silhouette of a jogger in sunrise

Patient Handbook

pdf_icon

Welcome

Simply put, it takes courage to face your addiction. The BrightView staff is here to help guide, support, and encourage you on your journey. Our experienced team of caring and trusted professionals works together to ensure that each and every patient is given the best possible tools and support to be successful in reaching their goals. Everyone deserves the opportunity to regain control of his/her life and return to a productive and meaningful way of living.

Addiction is a chronic, progressive, and potentially fatal disease for which there is effective medical treatment.

Therefore, BrightView is committed to addressing the unique needs of each patient and their family. We adhere to the medical model of addiction, recognizing that it needs to be treated on the biological, psychological, and social levels. The goal of life-long abstinence is the target and the use of ongoing recovery programs to maintain recovery is necessary. Our individualized treatment plans focus on these issues and are designed to ensure the best possible outcome for each patient.

BrightView’s program provides a framework for each patient to apply addiction recovery education to his/her own personal history of substance abuse. Because addiction not only affects the lives of individuals with the disease but also impacts the lives of those around them, BrightView offers education for both the patient and the family about the facts of addiction and the consequences of leaving it untreated. Our staff will assist patients in developing coping skills as well as other tools to address their destructive habits and behaviors. Individual counselors will provide case management services tailored to each patient’s distinct needs, and therapeutic crisis intervention is available for any patient struggling with recovery. In addition to the services we provide, BrightView is an advocate for community peer-group involvement and encourages patients to utilize these sober support networks.

Please let us know if there is anything we can do to assist in your recovery. Your success is our success…we want to do everything in our power to assist you in reaching your goals.

Sincerely,

Shawn A. Ryan, MD, MBA

Who We Are

BrightView was established to address a significant area of need for medical care that has been created by the current prescription drug/opiate epidemic plaguing our nation. This will be accomplished by providing those who suffer under the burden of opiate addiction and other chemical dependencies the chance to recover in a place where they are welcomed, encouraged, and respected. Through the use of medication-assisted treatment and in conjunction with psychological and social services, we will provide those suffering from addiction the necessary assistance to reach their goals.

Our Core Values:

  • Respect – for our patients, our employees, and our community
  • Accountability – to our patients and their families, and to our colleagues
  • Responsibility – by patients and employees, for the decisions we make and the actions we take
  • Excellence – in every task we perform, most importantly the care we provide

Our Standards of Care & Commitment:

  • Community – Offering the community the best possible medical and mental health services is our goal and commitment.
  • Safety – Providing our patients the safest level of care and treatment available.
  • Service – Being stewards of the community by delivering high quality medical and mental health care in a safe, cost-effective manner.
  • Knowledge – Providing treatment based on the latest scientific and clinical data. Being a leader and innovator in patient treatment and care.
  • Ethics – Acting with integrity and honesty. Upholding professional ethical standards and ensuring that the patient always comes first.
  • Teamwork – Recognizing the contributions and resources of every member of our team and realizing that each member is essential to achieving our goals.

Understanding the Disease of Addiction

Definition: Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry.

  • Addiction involves craving for something intensely, loss of control over its use, and continuing involvement with it despite adverse consequences.
  • Addiction changes the brain, first by changing the way it registers pleasure and then by corrupting other normal drives such as learning and motivation.
  • Although breaking an addiction can be challenging, it can be done. Recovery from addiction is best achieved through a combination of self-management, mutual support, and professional care provided by trained and certified professionals.

What Causes a Person to Become Addicted?

For many years, experts believed that only alcohol and powerful drugs could cause addiction. Neuroimaging technologies and more recent research, however, have shown that certain pleasurable activities, such as gambling, shopping, and sex, can also co-opt the brain.

Although a standard U.S. diagnostic manual (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition or DSM-IV) describes multiple addictions, each tied to a specific substance or activity, consensus is emerging that these may represent multiple expressions of a common underlying brain process.

Nobody starts out intending to develop an addiction, but many people get caught in its snare. Consider the latest government statistics:

  • Nearly 23 million Americans—almost one in 10—are addicted to alcohol or other drugs
  • More than two-thirds of people with addiction abuse alcohol
  • The top 3 drugs causing addiction are marijuana, opioid (narcotic) pain relievers, and cocaine

In the 1930s, when researchers first began to investigate what caused addictive behavior, they believed that people who developed addictions were somehow morally flawed or lacking in willpower. Overcoming addiction, they thought, involved punishing miscreants or, alternately, encouraging them to muster the will to break a habit.

The scientific consensus has changed since then. Today, we recognize addiction as a chronic disease that changes both brain structure and function. Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain. This happens as the brain goes through a series of changes, beginning with recognition of pleasure and ending with a drive toward compulsive behavior.

Pleasure and Reward

The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal. In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine in the nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex (see illustration). Dopamine release in the nucleus accumbens is so consistently tied with pleasure that neuroscientists refer to the region as the brain’s pleasure center.

All drugs of abuse, from nicotine to heroin, cause a particularly powerful surge of dopamine in the nucleus accumbens. The likelihood that the use of a drug or participation in a rewarding activity will lead to addiction is directly linked to the speed with which it promotes dopamine release, the intensity of that release, and the reliability of that release.

Even taking the same drug through different methods of administration can influence how likely it is to lead to addiction. Smoking a drug or injecting it intravenously, as opposed to swallowing it as a pill, for example, generally produces a faster, stronger dopamine signal and is more likely to lead to drug misuse.

The Brain’s Reward Center

brainrewardcenter_web

Addictive drugs provide a shortcut to the brain’s reward system by flooding the nucleus accumbens with dopamine.

The hippocampus lays down memories of this rapid sense of satisfaction, and the amygdala creates a conditioned response to certain stimuli.

The Learning Process

Scientists once believed that the experience of pleasure alone was enough to prompt people to continue seeking an addictive substance or activity. But more recent research suggests that the situation is more complicated. Dopamine not only contributes to the experience of pleasure, but also plays a role in learning and memory—two key elements in the transition from liking something to becoming addicted to it.

According to the current theory about addiction, dopamine interacts with another neurotransmitter, glutamate, to take over the brain’s system of reward-related learning. This system has an important role in sustaining life because it links activities needed for human survival (such as eating and sex) with pleasure and reward.

The reward circuit in the brain includes areas involved with motivation and memory as well as with pleasure.

Addictive substances and behaviors stimulate the same circuit—and then overload it.

Repeated exposure to an addictive substance or behavior causes nerve cells in the nucleus accumbens and the prefrontal cortex (the area of the brain involved in planning and executing tasks) to communicate in a way that couples liking something with wanting it, in turn driving us to go after it. That is the process which motivates us to take action to seek out the source of pleasure.

Do You Have an Addiction?

Determining whether you have an addiction isn’t completely straightforward. Admitting it isn’t easy, largely because of the stigma and shame associated with addiction but acknowledging the problem is the first step toward recovery.

A “yes” answer to any of the following three questions suggests you might have a problem with addiction and should—at the very least—consult a health care provider for further evaluation and guidance:

  • Do you use more of the substance or engage in the behavior more often than in the past?
  • Do you have withdrawal symptoms when you don’t have the substance or engage in the behavior?
  • Have you ever lied to anyone about your use of the substance or extent of your behavior?

Development of Tolerance

Over time, the brain adapts in a way that actually makes the sought-after substance or activity less pleasurable.

In nature, rewards usually come only with time and effort. Addictive drugs and behaviors provide a shortcut, flooding the brain with dopamine and other neurotransmitters. Our brains do not have an easy way to withstand the onslaught.

Addictive drugs, for example, can release 2 to 10 times the amount of dopamine that natural rewards do, and they do it quicker and more reliably. In a person who becomes addicted, brain receptors become overwhelmed. The brain responds by producing less dopamine or eliminating dopamine receptors—an adaptation similar to turning the volume down on a loudspeaker when noise becomes too loud.

As a result of these adaptations, dopamine has less impact on the brain’s reward center. People who develop an addiction typically find that, in time, the desired substance no longer gives them as much pleasure. They have to take more of it to obtain the same dopamine “high” because their brains have adapted—an effect known as tolerance.

Compulsion Takes Over

At this point, compulsion takes over. The pleasure associated with an addictive drug or behavior subsides—and yet the memory of the desired effect and the need to recreate it (the wanting) persists. It’s as though the normal machinery of motivation is no longer functioning.

The learning process mentioned earlier also comes into play. The hippocampus and the amygdala store information about environmental cues associated with the desired substance, so that it can be located again.

These memories help create a conditioned response—intense craving—whenever the person encounters those environmental cues.

Cravings contribute not only to addiction but to relapse after a hard-won sobriety. A person addicted to heroin may be in danger of relapse when he sees a hypodermic needle, for example, while another person might start to drink again after seeing a bottle of whiskey. Conditioned learning helps explain why people who develop an addiction risk relapse even after years of abstinence.

Persistent risk and/or recurrence of relapse, after periods of abstinence, is another fundamental feature of addiction.

This can be triggered by exposure to rewarding substances and behaviors, by exposure to environmental cues to use, and by exposure to emotional stressors that trigger heightened activity in brain stress circuits.

Recovery is Possible

It is not enough to “just say no”; as the 1980s slogan suggested. Instead, you can protect (and heal) yourself from addiction by saying “yes” to other things. Cultivate diverse interests that provide meaning to your life. Understand that your problems usually are transient, and perhaps most importantly, acknowledge that life is not always supposed to be pleasurable.

