2014 ashley oaks circle wesley chapel, fl 33544 813.999 ... · 2014 ashley oaks circle wesley...

2014 Ashley Oaks Circle Wesley Chapel, FL 33544 813.999.3030ph 813.333.0453fx

Suboxone induction instructions:

Patient: ___________________________________DOB:______________

Date: ___________________________________________

Allergies: ________________________________________

__ Suboxone Induction Regimen for Addiction/Opiate Dependence

__ Suboxone Induction Regimen for Addiction Relapse

HOW TO STOP CURRENT MEDICATION

__ 1. You meet detox criteria and withdrawal criteria to have induction today

__ 2. You DO NOT meet criteria and have to come back in the morning or some other

identified time for induction

__ 3. This information is being given for training and planning for Opiate dependence

after chronic opiate therapy for chronic pain condition, and possible Opiate induced

Hyperalgesia.

INDUCTION MEDICATION INFORMATION: SEE MARKED MEDICATIONS TO BE

GIVEN

A. ___ Suboxone 8mg/2mg film or ___ Suboxone 2mg/.5mg film


B. The prescription will be given as:

___ one film every 8 hours

___ one film every 12 hours

C. ___ Subutex 2mg pill was used or _____ Subutex 8mg was used and dose

frequency will

be 1/2 or 1 whole every 812 hours

D. The above dosing is to be followed for the first 710 days or until you are seen by

the provider again. Max dose is 3 films per 24 hours. Mimimum advised dose is

1/2 (half) film under tongue every 12 hours

E. ___ Clonidine pills 0.1mg po every 12 hours as needed for aggitation or ____

Clonidine TTS1 patch every 7 days

* Take as ordered by the provider, unless blood pressure is too low or doctor

advises

otherwise

F. ___ High dose Vitamin C to dose up to 4000 to 5000mg daily to optimize withdrawal

symptoms is advised. If you develop loose stool, reduce dose until it resumes normal

G. ___ Phenergan 25mg one po every 6 hours as needed for nausea or aggitation


PART 1 OF INDUCTION: BEGINS IN OFFICE

___ TODAY ____ OTHER DATE: _____________________

INITIATION OF TREATMENT/LOADING DOSE PART 1:

A. GIVEN 1/2 FILM/ FIRST DOSE TIME: _______

___ Suboxone 8/2mg half of a film

___ Suboxone 2/.5 half or whole film

___ Subutex 2mg pill


B. Given 2nd Dose/ Time: (2030 mins after first dose)





* This dose is 2030 minutes after first dose under your tongue if you still feel any

feelings of withdrawal like symptoms. This dose may have increased the withdrawal

you were having, or it may be the only other dose you need to load the medication in

your system or it completely resolved your withdrawal.


C. Given 3rd Dose/ Time: (2030 mins after 2nd dose)





* This dose may not be indicated... and again is 2030 minutes after the second dose

under your tongue, if you still felt any feelings of withdrawal like symptoms. This dose

may have increased the withdrawal you were having, or it may be the only other dose

you need to load the medication into your system, or it completely resolved your

withdrawal.

PART 2 INDUCTION DAY/STILL DAY ONE SCHEDULED DOSING1. After the induction in the office is done you will begin daily doses as listed.2. Your daily dose is determined by your provider and your response during induction. 3. Your next dose on the induction day is done at home, and is 68 hours from the very first dose given in the office by the provider. 4. YOUR NEXT DOSE IS: AT _______________

A. One full ___ Suboxone 8/2mg film or ____ Suboxone 2/.5 mg film B. Repeat one dose every 8 hours until you follow up with the provider (example of dose if FIRST LOADING DOSE WAS DONE AT 8AM THEN NEXT REGULAR DOSE IS DONE. NEXT SCHEDULED BY PHYSICIAN OR 6 HOURS LATER DOSE WOULD BE 2PM)


5. CONTINUE THIS DOSE AS PRESCRIBED. UNLESS THE DOSE MAKES YOU TOO SLEEPY. If symptoms of agitation and/or sweating, skin creepy crawling symptoms, or other agitation symptoms and not pain occur before the 6 hours is up you may use the Clonidine for that. If you are lightheaded or the medication makes you feel racing or highlike, this is very rare and means you are extra sensitive to the dose, and you must reduce all doses by half and contact the office. If you are not sure what you are feeling you must stop using this medication and contact the office and report symptoms as URGENT and FROM NEW SUBOXONE INDUCTION PATIENT to the staff. 813.999.3030 or email if provided to you.

