy services they will not be able to continue in the program. Clinic staff will not be able to intercede on your behalf.
10. Patients agree not to use cellular phones in the clinic.
11. Patients agree not to loiter in the clinic, parking lot or sidewalk or lawn adjacent to the clinic.
12. Please put your cigarette
butts in the ash bucket provided near the steps
Methadone treatment policies
Methadone prescribing and dispensing is regulated by a number of legal and clinical guidelines which clinic staff and patients are required to follow. Patient’s participation in MMT depends on the following:
1. Patients agree to pick up medication during pharmacy dispensing hours and to obey pharmacy rules.
2. Patients agree to use only one pharmacy for dispensing all methadone and other medications regardless of the prescribing physician.
3. Patients agree to notify Bluewater Methadone Clinic physicians of all prescription and non-prescription medications they are taking. If the treatment team advises against certain medications the patient agrees to refrain from these medications while participating in MMT.
4. Federal law requires patients to inform any physician if they have received a narcotic from another physician within the preceding 30 day period. Failure of the patient to notify BMC staff of any narcotic prescription from another doctor will be considered double doctoring.
5. Double doctoring is grounds for immediate dismissal or reduction in privileges at BMC.
6. Patients agree to provide written confirmation regarding the necessity of certain medications when this is requested.
7. Patients agree to attend a consultation with a specialist to confirm current treatment regimens if this is requested and arranged by Bluewater Methadone Clinic.
8. As patients progress in the program they may be offered carries (doses of methadone which can be taken home) therefore reducing the number of days they have to attend the pharmacy. The clinic physician determines the number of carries that are appropriate based on clinic and CPSO guidelines and clinical judgment. Patients may be required to demonstrate they can keep carries secure from children or other substance abusers.
9. During appointments patients may request to have their dose increased or decreased. Dosage changes cannot be made over the phone.
10. Patients agree to provide urine samples on the days requested by the Bluewater Methadone Clinic staff. The frequency of these will be at the discretion of the physician.
11. Bluewater Methadone Clinic staff will use sophisticated technology to check to ensure that patients are taking their methadone, that the urine produced is theirs and has not been tampered with and determine what other drugs the patient has been taking. Urine that tests positive for other drugs with a high potential for abuse will result in a reduction of carries. This may apply even if a physician or dentist prescribed the medication.
12. Missed urine samples will be treated as positive tests.
13. Tampering with urine samples is a serious program violation and will result in a reduction of carries and/or an increase in the frequency of clinic visits.
14. Patients that miss three or more days of methadone will have their dose of methadone reduced for safety reasons.
15. Patients that fail to
attend four consecutive clinic appointments will be considered to have self-discharged.
Notification will be sent to the CPSO.
Appointment policies
The initial assessment will usually take two separate appointments one of which will include a physical exam. Patients will undergo an annual physical exam thereafter while in the program (this will not include “Pap” testing). Subsequent appointments will be required to establish the correct dose of methadone; reassessment of substance use and lifestyle and emotional stability; education regarding harm reduction strategies and to generally facilitate recovery.
1. All patients will initially be required to attend clinic twice per week. Over time the frequency will decrease according to clinic guidelines and the physician’s clinical judgment. Attending appointments is mandatory – if you do not attend you will not get a prescription for methadone.
2. Bluewater Methadone Clinic is open at specific times only. Some patients may not be able to participate in this program for this reason. We are unable to accommodate patients whose schedule does not mesh with Bluewater Methadone Clinic’s hours of operation.
3. Patients must show a valid OHIP card at each visit or pay for the appointment with cash. Patients must sign a Health Number Release form.
4. Patients are expected to wait in the waiting room for their appointment and choose topics of conversation that are unlikely to offend the staff or other patients. Discussion about alcohol, substance use or gambling may serve as triggers and adversely affect the recovery of other patients.
5. Please do not bring friends or family to the clinic with you – the exception being children of patients when other childcare arrangements could not be made.
6. Any patient that misses an appointment may call and leave their name and phone number to have a subsequent appointment arranged. Missed appointments may result in changes in carries or frequency of subsequent clinic visits and urine testing.
7. Unforeseen emergencies resulting in missed appointments will require corroborative documentation to avoid the outcomes listed above.
8. Patients that show up late for their appointment or on the wrong day will be squeezed in as possible. Please note that patients with previously booked appointments will be seen at the time of their appointment even if they arrived after the patient requesting a special appointment.
9. Patients that are hospitalized or incarcerated should call Bluewater Methadone Clinic as soon as possible to arrange for a transfer of their methadone prescription. Notify Bluewater Methadone Clinic in advance of your release date in order to schedule the earliest possible appointment.
10. Temporary travel to other
cities may be accommodated at the discretion of the prescribing physician.
Privacy policies
Patients of Bluewater Methadone Clinic can expect their privacy will be respected as in other health care facilities. All information regarding their care is confidential within Bluewater Methadone Clinic and will not be communicated with others without signed consent excepting the points that follow.
Patients should be aware that the staff of Bluewater Methadone Clinic will need to discuss some aspects of a patient’s treatment or progress amongst themselves and from time to time the methadone pharmacist and other attending physicians. By signing this document they consent to this release of information in these circumstances.
Furthermore patients should be aware of certain legal requirements for the release of confidential information with or without the consent of the patient, including:
1. To provide professional, respectful and reliable services to patients.
2. To provide back-up coverage for holidays and periods when the physician is on vacation or unavailable. The contact number is available to the pharmacists. Note that generally speaking we will not renew your prescription if you have missed an appointment.
3. To provide appropriate notice to the patient should a physician choose to leave this area of practice. The physician should assist in the transfer of patients to other methadone prescribing physicians to ensure continuity of treatment.
4. To either provide or facilitate patient access to services related to recovery. This includes counseling, vocational support services, primary health care, etc.
5. To remain current in practices and standards for MMT and the treatment of opioid dependence.
Patients agree to inform all medical professionals providing them with care that they are on a MMT program.
In any circumstance where the patient requests information to be released to a person or agency a Consent to Release Medical Information Form will be required to be signed by the patient for that specific release. This includes communicating with the police or probation officers or Children’s Aid or other agencies for the purpose of verifying compliance with the MMT program.
Patients must agree to be
respectful of the privacy of the other patients they come into contact with
in the program. By signing this document you agree to maintain absolute confidentiality
of other patients identities. Failure to do so may result in dismissal from
Bluewater Methadone Clinic Bluewater Methadone Clinic MMT program.
Physician’s obligations to his/her patients
1. To provide professional, respectful and reliable services to patients.
2. To provide back-up coverage for holidays and periods when the physician is on vacation or unavailable. The contact number is available to the pharmacists. Note that generally speaking we will not renew your prescription if you have missed an appointment.
3. To provide appropriate notice to the patient should a physician choose to leave this area of practice. The physician should assist in the transfer of patients to other methadone prescribing physicians to ensure continuity of treatment.
4. To either provide or facilitate patient access to services related to recovery. This includes counseling, vocational support services, primary health care, etc.
5. To remain current in practices and standards for MMT and the treatment of opioid dependence.