In some cases of addiction, medication management can improve treatment outcomes. In most cases of addiction, the integration of psychosocial rehabilitation and ongoing care with evidence-based pharmacological therapy provides the best results. Chronic disease management is important for minimization of episodes of relapse and their impact. Treatment of addiction saves lives.

Addiction professionals and persons in recovery know the hope that is found in recovery. Recovery is available even to persons who may not at first be able to perceive this hope, especially when the focus is on linking the health consequences to the disease of addiction. As in other health conditions, self-management, with mutual support, is very important in recovery from addiction. Peer support such as that found in various “self-help” activities is beneficial in optimizing health status and functional outcomes in recovery.

Resources

http://www.helpguide.org/harvard/how-addiction-hijacks-the-brain.htm

http://www.asam.org/research-treatment/definition-of-addiction

Services Offered

BrightView offers Outpatient Therapy and Intensive Outpatient Therapy.

Our services include:

  • Medication Assisted Treatment
  • CBT (Cognitive Behavioral Therapy)
  • Individual & Group Therapy
  • Family Therapy
  • Relapse Prevention
  • Life – Purpose Counseling
  • Behavioral Modification
  • Professional Case Management
  • Patient Focused Assessment & Referral
  • Systematic Approach to Addiction Treatment
  • Health Coping & Wellness

Program Overview

Types of Programs: Substance Use Disorder; Intensive Outpatient and Outpatient Treatment

Program Length: Based on the medical and psychosocial needs of each patient.
General program length is between 12-15 months.

Outpatient Program:
Program standards:

  • 1 Physician visit per month
  • 1 Individual therapy session per month
  • 8 hours of group therapy per month
*Physician and therapy frequency is individualized and at the discretion of the treatment team

Intensive Outpatient Program:
Program standards:

  • 1 Physician visit per month
  • 4 or more individual therapy sessions per month
  • 9 hours per week of group therapy for up to 12 weeks
  • Patients are eligible to join the Outpatient Program
*Physician and therapy frequency is individualized and at the discretion of the treatment team

Hours of Operation: See online at http://brightviewhealth.com/contact-us/contact-us/

Admission Criteria: All of the following

  • 16 years of age or older
  • Primary diagnosis of substance use disorder
  • Completion of an assessment to determine the need for treatment

Completion Criteria: Successful completion of the comprehensive treatment program is demonstrated by achieving program goals and acquiring approval from the medical team and psychological staff

Patient Roadmap

patientroadmap

Explanation of the Program Components

Assessment/Evaluation

Assessments are required to determine the level of treatment needs and appropriateness for treatment. You will be placed into the level of care determined to be appropriate by the ASAM placement criteria.

Intake

In cooperation with the clinical team, you will decide whether or not to use medication assisted treatment for opiate withdrawal. Detoxification needs are assessed on a case by case basis. You will be given a comprehensive substance dependence assessment, as well as an evaluation of mental status, and physical exam. The pros and cons of medication assisted treatment will be presented to you.

Intake and Induction may both occur at the first visit, depending on your needs and your physician’s evaluation.

Stabilization & Maintenance

This is the second phase of treatment. During this phase, your physician may continue to adjust your dose until you find, and continue on, the dose that works for you. It is important to take your medication as directed. To evaluate the effectiveness of your dose, your physician may request urine samples from time to time.

During this phase is when you may also begin working on your treatment goals with your physician and counselor.

At times when you feel stressed, or experience triggers or cravings, your physician may suggest a dose adjustment, or there may be a need to change the frequency of counseling and/or behavioral therapy.

Occasionally, as you achieve your treatment goals and feel confident about your progress, your physician may suggest a dose decrease. During these times, you are “restabilized.” This is why stabilization and maintenance go together.

Tapering Off

There are no time limits for treatment with this medicine. Length of therapy is up to your physician, you, and sometimes your therapist or counselor. If you and your physician agree that the time is right to try and lower your dose (also known as a taper), he or she will reduce it slowly taking care to minimize withdrawal symptoms. If you feel at risk for relapse during a taper, let your physician know. You can be restabilized and continue maintenance if needed.

WARNING: This medicine is a narcotic medication indicated for the maintenance treatment of opioid dependence, available only by prescription, and must be taken under a physician’s care as prescribed. It is illegal to sell or give away your medicine.

Please see your physician or pharmacist for full product information and medication guidelines.

Side Effects

Patients will be provided with an orientation and educated on symptom management. Side effects of Buprenorphine/Naloxone are similar to those of other opioids and include nausea, vomiting, and constipation.

Buprenorphine/Naloxone can precipitate the opioid withdrawal syndrome. Additionally, the withdrawal syndrome can be precipitated in individuals maintained on Buprenorphine/Naloxone. Signs and symptoms of opioid withdrawal include:

  • Dysphoric mood (a state of feeling unwell or unhappy)
  • Nausea or vomiting
  • Muscle aches/cramps
  • Lacrimation (tearing)
  • Rhinorrhea (runny nose)
  • Pupillary dilation (wide pupils)
  • Sweating
  • Piloerection (hair standing on end)
  • Diarrhea
  • Yawning
  • Mild fever
  • Insomnia
  • Craving
  • Distress/Irritability

Drug Interactions, Cautions, and Contraindications

Refer to the Buprenorphine/Naloxone package inserts for a complete listing of drug interactions, contraindications, warnings, and precautions.

Under certain circumstances Buprenorphine/Naloxone by itself can also precipitate withdrawal in opioid-dependent individuals. This is more likely to occur with higher levels of physical dependence, with short time intervals (e.g., less than 12 hours) between a dose of opioid agonist (e.g., methadone) and a dose of Buprenorphine/Naloxone, and with higher doses of Buprenorphine/Naloxone.

Program Rules

As a participant in BrightView’s program, I freely and voluntarily agree to accept the terms and conditions of this agreement:

  • I agree to keep and be on time to all my appointments. Most appointments can be made within 24 hours and sometimes patients can be seen on the same day. If I miss my scheduled appointment, I must call within 24 hours to reschedule. Two consecutive missed appointments without calling to reschedule will likely result in discharge from the program.
  • I agree to conduct myself in a courteous manner in the BrightView offices. I agree not to conduct any illegal or disruptive activities in the BrightView offices.
  • I agree not sell, share, or give any of my medication to another person. I understand that such mishandling of my medication is a serious violation of this agreement and will result in my treatment being terminated without any recourse for appeal.
  • I understand that if I am observed or suspected of dealing, stealing, or performing an illegal or disruptive activity by an employee of the pharmacy where my medication is filled, that the behavior will be reported to BrightView and could result in my treatment being terminated without any recourse for appeal.
  • I understand that a missed scheduled physician’s visit will result in a charge.
  • I will provide a legal issued ID card, driver’s license, state issued ID card, or passport. No other method is acceptable.
  • I understand that payments may be made in the form of cash, credit or debit card.
  • I agree that my medication /prescription can only be given to me at my regular office visits. A missed visit may result in my not being able to get my medication /prescription until the next scheduled visit.
  • I agree that the medication I receive is my responsibility and I agree to keep it in a safe and secure place. I agree that lost medication will not be replaced regardless of why it was lost. BRIGHTVIEW WILL NOT CALL IN ANY REFILLS FOR ANY MEDICATIONS THAT HAVE BEEN LOST, STOLEN, DESTROYED OR MISPLACED— NO EXCEPTIONS WILL BE MADE. The safe keeping of my prescriptions is solely my responsibility.
  • I agree not to obtain medications from any physicians, pharmacies or other sources without telling my BrightView treating physician. BrightView has a zero tolerance policy for “physician shopping” and reports of falsified prescriptions or modified prescriptions will result in immediate discharge from the program.
  • I understand that mixing buprenorphine (Subutex®/Buprenorphine/Naloxone®) with other medications especially benzodiazepines [e.g. Valium®, Klonopin®, or Xanax®] can be dangerous. I also recognize that several deaths have occurred among persons mixing buprenorphine (Subutex®/Buprenorphine/Naloxone®) and benzodiazepines [especially if taken outside the care of a physician or using routes of administration other than sublingual or in higher than recommended therapeutic doses].
  • I agree to take my medication as the BrightView treating physician has instructed and not to alter the way I take my medication without first consulting my BrightView treating physician.
  • I understand that medication alone is not sufficient treatment for my condition, and I agree to consider other forms of treatment including counseling and substance abuse groups.
  • I agree to abstain from alcohol, opioids, marijuana, cocaine, and other addictive substances [except nicotine and caffeine].
  • I agree to provide a urine sample for drug testing at intake and as requested thereafter and to have my blood alcohol level tested. If I test positive for opiates or other controlled substances I may be put on a more frequent visit schedule until such time that the physician no longer deems it necessary. If I test positive for two consecutive urine tests, I will meet with the director and potentially be terminated from the program.
  • I understand that a violation of any of the above items may be grounds for discharge of my treatment in the sole absolute discretion of the ARNP, Medical Staff, Clinical Directors, or Executive Staff.

No refunds for advance payments shall be made. Patients may be reinstated without penalty at the discretion of the Medical Director and/or Clinical Staff. Reinstatement is not a guarantee. However, additional services and expenses may be assessed if necessary. After 30 days of discharge from the Program, patients must re-start the program.

For patients admitted into the Program, patients must re-start the program if they have missed more than 7 consecutive days, or as directed by the Medical Director.