PART 3 DAY AFTER YOUR LOADING DOSE/SCHEDULED DOSE___ Suboxone 8mg/2mg 1/2 film under your tongue as prescribed___ You may need the Clonidine in between the Suboxone/Subutex doses___ Keep appointment for followup___ Manditory Counseling providers that we use frequently are mandatory for program longterm___ Recommend Counseling___ HERE TO HELP MODULES Begin them

HERE TO HELP PROGRAM: ___ You must also register for the program, which is FREE with the drug company who makes the Suboxone product. This is an online registration. (THIS IS MANDATORY)

The Here to Help® Program ResourcesThe Here to Help Program website HeretoHelpProgram.com delivers guided support to help patients: patients can call 866973HERE (4373) for help finding counseling options in their area.

https://www.suboxone.com/patients/here_to_help/register/registration_step1.aspx

https://www.google.com/url?q=https%3A%2F%2Fwww.suboxone.com%2Fpatients%2Fhere_to_help%2Fregister%2Fregistration_step1.aspx&sa=D&sntz=1&usg=AFQjCNHJLE2XLrU99QyolLBDVyWdgYgDOA

https://www.google.com/url?q=https%3A%2F%2Fwww.suboxone.com%2Fpatients%2Fhere_to_help%2Fregister%2Fregistration_step1.aspx&sa=D&sntz=1&usg=AFQjCNHJLE2XLrU99QyolLBDVyWdgYgDOA


* Develop the skills to reinforce your successful recovery* Access additional resources that can help you understand and manage your disease

Heretohelpprogram.com is uniquely designed to provide customized and guided support to you through many of the situations you may face during treatment, including:

* Continuing to Grow Guided learning activities designed to keep patients engaged and active participants in their treatment. Key skills and topics include "Managing Stress," "Responding to Difficult Situations," and "Keeping Motivation"

* My Recovery is at Risk By answering 5 essential questions, patients can quickly understand and evaluate risk factors that could interfere with their success in treatment. patients can return to this section whenever they feel their recovery is at risk.

* Creating Personal Solutions Interactive tools to help patients create action plans to support their recovery. Action plans include "Managing Triggers and Risky Situations," "Setting Goals for Change," and "Strengthening Relationships."

* Finding Answers Provides easytounderstand information on topics patients want and need to know about their disease and treatment, including "Opioid dependence as a chronic disease," "What to expect during treatment," and "How to be Prepared in the event of a setback"

* I've had a Setback Provides patients with essential guidance to help them get back to treatment after a slip or a relapse

Each section is customized based on patient response. Patients can print or save their action plans and exercises to refer to offline or to share with their treatment


providers.

THIS IS A MANDATORY REGISTER (IT IS FREE). THIS IS AN ONLINE REGISTRATION. YOU WILL BE MANDATED TO BRING BACK THE EMAIL CONFIRMATION OF REGISTRATION AND SUBSEQUENT EMAIL VISITS OR DISCUSSION NOTES FOR THE CHART TO SHOW COMPLIANCE. IF YOU DO NOT BRING BACK THE INITIAL REGISTRATION YOU MAY JEOPARDIZE THE QUANTITY OF SUBOXONE YOU WILL BE GIVEN AT ONE TIME. I.E... YOU MAY ONLY GET ONE DAY'S MEDS, ETC.REMS DISCUSSIONThis checklist: (Courtesy of Reckitt Benckiser Manufacturer of Suboxone film and tablets): As a healthcare provider who prescribes SUBOXONE (buprenorphine and naloxone) sublingual film CIII, SUBOXONE (buprenorphine and naloxone) sublingual tablets CIII, or Subutex (buprenorphine) sublingual tablets CIII, this checklist is a useful reminder of the safe use conditions and monitoring requirements to be addressed during each patient's appointment. These include: 1) understanding and reinforcement of safe use conditions, 2) the importance of psychosocial counseling, and 3) screening and monitoring patients to determine progress toward treatment goals. If a patient continues to abuse various drugs or is unresponsive to treatment, including psychosocial intervention, it is important that you assess the need to refer the patient to a specialist and/or more intensive behavioral treatment environment. Additional resource: Clinical Support System: http://www.pcssb.org

Measurement to Ensure Appropriate UseInduction__ Verified patient meets diagnostic criteria for opioid dependence__ Discussed risk described in professional labeling and Medication Guide with


patient__ Explained or reviewed conditions of safe storage of medication__ Provided induction doses under appropriate supervision__ Prescribed limited amount of medication at first visit__ Scheduled next visit at interval commensurate with patient stability * weekly or more frequent visits are recommended for the first month

if YOU HAVE SIDE EFFECTS NOT LISTED OR WERE NOT DISCUSSED, PLEASE CONTACT THE OFFICE AT 813.999.3030

Jose de la Torre, MDNEW TAMPA INTERVENTIONAL PAIN AND SPORTS MEDICINE, INC.

