Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

Narcotics research, rehabilitation, and treatment. Hearings, Ninety ... Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

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190Attachment ThreeTo all medical staffOn schedules 10, 11, and 12, the value of X (the initial dose) must be specifiedon the initial prescription along with which schedule is being used.On schedule 12, it must be specified at what does the schedule stops.Day1 .2 .3 .45 .6 .7 .8 .9 .10Detoxification schedule 1Milligrams Day :20

191Day;Maintenance Schedule 10Day:1 X mgs. 10.2 X mgs. 11.3 X+5 mgs. 12.4 X+5 mgs. 13.5 X+10 " 14.6 X+10 " 15.7 X+15 " 16.8 X+15 " 17.9 X+20 " 18_X+20 mgs.X+25 "X+25 "X+30 "X+30 "X+35 "X+35 "X+40 "X+40 "To 100 mgs. total or until otherwise stopped by adding 5 mgs. to dose everyother day.Day:1.2.3-4.5-6.Maintenance Schedule 11-.X mgs...X mgs.-X mgs.-.X+5 mgs.- X-i-5 mgs.-.X+5 mgs.Day:7-8__9_-10-11_12.. X+10 mgs.-X+IO mgs.-X+IO mgs.-X+15 mgs.-.X+15 mgs..X+15 mgs.To 100 mgs. total by increasing by 5 mgs. every third day or until stopped byprescription.Maintenance Schedule 12Day:1 X mgs.8 X+5 mgs.15 X+10 mgs.Attachment FourDay:22 X+15 mgs.29 X+20 mgs.Statement of Responsibility for Take Home MedicationI, , understand that methadone is a powerful drug whichcan seriously harm or even kill a person who is not on methadone maintenance.For this reason, I agree to put my methadone bottle in a locked container, outof children's reach. I also agree to tell my family how dangerous methadone canbe and take all necessary precautions to prevent its accidental use.In addition, I understand that I must not lose, break or fail to return mymethadone bottle to the clinic or revert to drug u.se. If I do, I will not be ableto take methadone home but will have to I'eport into the clinic daily for at least30 days.Patient signature and datePrinted or typed nameID numberProgram nameNTAForm 22 (11-70).Clinic administrator, piiysicianor nurse signature and date

190Attachment ThreeTo all medical staffOn schedules 10, 11, <strong>and</strong> 12, the value of X (the initial dose) must be specifiedon the initial prescription along with which schedule is being used.On schedule 12, it must be specified at what does the schedule stops.Day1 .2 .3 .45 .6 .7 .8 .9 .10Detoxification schedule 1Milligrams Day :20

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