In addition, it is your responsibility to:

  1. Maintain your clean-time (sobriety) while receiving services at BrightView. Anyone who appears to be or proves to be under the influence of alcohol or drugs will be excluded from the group session. Patients may be randomly tested for alcohol or other drugs and may be directed to provide a urine specimen for analysis. Failure to do so will result in discharge from the program. Positive alcohol or drug testing may result in discharge from the program and referral to a more intensive treatment program.
  2. Refrain from using any type of chemical substance while in treatment unless approved by a physician.
  3. Cooperate and conduct yourself in a responsible and appropriate manner. Physical violence or threats of violence are grounds for discharge. You will also meet your probation officer monthly, if applicable.
  4. Be on time for all sessions. All sessions will begin promptly at the designated time. Failure to be on time will result in a case conference to determine necessary action.
  5. Respect and protect the confidentially of others. Also respect the property of others.
  6. Resolve grievances as outlined in the Patient’s Rights Policy.
  7. Agree to pay the plan specified by BrightView.

Patient Rights

Subject to applicable State and Federal law, BrightView will comply with the following Patient rights established by the Ohio Department of Mental Health and the State of Ohio Department of Alcohol and Drug Addiction Services to the extent applicable to our program:

  1. The right to be treated with consideration and respect for personal dignity, autonomy, and privacy;
  2. The right to service in a humane setting, which is the least restrictively feasible as defined in the treatment plan;
  3. The right to be informed of one’s own condition, of proposed or current services, treatment or therapies, and of the alternatives and of available prevention services;
  4. The right to consent to or refuse any service, treatment, or therapy upon full explanation of the expected consequences of such consent or refusal. A parent or legal guardian may consent to or refuse any service, treatment, or therapy on behalf of a minor Patient;
  5. The right to a current, written, individualized service plan that addresses one’s own mental health, physical health, social and economic needs, and that specifies the provision of appropriate and adequate services, as available, either directly or by referral;
  6. The right to active and informed participation in the establishment, periodic review, and reassessment of the service plan;
  7. The right to freedom from unnecessary or excessive medication;
  8. The right to freedom from unnecessary physical restraint or seclusion;
  9. The right to participate in any appropriate and available agency service, regardless of refusal of one or more other services, treatments, or therapies, or regardless of relapse from earlier treatment in that or another service, unless there is a valid and specific reason which precludes and/or requires that Patient’s participation in other services. This necessity shall be explained to the Patient and written in the Patient’s current service plan;
  10. The right to be informed of and refuse any unusual or hazardous treatment procedures;
  11. The right to be advised of and refuse any observation by techniques such as one-way vision mirrors, tape recorders, televisions, movies or photographs;
  12. The right to have the opportunity to consult with independent treatment specialists or legal counsel, at one’s own expense;
  13.  The right to confidentiality of communications and of all personally identifying information within the limitations and requirements for disclosure of various funding and/or certifying sources, state or federal statutes, unless release of information is specifically authorized by the Patient or parent or legal guardian of a minor Patient or court-appointed guardian of the person of an adult Patient in accordance with rule 3793:2-1-07 of the Ohio Administrative Code;
  14. The right to have access to one’s own psychiatric, medical or other treatment records, unless access to particular identified items of information is specifically restricted for that individual Patient for clear treatment reasons in the Patient’s treatment plan. “Clear treatment reasons” shall be understood to mean only severe emotional damage to the Patient such that dangerous or self-injurious behavior is an imminent risk. The person restricting the information shall explain to the Patient and other persons authorized by the Patient the factual information about the individual Patient that necessitates the restriction. The restriction must be renewed at least annually to retain validity. Any person authorized by the Patient has unrestricted access to all information. Patients shall be informed in writing of agency policies and procedures for viewing or obtaining copies of personal records;
  15. The right to be informed in advance of the reason(s) for discontinuance of service provision, and to be involved in planning for the consequences of that event;
  16. The right to receive an explanation of the reasons for denial of services;
  17. The right not to be discriminated against in the provision of service on the basis of religion, race, color, creed, sex, national origin, age, lifestyle, physical or mental handicap, developmental disability, sexual orientation, disability or HIV infection, whether symptomatic or asymptomatic of AIDS
  18. The right to know the cost of services;
  19. The right to be fully informed of all consumer rights;
  20. The right to exercise any and all rights without reprisal in any form including continued and uncompromised access to service;
  21. The right to file a grievance; and
  22. The right to have oral and written instructions for filing a grievance.

Causes for Dismissal

  1. Violation of various program rules as described in this policy, (60 day suspension)
  2. Failure to return within 2 hours after prescription of Buprenorphine/Naloxone is written (60 day suspension)
  3. Inability to remain abstinent per drug testing policy (60 day suspension)
  4. Refusal to participate in treatment (60 day suspension)
  5. Non-compliance with medical protocol (60 day suspension)
  6. Inappropriate behavior that places self or others in danger (60 day suspension)
  7. Verbal or physical threats of violence against other patients or staff (120 day suspension)
  8. Acts of violence (Revocation, patient is not permitted reinstatement into the program)
  9. Repeated unexcused absences from program (60 day suspension)
  10. Harassment (verbal, social or sexual) against other patients or staff (Revocation, patient is not permitted reinstatement into the program)
  11. Trading, selling, buying or otherwise diverting any and all drugs (including those prescribed by a physician) (1-year suspension)
  12. Need to leave program for a medical or other mental health issue (Suspension to be determined by the Medical Director)

Reinstatement into the treatment program is not guaranteed. Reinstatement is at the sole discretion of the Medical Director and/or the patient’s clinical treatment team.

Confidentiality

The confidentiality of patient alcohol and drug abuse records maintained by this program is protected by Federal law and regulations. Generally, BrightView personnel may not disclose information regarding the attendance of a patient in the program, or disclose any information identifying a patient as an alcohol or drug abuser unless:

  1. The patient consents in writing;
  2. The disclosure is allowed by a court order; or
  3. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.

Violation of the Federal law and regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.

Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime.

Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.

Patients of BrightView are also expected to maintain the confidentiality of other patients at the program. Any information that patients may learn about others patients (including attendance) is considered PHI (protected health information) and is required to be kept confidential at all times.

Special Circumstances

Pregnancy

Pregnancy is not a cause of refusal of treatment or for dismissal from the treatment program. Notify your medical physician or counselor immediately if you think you are pregnant or become pregnant. Your treatment program will be altered, if necessary, after consultation with your treatment team.

Suicidal Risk

Each patient will be routinely assessed for suicidal risk. Patients found to have high suicidal risk will be referred to a local facility with emergency psychiatric services and local emergency medical services may be utilized. Patient safety is a top priority at BrightView. Patients may be reinstated for treatment at a later date after stabilization has occurred and the patient presents with low suicidal risk.

Your First Visit

Your first visit is generally the longest, and may last anywhere from 2 to 6 hours.

When preparing for your first office visit, there are a few logistical issues you will want to consider:

  • You may not want to return to work on the day of your visit – this is very normal, so just plan accordingly
  • Because the medication can cause drowsiness and slow reaction times, particularly during the first few weeks of treatment, driving yourself home after the first visit is generally not recommended. You may want to arrange for a ride home. It is very important to arrive for your first visit already experiencing moderate opioid withdrawal symptoms. If you are in withdrawal, the medicine is supposed to help lessen the symptoms.

However, if you are not in withdrawal, the medicine will “override” the opioids already in your system, which will cause severe withdrawal symptoms.

The following guidelines are provided to ensure you are in withdrawal for the visit. (If this concerns you, it may help to schedule your first visit in the morning; some patients find it easiest to skip what would normally be their first dose of the day.)

  • No methadone or long-acting painkillers for at least 36 hours
  • No heroin or short-acting painkillers for at least 24 hours
  • No alcohol

Bring a list of ALL current medications with you to your first appointment.

Urine drug screening is a regular part of treatment. It provides physicians with important insights into your health and treatment. Your first visit will include urine drug screening, and may also include a Breathalyzer®* test and blood work.

Before you can be seen by the physician, all of the paperwork provided must be completed. If you were provided the paperwork prior to this visit, bring it completed; otherwise arrive about 30 minutes prior to your appointment to complete the paperwork.

After this portion of your visit is completed, your physician will administer your first dose. Your physician may have you fill the prescription at the pharmacy and return to the physician’s office so you can take the medication in a safe place where the medical staff can monitor your response.

Once you take your first dose, you should begin to feel better within 30 minutes. Your physician may choose to give you additional doses while you are in the office. It’s important that you are honest about how you are feeling during induction so your physician can find the appropriate dose for you.

When you leave the office, the physician will likely give you a prescription that will last until your counseling appointment. You will not receive additional prescriptions until you have attended your counseling appointment.

Your physician may ask you to keep a record of any medications you take at home to control withdrawal symptoms. You will also receive instructions on how to contact your physician in an emergency, as well as additional information about treatment.

CHECKLIST FOR YOUR FIRST VISIT:

  • Arrive experiencing moderate opioid withdrawal symptoms
  • Arrive prepared to give a urine sample for screening
  • Bring completed forms (or come 30 minutes early)
  • Bring a list of ALL current medications
  • Pay all fees due at the time of your visit

Here to Help® is a registered trademark of Reckitt Benckiser Healthcare (UK) Ltd.

*Breathalyzer is a registered trademark of Draeger Safety, Inc., Breathalyzer Division.

Please see your physician or pharmacist for full product information for your medicine.

Safe Medication

Patients who are prescribed buprenorphine/naloxone (Suboxone, Zubsolv, etc.) may need other medications at times (both prescription and over-the-counter). Many medications interact with buprenorphine/naloxone (Suboxone, Zubsolv, etc.). Some medications raise, and some lower the blood level of buprenorphine. It is essential that patients inform all healthcare providers that they have been diagnosed with opioid dependence and are taking buprenorphine/naloxone (Suboxone, Zubsolv, etc.) before starting any new medication.