COUNSELORS TO CHOOSE FROM (also look at your insurance listing of counselors):

Addiction Counseling/ Therapists:Resource link:

http://therapists.psychologytoday.com/rms/prof_results.php?city=Tampa&county=hillsborough&state=FL&spec=4

Psychologists:

Achieve Wellness Group13039 W. Linebaugh AveBuilding 5, Suite #101

http://www.google.com/url?q=http%3A%2F%2Ftherapists.psychologytoday.com%2Frms%2Fprof_results.php%3Fcity%3DTampa&sa=D&sntz=1&usg=AFQjCNFiAFmR8KQ4JeWCLSIBJLdgg_Xi2g


Tampa, FL 33626

Kristin KeoughPsyD, LCPC, CADC

888.531.1313

Karen M Milo, PhDPsychology Center of Tampa Bay

13357 North 56th St Tampa, FL 33617Office # 813.914.9000

Brad Palermo PsyDPsychology Addiction treatment

888.899.7736

COUNSELORS:

Back to Work CounselorsBrandon, FL

Dan Cosby Independent Counselor813.262.0471

Mr. M. Shawn KellermanCounselor, LMHC, SAP, MAC, CAP, ICADC

3110 1st Ave North Ste # 6W Saint Petersburg,FL 33713

Additional office on Hobbs Street in Tampa727.233.5524

Saralee H FackelmanCounselor, MS, LMHC, CAP


THe Life Center6811 N. Central AveTampa, FL 33604813.377.3973

John J. BosworthCounselor, MA, LMHC

5201 W. Kennedy Blvd. Ste # 708Tampa, FL 33609

Additional office in Clearwater727.386.8996

Pathworks Workshop, PACounselor

Pathworks Workshop,PA4144 N Armenia Ave Ste 301

Tampa 33607

Dr. Douglas UzzellPhD, LMHC, CAP813.358.1957

SOCIAL WORKERS:

Mark Davis Davis Sound (another favorite of mine in North Tampa)3820 Northdale Blvd 312B 33624

813.968.3417


Dr. Stacie LauroBerlowitzPsychiatrist, MD,APBN

Psychiatry Specializing in You4320 W El Prado Blvd

Tampa 33629813.395.0036

FACILITIES:http://www.recoverycorps.org/treatmentcenters/florida/stpetersburg/

Fairwinds Treatment Center1569 South Fort Harrison Ave

Clearwater 33756Fairwinds Treatment Center is no addiction treatment center serving PINELLAS county and the city of Clearwater. The primary focus of Fairwinds Treatment Center is a mix of substance abuse and mental health services. They provide hospital inpatient, residential shortterm treatment (less than 30 days) services for detoxification, substance abuse treatment...

TOWN AND COUNTRY HOSPITAL Odessa6601 Webb Road Tampa 33615813.888.7060

ACTS3170 North 50th StTampa 33610866.801.8205

WestCare Gulfcoast Florida, Inc. 2510 Central AveSt. Pete, FL 33712

WestCare Gulfcoast Florida Inc. is an addiction treatment center serving PINELLAS county and the city of St. Petersburg. The primary focus of WestCare Gulfcoast Florida, Inc is a mix of substance abuse and mental health service. They provide residential longterm treatment (30


days or more) services for substance abuse treatment including drug addiction and alcohol...

WestCare Florida Inc.1735 MLK Street SouthSt Petersburg, FL 33705

Westcare Florida, Inc is an addiction treatment center serving PINELLAS county and the city of St. Petersburg. The primary focus of WestCare Florida Inc is substance substance abuse

treatment services. They provide outpatient services for substance abuse treatment including drug addiction and alcohol addiction. They have treatment programs and services

for adolescents...

Gulf Coast Jewish Family Services Inc.3180 66th Street North

Saint Petersburg,FL 33710GulfCoast Jewish Family Services Inc is an additional treatment center serving PINELLAS

county and the city of St Petersburg. The primary focus of Gulf Coast Jewish Family Services, Inc is a mix of substance abuse and mental health services. They provide residential longterm treatment (30days or more) services for substance abuse treatment including drug addiction

and...

Boley Centers for Behav Healthcare Inc12809 Wild Acres Road

Largo, FL 33773Boley Centers for Behav Healthcare, Inc is an addiction treatment center serving PINELLAS

county and the city of Largo. THe primary focus of Boley Centers for Behav Healthcare Inc is a mix of substance abuse and mental health services. They provide residential longterm

treatment (30 days or more), outpatient services for substance abuse treatment including drug...

PSYCHIATRISTS:

Dr. Sheehan Drs. Edson, Singh, De Ganuza, Sheehan, MDs16554 North Dale Mabry Highway Tampa

813.968.7188

Dr. Linda A. Lefler, MD St. Petersburg, FL Addiction Psychiatry


Dr. Syed K. Zaidi, MD St. Petersburg, FL Addiction Psychiatry

Dr. Bruce Welch, MD St. Petersburg, FL Addiction Psychiatry

Suncoast Center Community Mental: Dr. Jackson, MD4024 Central Ave. St Petersburg 727.327.7656

2014 ashley oaks circle wesley chapel, fl 33544 813.999 ... · 2014 ashley oaks circle wesley...

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