Setting Rules and Expectations

Setting Rules and Expectations

Perhaps the most obvious thing that the physician and patient need to address is the functioning of the office-based buprenorphine program. Things to discuss include cancelled appointments, how to contact the physician after office hours, payment of fees, and prescription procedures. Also, be sure to discuss things of particular interest to the patient, such as confidentiality and urine testing.

Furthermore, the patient and the physician need to discuss things that will certainly affect the course of treatment. Such topics include proper adherence to induction and maintenance protocols, disclosure of nonprescriptive psychoactive substances, other prescriptions, and problematic behaviors and their consequences. As always, physicians should ensure that they have complete knowledge of all drugs their patient is currently using.

The following is a list of examples of specific rules on which you and your patient can agree, broken down by topic. Appropriate consequences should accompany each rule.

 

Office Protocol	The patient will call at least X hours before a scheduled appointment to say that he or she is unable to attend. The patient will make satisfactory arrangements with the treating physician to pay for all services.
Prescription Procedures	The patient must visit the office for the first X days of treatment to receive buprenorphine doses. If the physician determines acceptable progress, a prescription may be written. Lost prescriptions will not be rewritten.
Urine Testing	The patient will disclose to the physician all opioid or other drug use. The patient agrees to random urinalysis when requested by the physician.
Patient Responsibilities	The patient will not alter his or her own buprenorphine dose. The patient will make a concerted effort to learn about community support and/or self-help groups and meetings.