Any mood altering substance or medication, even if it is not the “drug of choice”, can trigger the reward pathway in the brain and eventually lead the addict back to the behaviors of addiction. This is called cross-addiction. Below, are two tables that patients should consult when trying to determine if a medication is safe to take while being on buprenorphine/naloxone (Suboxone, Zubsolv, etc.).

POTENTIAL DRUG INTERACTIONS WITH BUPRENORPHINE

Drug: Benzodiazepines
Use: Anxiety/Panic Disorder
Common Name/Brand Names: Xanax, Ativan, Klonopin, Librium, Serax, Tranxene
Potential Effect: Can suppress breathing, deaths reported if abused (especially IV)

Drug: Alcohol
Use: Recreational
Common Name/Brand Names: Beer, wine, champagne, liquor
Potential Effect: Can suppress breathing, deaths reported with heavy use

Drug: Hypnotics
Use: Insomnia
Common Name/Brand Names: Ambien, Lunesta, Benadryl, Tylenol PM, Nyquil
Potential Effect: Can suppress breathing

Drug: Naltrexone
Use: Relapse prevention
Common Name/Brand Names: Revia, Vivitrol
Potential Effect: Can cause withdrawal

Drug: Erythromycin
Use: Antibiotic
Common Name/Brand Names: Biaxin, Z-Pack
Potential Effect: Can increase levels of buprenorphine

Drug: Rifampin
Use: Antibiotic
Potential Effect: Can increase levels of buprenorphine

Drug: Metronidazole
Use: Antibiotic
Common Name/Brand Names: Flagyl
Potential Effect: Can increase levels of buprenorphine

Drug: Fluconazole
Use: Anti-fungal
Common Name/Brand Names: Diflucan
Potential Effect: Can increase levels of buprenorphine

Drug: Ketoconazole
Use: Anti-fungal
Common Name/Brand Names: Nizoral
Potential Effect: Can increase levels of buprenorphine

Drug: Anti-virals
Use: HIV treatment
Common Name/Brand Names: Multiple drugs
Potential Effect: Can increase levels of buprenorphine

Drug: Paroxetine
Use: Anxiety, depression
Common Name/Brand Names: Paxil
Potential Effect: Can increase levels of buprenorphine

Drug: Sertraline
Use: Anxiety, depression
Common Name/Brand Names: Zoloft
Potential Effect: Can increase levels of buprenorphine

Drug: Fluoxetine
Use: Anxiety, depression
Common Name/Brand Names: Prozac
Potential Effect: Can increase levels of buprenorphine

Drug: Carbamazepine
Use: Seizures, Neuropathy
Common Name/Brand Names: Tegretol
Potential Effect: Can decrease levels of buprenorphine

Drug: Phenobarbital
Use: Seizures
Common Name/Brand Names: Phenobarbital
Potential Effect: Can decrease levels of buprenorphine

Drug: Phenytoin
Use: Seizures
Common Name/Brand Names: Dilantin
Potential Effect: Can decrease levels of buprenorphine

Drug: Primidone
Use: Seizures
Common Name/Brand Names: Mysoline
Potential Effect: Can decrease levels of buprenorphine

GENERAL MEDICATION GUIDELINES IN RECOVERY

Classification: Allergy/Decongestants
Drugs to Avoid if Possible: Dimetap, Benadryl, Afrin, Acted, Phenergan, Sudafed, Novafed, Dristan, Allegra D, Claritin D, Allerest, Zyrtec D, Neosynephrine
Safe Medications List – Usually OK to Use: Claritin, Clarinex, Allegra, Zyrtec, Taoist, Nasonex, Flonase, Beconase, Humist, Vancenase, Rhinocort

Classification: ADHD
Drugs to Avoid if Possible: Adderall, Concerta, Provigil, Adipex, Amphetamine, Ritalin, Methylin
Safe Medications List – Usually OK to Use: Strattera and Wellbutrin

Classification: Pain Relief
Drugs to Avoid if Possible: All full opioids including Ultram, Ultracet (tramodol), Duragesic
Safe Medications List – Usually OK to Use: Advil, Aleve, Tylenol, Bufferin, Aspirin, Dolobid, Anaprox, Bextra, Celebrex, Daypro, Feldene, Indocin, Motrin, Naprosyn, Naproxen, Relafen, Toradol

Classification: Muscle Relaxants
Drugs to Avoid if Possible: Carisoprodol (Soma), Baclofen
Safe Medications List – Usually OK to Use: Flexeril, Robaxin, Skelaxin

Classification: Migraine Medications
Drugs to Avoid if Possible: Fiorinal, Fioricet, Stadol nasal, Midrin
Safe Medications List – Usually OK to Use: Imitrex, Maxalt, Inderal, Depakote, Zomig, Caffergot

Classification: Asthma
Drugs to Avoid if Possible: Ephedrine-Primatene
Safe Medications List – Usually OK to Use: Advair, Pro-Air, Combivent, Proventil, Duoneb, Maxair, Pulmicort, Vanceril, Alupent, Xopenex inhaled

Classification: Cough
Drugs to Avoid if Possible: Phenergan with codeine, Dimetapp, Contac, Nyquil, Hycodan, Hycotuss, Dextromethorphan, Tussionex, Robitussin AC, Robitussin DM
Safe Medications List – Usually OK to Use: Guaifenesin, Organidin, Duratuss G, Tessalon Perles, Humabid LA, Robitussin Plain, Mucinex tablets

Classification: Diarrhea
Drugs to Avoid if Possible: Lomotil, Paregoric, Bentyl, Imodium A-D liquid
Safe Medications List – Usually OK to Use: Kaopectate, Pepto-Bismol, Imodium A-D capsules

Classification: Sedatives/Anti-anxiety/Sleep
Drugs to Avoid if Possible: All benzodiazepines (Xanax, Librium, Klonopin, Tranxene, Valium, Dalmane, Ativan, Serax, Restoril), Vistaril, Sinequan, Seroquel, Benadryl, NyQuil, Unisom, Atarax (hydralazine), Ambient, Lunesta
Safe Medications List – Usually OK to Use: Buspar, Trazodone, Elavil, Paxil, Zyprexa, Prozac, Celexa, Effexor XR, Lexapro, Remeron, Risperdal, Trilafon, Zoloft

Classification: Nausea
Drugs to Avoid if Possible: Antivert
Safe Medications List – Usually OK to Use: Zofran, Reglan, Compazine

Classification: Smoking Cessation
Drugs to Avoid if Possible: n/a
Safe Medications List – Usually OK to Use: Wellbutrin, Zyban, Nicorette, Nicoderm (if used appropriately)

Classification: Alcoholism
Drugs to Avoid if Possible: Benzodiazepines except for acute withdrawal
Safe Medications List – Usually OK to Use: Acamprosate (Campril), Antabuse, Naltrexone (oral or injectable)

Infectious Disease Education

VIRAL HEPATITIS B

Signs & Symptoms

  • About 30% of persons have no signs or symptoms
  • Signs and symptoms are less common in children than adults:
    • Jaundice
    • Loss of appetite
    • Fatigue
    • Nausea, vomiting
    • Abdominal pain
    • Joint pain

Long-Term Effects Without Vaccination

Chronic Infection occurs in:

  • 90% of infants infected at birth
  • 30% of children infected at age 1-5 years
  • •% of persons infected after age 5 years

Death from chronic liver disease occurs in:

  • •5-25% of chronically infected persons

Transmission

  • Occurs when blood or body fluids from an infected person enters the body of a person who is not immune.
  • HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmissions), sharing needles or “work” when “shooting” drugs, through needle sticks or sharps exposures on the job, or from infected mother to her baby during birth.

Persons at risk for HBV might also be at risk for infection with hepatitis C virus (HCV) or HIV.

Risk Groups

  • Persons with multiple sex partners or diagnosis of a sexually transmitted infection
  • Men who have sex with men
  • Sex contacts of infected persons
  • Intravenous drug users
  • Household contacts of chronically infected person
  • Infants born to infected mothers
  • Infants/children of immigrants from areas with high rates of HBV infection
  • Health care and public safety workers
  • Hemodialysis patients

Prevention

  • Hepatitis B vaccine is the best protection
  • If you are having sex, but not with one steady partner, use latex condoms correctly and every time if you have sex. The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission
  • If you are pregnant, you should get a blood test for hepatitis B; infants born to HBV-infected mothers should be given HBIG (hepatitis immunce globulin) and vaccine within 12 hours after birth.
  • Do not shoot drugs, if you shoot drugs, stop and get into a treatment program; if you cannot stop, never share needles, syringes, water, or “works”, and get vaccinated against hepatitis A and B.
  • Do not share personal care items that might have blood on them (razors, toothbrushes).
  • Consider the risks if you are thinking about getting a tattoo or body piercing. You might be infected if the tools have someone else’s blood on them or if the artist or pierced does not follow standard health practices.
  • If you have or had hepatitis B, do not donate blood, organs or tissue.
  • If you are a health care or public safety worker, get vaccinated against hepatitis B, and always follow routine barrier precautions and safely handle needles and other sharps.

Vaccine Recommendations

  • Hepatitis B vaccine available since 1982
  • Routine vaccination of 0-18 year olds
  • Vaccination of risk groups of all ages (see section on risk groups)

Treatment & Medical Management

  • HBV Infected persons should be evaluated by their doctor for liver disease
  • Alpha interferon and lamivudine are two drugs license for the treatment of persons with chronic hepatitis B.

These drugs are effective in up to 40% of patients.

