Psychopharmacology
Medications that we prescribe to our patients are intended to only result in relief of suffering or a cure. However, all medications can potentially cause uncomfortable or serious side effects. Additional problems can arise from drug-drug interactions, drug-food interactions or variations in drug metabolism due to your unique genetic makeup. An unfortunate risk with some prescriptions is developing dependency or diversion of the medication to others. For all of these reasons, we see our patients frequently and consider the ongoing risk-benefit ratio of the medications that we prescribe. This is the standard of care that you deserve.
In addition to the concerns we have as physicians-caregivers, we are also assigned a role of physician-gatekeepers. Medications that require a prescription are governed by federal and state laws and monitored through multiple agencies including: Drug Enforcement Agency, Florida’s Department of Health, Florida Board of Medicine, Florida Board of Pharmacy and Palm Beach Sheriff’s Department. The Prescription Drug Monitoring Program allows us to see any prescriptions that have been filled anywhere in the state even if they were paid for with cash.
Our final responsibility is to the community of patients as a whole, as physician-advocates. There are very ill patients who require medications that have a high risk of diversion or abuse. We have a responsibility to maintain more rigid rules regarding access to these medications so that the Food and Drug Administration does not pull these medications off of the market completely.
Several General Guidelines:
Patients start off being seen every week, then every other week, then every month or less frequently as they heal. The frequency is determined at the most recent visit with the psychiatrist. Reasons for frequent visits once medication doses have already been established include: psychotherapy, external stressors, frequent relapses, specifically risky medications and especially high doses of medications. The longest interval between visits is six months.
No prescriptions will be written for you unless you accept the following agreement.
- I agree to follow the dosing schedule prescribed to me with my doctor.
- I will never share, sell or exchange my medications with anyone for any reason. This is a felony and very dangerous.
- I understand that I am solely responsible for the safekeeping of my medications. I will treat my medication as I would any valuable possession. I know that my doctors at Advanced Mental Health Care cannot replace lost or stolen prescriptions of controlled medications without a police report.
- The maximum quantity of stimulant medication that may be dispensed is a ninety-day supply. One-month prescriptions may not be pre or post-dated, but may have a “do not fill date”. Even if you are stable on the medication, an evaluation of your progress on these medications needs to take place at least every three months. It is unlawful to phone or fax these medications or medication refills into a pharmacy. Patients must present the hand written prescription at their pharmacy.
- Controlled Medications: Stimulants, Opiates/Narcotics and Sedatives should only be filled in Florida. If you take the prescription to another state it is likely that the pharmacy there will not fill the medication. Controlled substance medications should be filled within seven days of the date on the prescription; otherwise many pharmacies will not fill the prescription.
- Opiate / Narcotic / Pain medications (with a few low potency exceptions) cannot be written for over a one month supply and cannot be called in to a pharmacy.
- I understand that I should not drive or operate heavy machinery while I am taking medications that may cause drowsiness or impaired cognitive function.
- I agree to notify my doctor if I experience any adverse effects or dosage problems with my prescribed medications. I may be asked to bring any unused medications to the office for disposal.
- I agree that if I receive a controlled substance prescription from my doctor, I am not allowed to accept controlled substance prescriptions from any other physician without my doctor’s consent and notification. It is a felony.
- I agree to use only one pharmacy for all of my controlled substance medications. In the event that circumstances require the use of another pharmacy, I will notify my doctor immediately and provide them with all pertinent contact information. I will notify both pharmacies of the situation.
- I understand that medication refills for narcotic pain medication or stimulant medication requires a scheduled appointment with my primary doctor in the office. For this type of medication, refills cannot be called into a pharmacy and dosages will not be adjusted by phone.
- I agree to keep all scheduled appointments. I understand that no medications will be given for canceled or no-show appointments. I understand that if I am more than 15 minutes late to my scheduled appointment time, I will have to reschedule for another time.
- Advanced Mental Health Care medication refill triage hours are 8:00 am to 4:00 pm, Monday through Friday for Non-Emergency medication questions and refill requests. Please limits calls to this line to two calls in a day. It may take up to 48 hours before I receive a response to my request for a prescription refill. Because the prescription is expected to run out every month, you should make an appointment in advance. Poor planning on your part does not constitute an emergency on our part. Calling after hours or on the weekend raises suspicions.
- I know that I may be asked to bring any or all of my prescribed medications to my office appointment or at a random time for prescription compliance check (pill count).
- I understand Advanced Mental Health Care reserves the right to perform a urine drug screen at any time while I am being treated with prescribed controlled substances.
- If I do not comply with the pill count request or a urine drug screen within twenty-four hours I will be dismissed from the practice.
- I understand that abusive behavior or harassment toward any office staff cannot be tolerated. The doctor will determine what actions can be considered harassment on a case-by-case basis and, if warranted, I can be dismissed from the practice.
- I understand that dealing with a forged, falsified, or altered prescription will result in a report to the police.