  • These drugs should not be used by pregnant women.
  • Drinking alcohol can make your liver disease worse.

Trends & Statistics

  • Number of new infections per year has declined from an average of 450,000 in the 1980s to about 80,000 in 1999.
  • Highest rate of disease occurs in 20-49 year olds
  • Greatest decline has happened among children and adolescents due to routine hepatitis B vaccination.
  • Estimated 1.25 million chronically infected Americans, of whom 20-30% acquired their infection in childhood.

VIRAL HEPATITIS C

What is Hepatitis C?

Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. When first infected, a person can develop an “acute” infection, which can range in severity from a very mild illness with few or no symptoms to a serious condition requiring hospitalization.

Acute Hepatitis C is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For reasons that are not known, 15%–25% of people “clear” the virus without treatment.

Approximately 75%–85% of people who become infected with the Hepatitis C virus develop “chronic,” or lifelong, infection.

Chronic Hepatitis C is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Over time, it can lead to serious liver problems, including liver damage, cirrhosis, liver failure, or liver cancer.

How is Hepatitis C spread?

Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with Hepatitis C by sharing needles or other equipment to inject drugs. Before widespread screening of the blood supply began in 1992, Hepatitis C was also commonly spread through blood transfusions and organ transplants. Although uncommon, outbreaks of Hepatitis C have occurred from blood contamination in medical settings.

Can Hepatitis C be spread through sex?

Yes, although scientists do not know how frequently this occurs. Having a sexually transmitted disease or HIV, sex with multiple partners, or rough sex appears to increase a person’s risk for Hepatitis C. There also appears to be an increased risk for sexual transmission of Hepatitis C among gay men who are HIV-positive.

Can a person get Hepatitis C from a tattoo or piercing?

There is little evidence that Hepatitis C is spread by getting tattoos in licensed, commercial facilities. Whenever tattoos or body piercings are given in informal settings or with non-sterile instruments, transmission of Hepatitis C and other infectious diseases is possible.

How common is Hepatitis C?

An estimated 3.2 million people in the United States have chronic Hepatitis C. Most are unaware of their infection.

Each year, about 17,000 Americans become infected with Hepatitis C.

How serious is Hepatitis C?

Chronic Hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, and liver cancer. Approximately 12,000 people die every year from Hepatitis C-related liver disease.

What are the symptoms of Hepatitis C?

Many people with Hepatitis C do not have symptoms and do not know they are infected. Even though a person has no symptoms, the virus can still be detected in the blood.

If symptoms occur with acute infection, they can appear anytime from 2 weeks to 6 months after exposure.

Symptoms of chronic Hepatitis C can take up to 30 years to develop. Damage to the liver can silently occur during this time. When symptoms do appear, they often are a sign of advanced liver disease. Symptoms for both acute and chronic Hepatitis C can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, grey-colored stools, joint pain, and jaundice.

How is Hepatitis C diagnosed?

Doctors can diagnose Hepatitis C using specific blood tests that are not part of blood work typically done during regular physical exams. Typically, a person first gets a screening test that looks for “antibodies” to the Hepatitis C virus. Antibodies are chemicals released into the bloodstream when a person becomes infected. The antibodies remain in the bloodstream, even if the person clears the virus. If the screening test is positive for Hepatitis C antibodies, different blood tests are needed to determine whether the infection has been cleared or has become a chronic infection.

Who should get tested for Hepatitis C?

Testing for Hepatitis C is recommended for certain groups, including people who:

  • Currently inject drugs
  • Injected drugs in the past, even if it was just once or occurred many years ago
  • Have HIV infection
  • Have abnormal liver tests or liver disease
  • Received donated blood or organs before 1992
  • Have been exposed to blood on the job through a needle stick or injury with a sharp object
  • Are on hemodialysis

How is Hepatitis C treated?

Since acute Hepatitis C rarely causes symptoms, it often goes undiagnosed and therefore untreated. When it is diagnosed, doctors recommend rest, adequate nutrition, fluids, and antiviral medications. People with chronic Hepatitis C should be monitored regularly for signs of liver disease. Even though a person may not have symptoms or feel sick, damage to the liver can still occur. Antiviral medications can be used to treat some people with chronic Hepatits C, although not everyone needs or can benefit from treatment. For many, treatment can be successful and results in the virus no longer being detected.

For more information Talk to your health professional, call your health department, or visit www.cdc.gov/hepatitis.

HIV (Human Immunodeficiency Virus)

What is HIV?

HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life.

No safe and effective cure currently exists, but scientists are working hard to find one, and remain hopeful.

Meanwhile, with proper medical care, HIV can be controlled. Treatment for HIV is often called antiretroviral therapy or ART. It can dramatically prolong the lives of many people infected with HIV and lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years.

Today, someone diagnosed with HIV and treated before the disease is far advanced can have a nearly normal life expectancy.

HIV affects specific cells of the immune system, called CD4 cells, or T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. When this happens, HIV infection leads to AIDS.

Where did HIV come from?

Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans. They believe that the chimpanzee version of the immunodeficiency virus (called simian immunodeficiency virus, or SIV) most likely was transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and came into contact with their infected blood. Studies show that HIV may have jumped from apes to humans as far back as the late 1800s. Over decades, the virus slowly spread across Africa and later into other parts of the world. We know that the virus has existed in the United States since at least the mid- to late 1970s.

What are the stages of HIV?

HIV disease has a well-documented progression. Untreated, HIV is almost universally fatal because it eventually overwhelms the immune system—resulting in acquired immunodeficiency syndrome (AIDS). HIV treatment helps people at all stages of the disease, and treatment can slow or prevent progression from one stage to the next.

A person can transmit HIV to others during any of these stages:

Acute infection: Within 2 to 4 weeks after infection with HIV, you may feel sick with flu-like symptoms. This is called acute retroviral syndrome (ARS) or primary HIV infection, and it’s the body’s natural response to the HIV infection.

(Not everyone develops ARS, however—and some people may have no symptoms.)

During this period of infection, large amounts of HIV are being produced in your body. The virus uses important immune system cells called CD4 cells to make copies of itself and destroys these cells in the process. Because of this, the CD4 count can fall quickly.

Your ability to spread HIV is highest during this stage because the amount of virus in the blood is very high.

Eventually, your immune response will begin to bring the amount of virus in your body back down to a stable level.

At this point, your CD4 count will then begin to increase, but it may not return to pre-infection levels.

Clinical latency (inactivity or dormancy): This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase, HIV is still active, but reproduces at very low levels. You may not have any symptoms or get sick during this time. People who are on antiretroviral therapy (ART) may live with clinical latency for several decades. For people who are not on ART, this period can last up to a decade, but some may progress through this phase faster. It is important to remember that you are still able to transmit HIV to others during this phase even if you are treated with ART, although ART greatly reduces the risk. Toward the middle and end of this period, your viral load begins to rise and your CD4 cell count begins to drop. As this happens, you may begin to have symptoms of HIV infection as your immune system becomes too weak to protect you .

AIDS (acquired immunodeficiency syndrome): This is the stage of infection that occurs when your immune system is badly damaged and you become vulnerable to infections and infection-related cancers called opportunistic illnesses. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (Normal CD4 counts are between 500 and 1,600 cells/mm3.) You can also be diagnosed with AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count.

Without treatment, people who are diagnosed with AIDS typically survive about 3 years. Once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about 1 year. People with AIDS need medical treatment to prevent death.

How can I tell if I am infected with HIV?

The only way to know if you are infected with HIV is to be tested. You cannot rely on symptoms to know whether you have HIV. Many people who are infected with HIV do not have any symptoms at all for 10 years or more. Some people who are infected with HIV report having flu-like symptoms (often described as “the worst flu ever”) 2 to 4 weeks after exposure. Symptoms can include:

  • Fever
  • Enlarged lymph nodes
  • Sore throat
  • Rash

These symptoms can last anywhere from a few days to several weeks. During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others.

However, you should not assume you have HIV if you have any of these symptoms. Each of these symptoms can be caused by other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection.

For information on where to find an HIV testing site, • Visit National HIV and STD Testing Resources and enter your ZIP code.

  • Text your ZIP code to KNOWIT (566948), and you will receive a text back with a testing site near you.
  • Call 800-CDC-INFO (800-232-4636) to ask for free testing sites in your area.

These resources are confidential. You can also ask your health care provider to give you an HIV test.

Two types of home testing kits are available in most drugstores or pharmacies: one involves pricking your finger for a blood sample, sending the sample to a laboratory, then phoning in for results. The other involves getting a swab of fluid from your mouth, using the kit to test it, and reading the results in 20 minutes. Confidential counseling and referrals for treatment are available with both kinds of home tests.

If you test positive for HIV, you should see your doctor as soon as possible to begin treatment.

Is there a cure for HIV?

For most people, the answer is no. Most reports of a cure involve HIV-infected people who needed treatment for a cancer that would have killed them otherwise. But these treatments are very risky, even life-threatening, and are used only when the HIV-infected people would have died without them. Antiretroviral therapy (ART), however, can dramatically prolong the lives of many people infected with HIV and lower their chance of infecting others. It is important that people get tested for HIV and know that they are infected early so that medical care and treatment have the greatest effect.

TUBERCULOSIS

What is Tuberculosis?

TB, or tuberculosis, is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria can attack any part of your body, but they usually attack the lungs. TB disease was once the leading cause of death in the United States.

In the 1940’s, scientists discovered the first of several drugs now used to treat TB. As a result, TB slowly began to disappear in the United States. But TB has come back. Between 1985 and 1992, the number of TB cases increased.

The country became complacent about TB and funding of TB programs was decreased. However, with increased funding and attention to the TB problem, we have had a steady decline in the number of persons with TB. But TB is still a problem; more than 16,000 cases were reported in 2000 in the United States.

People who are infected with latent TB do not feel sick, do not have any symptoms, and cannot spread TB. But they may develop TB disease at some time in the future. People with TB disease can be treated and cured if they seek medical help. Those who have latent TB infection but are not yet sick can take medicine so they will never develop TB.

How is Tuberculosis Spread?

TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected.

When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine and brain.

TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spin, is usually not infectious.

People with TB are most likely to spread it to people they spend time with every day. This includes family members, friends and co-workers.

What is Latent Tuberculosis Infection?

In most people who breath in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection. People with latent TB infection

  • Have no symptoms
  • Do not feel sick
  • Cannot spread TB to others
  • Usually have positive skin test reaction
  • Can develop TB disease later in life if they do not receive treatment for latent TB infection

Many people who have latent TB infection never develop TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active and cause TB disease.

What is Tuberculosis Disease?

TB bacteria become active if the immune system cannot stop them from growing. The active bacteria begin to multiply in the body and cause TB disease. Some people develop TB disease soon after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick later, when their immune system becomes weak for some reason.

Babies and young children often have weak immune systems. People infected with HIV, the virus that causes AIDS, have very weak immune systems. Other people can have weak immune systems, too, especially people with any of these conditions.

  • Substance abuse • Diabetes mellitus
  • Silicosis • Cancer of the head or neck
  • Leukemia or Hodgkin’s disease • Severe kidney disease
  • Low Body Weight • Certain Medical Treatments (such as corticosteroid treatment or organ transplants

Symptoms of TB depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs.

TB in the lungs may cause:

  • A bad cough that lasts longer than 2 weeks
  • Pain in the chest
  • Coughing up blood or sputum (Phlegm from deep inside the lungs)

Other symptoms of TB disease are

  • Weakness or fatigue
  • Weight loss
  • No Appetite
  • Chills
  • Fever
  • Sweating at night

Difference Between Latent TB Infection and TB Disease

Latent TB Infection

Have no symptoms

Do not feel sick

Cannot Spread TB to others

Usually have a positive skin test

Chest X-Ray and Sputum test normal

TB Disease

Symptoms include:

  •  A bad cough that lasts longer than 2 weeks
  •  Pain the chest
  •  Coughing up blood or sputum
  •  Weakness or fatigue
  • Weight loss
  • No appetite
  • Chills
  • Fever
  • Sweating at night

May spread TB to others

Usually have a positive skin test

May have abnormal chest X-Ray and/or positive sputum smear or culture

How can I keep from spreading Tuberculosis?

The most important way to keep from spreading TB is to take all your medicine, exactly as directed by your doctor or nurse. You should also keep all of your clinic appointments! Your doctor or nurse need to see how you are doing.

You may need another chest x-ray or a test of the phlegm you may cough up. These tests will show whether the medicine is working. They will also show if you can still give TB bacteria to others. Be sure to tell the doctor about anything you think is wrong.

If you are sick enough with TB to go to a hospital, you may be placed in a special room. These rooms use air vents that keep TB from spreading. People who work in these rooms must wear a special facemask to protect themselves from TB bacteria. You must stay in the room so that you will not spread TB bacteria to other people. Ask a nurse if you need something that is not in your room.

If you are infectious while you are at home, there are certain things you can do to protect yourself and others near you. Your doctor may tell you to follow these guidelines to protect yourself and others:

  • The most important thing is to take your medication.
  • Always cover your mouth with a tissue when you cough, sneeze, or laugh. Put the tissues in a closed paper sack and throw it away
  • Do not go to school or work. Separate yourself from others and avoid close contact with anyone. Sleep in a bedroom away from other family members.
  • Air out your room often to the outside of the building (if it is not too cold outside). TB spreads in small closed spaces when air does not move. Put a fan in your window to blow out (exhaust) air that may be filled with TB bacteria. If you open other windows in the room, the fan also will pull in fresh air. This will reduce the chances that TB bacteria stay in the room and infect someone who breathes the air.

Remember, TB is spread though the air. People cannot be infected with TB bacteria through handshakes, sitting on toilet seats, or sharing dishes and utensils with someone who has TB.

After you take medicine for about 2-3 weeks, you may not longer be able to spread TB bacteria to others. If your doctor or nurse agrees, you will be able to go back to your normal routine. Remember, you will get well only if you take your medicine exactly as your doctor or nurse tells you.

Think about people who may have spent time with you, such as family members, close friends and co-workers. The local health department may need to test them for latent TB infection. TB is especially dangerous for children and people with HIV infection. If infected with TB bacteria, these people need preventative therapy right away to keep from developing TB disease.

What is multi-drug resistant Tuberculosis (MDR TB)?

When TB patients do not take their medicine as prescribed, the TB bacteria may become resistant to a certain drug.

This means the drug can no longer kill the bacteria. Drug resistance is more common in people who:

  • Have spent time with someone with drug resistant-TB
  • Do not take their medicine regularly
  • Do not take all of their prescribed medicine
  • Develop TB disease again, after having taken TB medicine in the past
  • Come from areas where drug resistant TB is common

Sometimes the bacteria become resistant to more than one drug. This is called multi-drug resistant TB, or MDR TB.

This is a very serious problem. People with MDR TB must be treated with special drugs. These drugs are not as good as the usual drugs for TB and they may cause more severe side effects. Also, some people with MDR TB must see a TB expert who can closely observer their treatment to make sure it is working.

People who have spent time with someone sick with MDR TB can become infected with TB bacteria that are resistant to several drugs. If they have a positive skin test reaction, they may be given preventative therapy. This is very important for people at high risk of developing MDR TB, such as children and HIV infected people.

TUBERCULOSIS (TB) TESTING

BrightView may require TB testing as part of a Wellness Treatment for patients at risk of Tuberculosis

Risk Factors for TB:

  • Living or working in close contact with a large group of people (a hospital ward, homeless shelter or jail) increases TB risk
  • History of intravenous drug use increases TB risk
  • Living or working with someone who has active TB increases risk
  • HIV infection increases risk for TB

Testing Positive for TB

Testing positive for TB does not necessarily mean a person has active TB. A positive test for TB does not necessarily mean the person should be treated for TB or that the person can give TB to someone else.

Testing positive for TB means a person has been exposed to the disease and should be watched for symptoms of active TB by medical personnel.

Only active TB is contagious. Active TB requires medical treatment from a doctor/clinic.

Getting a TB test if you’re at risk

TB testing tells you if you need to watch for symptoms of active TB. Your doctor can give you a TB test in two visits, two or three days apart. A small amount of fluid is placed under the skin on the left arm and yours skin’s reaction to that fluid is checked by a nurse or doctor 48-72 hours later. If your skin shows a “positive” reaction, your doctor may recommend a chest x-ray to see if you have active TB.

This test can also be done a the Hamilton County Tuberculosis Control Clinic for a small fee. Their offices are located at 184 East McMillan Street, Cincinnati, OH 45219. For more information or to schedule an appointment call:

513-946-7610.

If you are pregnant (or think you might be), please talk to your doctor or clinic before your TB test.

BrightView wants you to be well. Call BrightView at 513-834-7063 for information on tuberculosis and other wellness topics.

Advance Directives- for more information on end of life decisions including durable power of attorney and living wills see a counselor, case manager, or clinical supervisor. Or you can access the information at http://www.caringinfo.org/files/public/ad/Ohio.pdf

Frequently Asked Questions

How is patient absence and tardiness managed at BrightView?

  • Detoxification/Induction: Absence is ONLY excused for a medical emergency or a scheduled legal proceeding. An absence for any other reason is unacceptable and will result in discharge from the program.
  • Appointment Cancellations with Counselors & Physicians: A patient must call and give at least 24 hours notice for any clinical appointment at BrightView. Any absence where a patient calls in and notifies BrightView in less than 24 hours will be considered an unexcused absence. After two or more unexcused absences, a patient can be discharged from the program.
  • No Call/No Show Absences: It is considered a serious violation of BrightView’s policies if a patient does NOT call and does NOT arrive at BrightView when they were scheduled for a clinical visit. A no call/no show always raises the question of a relapse. If a patient wishes to remain in the program, the patient MUST appear the following morning for a drug screen and evaluation. At that time, the patient will be asked to complete a Behavior Contract stating that a second No Call/No Show will result in discharge from the program.
  • Tardiness: A late arrival for a scheduled appointment time may result in cancellation of that appointment and a cancellation fee. If you arrive late for a group session, you may be asked to wait to enter the group until the next break.
  • Vacation: We strongly recommend that patients delay or reschedule any planned vacations until the After Care phase of treatment.
  • Medical Emergencies: We consider medical emergencies excused absences. However, in the event of a medical emergency, documentation from the medical provider must be furnished to BrightView.
  • Legal Proceedings: If a patient has a scheduled court hearing or an appointment with a probation officer or CPS caseworker, the patient MUST give 24 hours notice and supply documentation verifying the date and time of the appearance.

What is considered acceptable patient behavior at BrightView?

  • Patients are expected to carry themselves in a calm, courteous, and cooperative manner while at BrightView. Any profane or threatening language directed at any BrightView employee or patient is considered unacceptable and may result in an immediate discharge. Any disruptive behavior in a group counseling session may require the patient to be removed from the session immediately. This may also trigger a case review with the BrightView staff to determine if the patient is still able to remain in the program.

Does BrightView offer a medication-only program?

  • No, BrightView does not prescribe medication to a patient unless they are willing to engage in one of our comprehensive treatment programs.

Are family education and/or social support sessions necessary to stay in the program?

  • Yes, all patients MUST participate in the family education or social support sessions that are held each month. Family members, significant others, and children at least 12 years of age are invited to attend. These sessions do count towards a patient’s weekly counseling requirements.

Do patients have to see an individual counselor as described in the IOP and OP programs?

  • Yes, it is the patient’s responsibility to schedule individual counseling appointments as required by their IOP or OP program. At their first appointment, the counselor will develop a master treatment plan the patient will agree to and sign. The counselor will evaluate the patient’s progress in treatment each week and month.

Individual counseling appointments are critical to a patient’s success in the program and approval for their next prescription. Patients should not miss these appointments.

How many days of therapy can be provided to a patient that is compliant and progressing through the program?

  • If a patient is in the Intensive Outpatient Program (IOP) and attends all of their appointments and group sessions, and has a negative drug screen, the physician will typically write a prescription for a 7-day supply of medication.
  • If a patient is in the Outpatient Program (OP) and attends all of their appointments and group sessions, and has a negative drug screen, the physician will typically write a prescription for 14 to 28 days worth of medication.

Tapering of the dosage may begin in the 2nd or 3rd month of maintenance therapy with the goal of being completely off maintenance therapy within 12 to 18 months.

How many days of therapy are provided to a patient that is non-compliant in the program?

  • If a patient is deemed “non-compliant”, the patient will need to make an appointment to see their physician to explain the reason for non-compliance BEFORE any further prescriptions medication is furnished. The physician will then determine if the patient may receive additional therapy after also discussing the situation with the counselors involved with the patient.

What type of living environment is recommended for patients in the program?

  • Patients must maintain a sober living environment to participate in the program. If a patient makes a poor decision to resume living with an active user, the patient will be violating the treatment agreement and jeopardizing recovery. A patient’s chance of recovering while living with an active user is extremely low.

Although an active user may promise to support a patient’s recovery, at some point that person will likely be in withdrawal and will beg, borrow, or steal the patient’s medication. If a patient relapses while they are living in a non-sober environment and are unwilling to change that environment, they will be referred to a higher level of care (a residential treatment program). A patient needs to surround themselves with sober people – it gives them the best chance at success. Maintaining contact with active users will trigger cravings and increase a patient’s risk of relapse.

Does BrightView recommend addiction recovery support groups?

  • Yes, BrightView recommends that all patients attend an addiction recovery support group (AA, NA, SMART Recovery, etc…). This is not a requirement of BrightView’s program but it is strongly recommended as an important tool in a patient’s successful recovery.

What does a patient do if their support group sponsor has an issue with buprenorphine/naloxone (Suboxone, Zubsolv, etc.)?

  • Alcoholics Anonymous and Narcotics Anonymous were founded and based on the principle of complete abstinence from alcohol and all mood-altering drugs. Many members have a strong bias against the use of any medication to assist in recovery. Unfortunately, in the case of opiate addiction, this is extremely difficult to achieve. The success rate for opiate-dependent patients who rely solely on a 12-Step Program for recovery is reported at less than 5%. Most individuals in these groups are well intentioned but are not medical or treatment professionals and do not understand the unique nature of a partial opioid like buprenorphine/naloxone (Suboxone, Zubsolv, etc.). Narcotics Anonymous has published a pamphlet entitled, “NA Groups and Medication”, and it addresses this very topic.

What should a patient do if the patient needs to see another healthcare provider for medical, dental, or mental health issues?

  • While enrolled in BrightView’s program, patients agree to disclose to all healthcare providers that they have been diagnosed with opioid dependence and are taking buprenorphine/naloxone (Suboxone, Zubsolv, etc.).

Patients also agree to sign a Release of Confidential Information Form for each encounter allowing that medical provider to discuss and coordinate care with BrightView. Many health professionals are not familiar with buprenorphine (Suboxone). We ask that patients have their healthcare providers contact BrightView if they have any questions about buprenorphine/naloxone (Suboxone, Zubsolv, etc.) since many medications can interact with buprenorphine/naloxone (Suboxone, Zubsolv, etc.).

A patient failing to inform a healthcare provider that he/she is prescribed buprenorphine and obtaining or attempting to obtain a controlled substance from that provider may constitute a felony (Section 2925.22 of the Ohio Revised Code-Deception to Obtain a Dangerous Drug).

What should a patient do if experiencing acute and/or severe pain?

  • Patients need to understand that if they have an acutely painful medical, surgical, or dental condition that buprenorphine/naloxone (Suboxone, Zubsolv, etc.) has only limited pain-relieving qualities and may not be adequate to control severe pain. The management of severe pain can be challenging for the first 24-48 hours after a patient’s last dose of buprenorphine/naloxone (Suboxone, Zubsolv, etc.). Unfortunately, this is the risk that a patient agrees to when they are prescribed buprenorphine/naloxone (Suboxone, Zubsolv, etc.). If a patient is in pain due to a medical or dental procedure, they should have their physician contact BrightView.
  • On a rare occasion, a patient may need to come off of buprenorphine/naloxone (Suboxone, Zubsolv, etc.) for several days and take a full opioid for adequate pain control. This is a potentially hazardous situation and can lead to a relapse if not carefully planned and managed. If a patient is prescribed an opioid by another physician, they may not be permitted to attend any group sessions until they are off the medication. The patient must continue to attend their individual counseling sessions during this time period and they may be asked to attend additional individual counseling sessions until they are off the medication. Attempting to conceal the prescribing of any opioid, a benzodiazepine, or an amphetamine by another doctor or dentist is strictly prohibited and will result in immediate discharge from the BrightView program.

What does a patient do if they are taking benzodiazepine or amphetamine at the time of enrollment?

  • At the time of initial assessment, patients who are abusing or physically dependent on benzodiazepines are not eligible for therapy with BrightView. If a patient is prescribed a benzodiazepine for a legitimate anxiety or panic disorder, or an amphetamine for ADHD, and taking the drug as prescribed; the BrightView physician will speak with the prescribing doctor to determine if the patient can be taken off of the medication and use alternative medications or therapies to address the condition.

What happens if a patient has a positive drug screen while at BrightView?

  • BrightView monitors a patient’s abstinence through the use of drug screens. All patients are screened randomly at least every two weeks and typically more frequently. At times, an observed urine specimen will be requested especially if the staff is concerned that a patient is concealing use or attempting to provide a false or adulterated specimen. The absence of buprenorphine in the urine, or refusal by a patient to provide a urine sample, may result in the immediate discharge of the patient from the program. A “positive” drug screen may be sent for further analysis if a) the counselor or physician determines it is necessary, b) it is required by a patient’s insurance carrier, c) it is a condition of a patient’s probation, parole or Children’s Protective Services (CPS) agreement, d) if a patient denies using the substance that tested positive and a confirmatory test is required.

What is a medication count and when does it occur?

  • At times, BrightView will contact a patient on short notice and instruct them to bring in all of their medication to confirm that they have the appropriate amount of medication on hand. The following are unacceptable reasons for a medication count being short: a) a patient has taken more medication than prescribed, b) a patient has loaned, shared, sold, or lost their medication. Failure to comply with the request for a medication count may result in the immediate discharge of a patient from the program.

What happens in the case of lost or stolen medication?

  • All patients should store their medication in a locked, safe, and secure location in their home. Patients should not allow family, friends, or visitors into their home who are known users. Lost or stolen prescription medication will NOT be replaced for any reason until the next scheduled prescription date. The physician may approve daily, observed administration of the medication by a BrightView health professional until the patient’s next prescription date.

What should a patient do if they miss a dose of medication or run short on medication?

  • If a patient misses a dose of medication, they should NOT double up on their dose of medication the following day – they should take the usually prescribed dosage. If a patient takes more than their prescribed amount and runs out of medication, the BrightView physician will NOT prescribe additional medication to compensate for the shortfall.

What should a patient do if they are thinking about using opiates?

  • If a patient is experiencing intense cravings for opioids and is considering use, they should contact a BrightView counselor BEFORE they use. They should also contact their sponsor or sober-support network of friends BEFORE they use. If a patient has properly taken their medication, there is no benefit to using an opioid since they will NOT get high, will NOT get pain relief, and WILL likely become sick.

What should a patient do if they do use opiates and relapse?

  • If a patient uses any drug of abuse, we ask that they promptly report their use to a BrightView employee. We cannot help our patients unless they are truthful with us. We encourage our patients to be honest about their use because we may be able to intensify their outpatient care and keep them enrolled in the program. If a patient tries to conceal use, or waits to disclose use until asked or selected to provide a drug screen, outpatient treatment is probably not adequate to manage the severity of the condition. A referral to an inpatient/residential program will likely be recommended.
  • IMPORTANT: If BrightView staff believe a patient has engaged in highly dangerous use of a substance while on buprenorphine/naloxone (Suboxone, Zubsolv, etc.), then the staff will refer the patient to a higher level of care and no further medication will be administered. Patient safety, to themselves and their loved ones, is of paramount importance.

What if a patient has anxiety, depression, suicidal, or homicidal thoughts?

  • Many patients with substance dependence also suffer from mental health issues and require counseling and medication. If a patient experiences suicidal or homicidal thoughts at any time, they should promptly contact their mental health provider. If the patient does not have a mental health provider, they should promptly report to the local Emergency Department for further evaluation. University Hospital Psychiatric Emergency Services (PES) in Cincinnati is open 24 hours a day for psychiatric emergencies – 513.584.8577.

What if a patient is struggling with relapse during their outpatient care?

  • If a patient is struggling to maintain abstinence on an outpatient basis BrightView may consider a trial of intensifying care before referral to a residential program. This may involve additional individual counseling sessions, a behavior contract to address obstacles to recovery, or a case review with the patient and the BrightView treatment team.

What happens after a patient is referred to a higher level of care?

  • If a patient is referred to a higher level of care, BrightView will continue to work with that patient until placement in a residential or inpatient program is possible. If the patient is going to an inpatient program that does not utilize buprenorphine/naloxone (Suboxone, Zubsolv, etc.), BrightView will taper the patient off medication and try to minimize withdrawal symptoms. If a patient refuses referral, BrightView may discharge the patient for failing to follow medical advice.

How does discharge from the BrightView program work?

  • Discharge from BrightView may be voluntary (at the patient’s request) or involuntary (determined by BrightView policy and procedure). A patient may request to be discharged because the patient is unable or unwilling to complete the program or wishes to transfer to another program or provider. A patient may be involuntarily discharged from the program for:
    • Engaging in unacceptable behavior
    • Refusing to accept referral to a higher level of care
    • Non-compliance with attendance requirements, treatment recommendations, or a behavior contract
    • Failure to meet financial obligations
    • Obtaining maximum benefit from the treatment program

What behaviors are considered unacceptable at BrightView?

  • Unacceptable behaviors are described in the patient treatment agreement but are described in this section as a helpful reminder to patients. Engaging in any of these behaviors will result in the patient being discharged from BrightView’s program:
  • Using profane or threatening language towards any BrightView employee or patient.
  • Providing false or misleading information about identity, criminal history, reporting requirements for probation, or Children’s Protective Services agreements.
  • Engaging in criminal activity such as buying, selling, borrowing, or giving medication or drugs to any other person.
  • Falsifying a prescription.
  • Refusing to provide a drug screen, refusing to provide medication during a medication count, or providing a urine drug screen that does not show the presence of buprenorphine/naloxone (Suboxone, Zubsolv, etc.).
  • Attempting to conceal the prescribing of an opiate, benzodiazepine or amphetamine by another prescribing physician.
  • Unexcused absence for a scheduled induction day or a scheduled case review appointment.
  • Failure to make payment or payment arrangements for an outstanding balance owed to BrightView.

If a patient is discharged from BrightView and cannot find another buprenorphine/naloxone (Suboxone, Zubsolv, etc.) provider, will BrightView continue to prescribe medication for the patient?

  • There are a limited number of buprenorphine/naloxone (Suboxone, Zubsolv, etc.) providers in the region.
  • BrightView cannot guarantee that another provider will have availability for patients in their program. If a patient is unable to find another provider or pay for treatment at BrightView, this is NOT a reason for continued prescribing by BrightView. Patients should take this into careful consideration when making any decisions about voluntarily leaving the program or participating in non-compliant behavior.

Can a patient re-enter the BrightView program after a discharge?

  • • Patients who have been discharged by BrightView for unacceptable behaviors are not eligible for re-enrollment at BrightView. All other patients requesting re-enrollment will be evaluated on a case-by-case basis after a reassessment of their condition.

What can a patient do if they wish to taper off of buprenorphine/naloxone (Suboxone, Zubsolv, etc.) earlier than the BrightView recommendation?

  • Patients who want to come off of buprenorphine/naloxone (Suboxone, Zubsolv, etc.) earlier than BrightView recommends should contact BrightView and schedule an appointment with a physician. If a patient wishes, tapering off of buprenorphine/naloxone (Suboxone, Zubsolv, etc.) can happen at any time. However, one should be aware that the most recent studies show treatment with medication for a minimum of 12 months is recommended for the best outcome. Most patients can taper off of the medication with minimal withdrawal symptoms. However, patients should not attempt to taper off themselves.

What can a patient do if they are having trouble paying for medication and treatment?

  • If a patient does not have prescription coverage, buprenorphine/naloxone (Suboxone, Zubsolv, etc.) can be expensive and range anywhere from $5 to $20 per day of therapy. However, most patients spend between $20 and $200 per day engaging in criminal activity to support their addiction, so the cost is relatively low in comparison. If a patient is struggling to pay for medication, they should contact BrightView immediately. The manufacturer may be able to provide financial assistance through a rebate program. If a patient is having challenges in paying their BrightView fees, speaking with a billing representative is recommended.

If a patient is about to be incarcerated, how will treatment be handled?

  • Buprenorphine/naloxone (Suboxone, Zubsolv, etc.) will not be administered to a patient facing incarceration in the next 30 days. Many facilities do NOT administer buprenorphine/naloxone (Suboxone, Zubsolv, etc.) and will not allow a patient to take the medication while incarcerated. If a patient is currently taking the medication and scheduled to be incarcerated, a BrightView physician should be notified immediately. This will allow the physician to possibly taper the patient off of buprenorphine/naloxone (Suboxone, Zubsolv, etc.) prior to incarceration. The patient can re-start treatment upon release.

How are patients associated with Children’s Protective Services (CPS) managed?

  • CPS refers many patients to BrightView for substance abuse assessment and treatment. If a patient has an active case, we will work with the patient and the case manager to coordinate treatment and report progress.

Patients should be aware that if they refuse treatment, or if BrightView staff believe that a patient is continuing to use alcohol or other substances that might impair one’s ability to care for a child, BrightView is obligated by law to report to CPS for investigation. Privacy and confidentiality laws make provisions for release of such information to protect a child.

What should a patient do if they become pregnant while taking buprenorphine/naloxone (Suboxone, Zubsolv, etc.)?

  • BrightView does enroll patients who are pregnant into our program. Patients who are pregnant are referred to a high-risk pregnancy program that specializes in managing opioid dependence during pregnancy. All women of child-bearing age who are enrolled in the program are advised to use reliable pregnancy prevention. The safety of buprenorphine/naloxone (Suboxone, Zubsolv, etc.) has not been established in pregnancy but recent studies suggest that it is probably as safe as methadone. If a patient believes they are pregnant, they should not panic but should notify a BrightView physician as soon as possible.

What will happen if a patient arrives at BrightView and appears to be under the influence?

  • If a patient arrives at BrightView and is suspected of being under the influence of drugs or alcohol, an immediate drug screen and alcohol breath test will be administered. If the patient attempts to leave the premises against the advice of BrightView staff, and is operating a motor vehicle, the police will be contacted immediately.

What should a patient do if confronted by another patient who wants to either buy or sell medication?

  • If a patient has knowledge of another patient trafficking any medication or drug while in treatment, the patient is asked to promptly inform a BrightView counselor or physician of this fact. This behavior is not only unacceptable but also a felony. If BrightView has credible reports to support the allegation, the center may file a police report and/or report with the US Drug Enforcement Agency (DEA). If a patient conceals their knowledge of criminal activity, discharge from the program and implication in the criminal activity will likely occur.

What happens if a patient completes treatment but cannot come off of buprenorphine/naloxone (Suboxone, Zubsolv, etc.)?

  • If a patient has completed the entire program and is unable or unwilling to stop the use of buprenorphine/naloxone (Suboxone, Zubsolv, etc.), the patient has the potential option of remaining in the After Care Program or the option of a final 32-day prescription at standard dosage (if the patient wishes to continue on medication with another provider). Each case will be determined individually based on the patient’s treatment course.

What happens if a patient has a positive Hepatitis or HIV Test?

  • Patients should not panic if they have a positive Hepatitis or HIV Test. A physician will review test results with the patient. All patients will be referred to their primary care physician for referral to an appropriate specialist or BrightView may refer the patient directly to a specialist.

What should patients do if they have a family member, partner, or roommate who also needs treatment?

  • Anyone a patient has a close personal relationship with may not be eligible to start a program at BrightView until the patient has completed the Intensive Outpatient phase (IOP) of treatment. Further, the other individual will likely need to enroll in an alternate IOP session than the patient to ensure little to no crossover. Close relationships can inhibit someone’s ability to be honest and open at all times and this can be counterproductive for both individuals in group therapy.

What if a patient has transportation issues?

  • Patients who are enrolled in the Intensive Outpatient Program (IOP) are not permitted to transport other patients without the permission of the BrightView Medical Director or Clinical Supervisor. If a patient is having transportation issues, asking the BrightView counseling staff for assistance is recommended.

Several assistance programs are available through county government, Medicaid, and some private insurance plans.

Miscellaneous Items

Smoking Policy

It is the responsibility of all employees, patients, and the medical staff to follow the smoking policy at all times. The BrightView policy prohibits smoking in all areas of the building under BrightView’s control. Designated smoking areas are outside of the building. The support staff will ensure that designated smoking areas are clean and properly maintained to reduce potential fire hazards.

Patient Satisfaction

It is the policy of BrightView to regularly solicit the opinions of our patients as it regards to their satisfaction with our services. This may include, but is not limited to, verbal discussion, questionnaires/surveys, and electronic communication.

Transportation

BrightView does not provide any transportation to and from our site for services, nor anywhere else for our patients.

We will attempt to assist in obtaining transportation services when medical necessity is a criteria and we may play some role facilitating those services (ie. filing or completing of paperwork).

Ancillary Services

It is the policy of BrightView to assist each client in obtaining ancillary services to the best of our ability – such as legal, vocational, employment, mental health, prenatal care, diagnostic testing, public assistance, child care, and transportation – they may be either essential or incidental to recovery.

Research

BrightView may occasionally participate in research intended to improve the treatment of patients with substance use disorders. No patient information will ever be disclosed for these purposes without the knowledge and consent of the patient.