The purpose of this agreement is to protect your access to controlled substances and to ensure our ability to prescribe them to you. Due to the potential for tolerance, dependence, and side effects, you will need to sign an informed consent when the use of controlled substances is expected to be ongoing. These medications have a high potential for abuse or diversion, which
means the prescribing of such medicines is tightly regulated, and we are strictly accountable for our prescribing policies. Therefore, the following guidelines must be agreed to by you as a condition for our willingness to prescribe controlled substances. A controlled substance is a drug or other substance that the government tightly regulates because it may be abused or cause addiction. This control applies to how the substance is manufactured, used, handled, stored, and distributed. Controlled substances include opioids, stimulants, depressants, hallucinogens, and anabolic steroids.

These medications primarily affect the central nervous system and can potentially cause physical and mental dependence, leading to addiction. Additionally, they can have significant health
consequences at high doses. Controlled substances are prescribed for treating various conditions, such as insomnia, anxiety, severe pain, and attention-deficit/hyperactivity disorder (ADHD). For instance, benzodiazepines and opioids with high abuse potential are commonly prescribed for anxiety and seizures. Unfortunately, the overuse of opioids has led to numerous cases of opioid use disorders and overdose. As a result, federal and state regulations have been implemented to prevent further drug abuse, given their high potential to cause dependence.

**General Rules**

1. **Prescription Management**: Medications will be prescribed by Thrive Mental Health Services providers or a covering provider at the practice. The appropriate number of refills will be provided during your appointment. You are responsible for scheduling an appointment before your specified follow-up date. Refills for controlled substances will only be issued during appointments.

2. **Outside Prescriptions**: You will not accept a prescription for a controlled substance from any provider outside of Thrive Mental Health Services, with the following exceptions:
– If you need to seek care for an acute injury, illness, hospitalization, or surgery requiring controlled substances, you may accept and use such a prescription.
– If you do accept controlled substances from another provider, you must contact our office on the next business day to inform us of the drug, dosage, and amount received. You will then receive further instructions on how to proceed.

3. **Pharmacy Selection**: You must use only one pharmacy for filling prescriptions. If you need to change pharmacies, our office must be informed, except in cases of acute needs outside the local area.

4. **Prescription Security**: You will only fill prescriptions for controlled substances at your designated home pharmacy and must notify your provider of any plans to change pharmacies.

Thrive Mental Health Services providers have permission to discuss all diagnostic and treatment details with the dispensing pharmacist or other healthcare providers to maintain accountability.

– Medications must not be shared, sold, or used by anyone else and should be taken exactly as prescribed. At scheduled office visits, we will discuss any changing needs, problems, or new circumstances, at which point treatment changes will be considered.
– The aim of these medications is to safely improve your function and quality of life. There is no guarantee that anxiety or any specific symptom can or will be fully relieved. If it becomes evident that the goals related to safety, function, and quality of life are not being met, your provider may change the treatment plan, which could include discontinuing controlled substances.
– Controlled substances can be hazardous or even lethal when used by someone other than the intended patient, especially children. These drugs are also at risk of theft. You are responsible for the safe storage of your medications and should not leave them where others might access them.
– Lost, stolen, or damaged prescriptions will not be replaced.
– These medicines must not be mixed with alcohol, non-prescribed sedatives, or illegal drugs.
– Your provider may request unannounced urine or blood tests, and your cooperation is required.
Evidence of unauthorized drugs, illegal substances, alcohol use, misuse of prescribed medications, or attempts to falsify results will be considered a violation of this agreement.
– If necessary, your Thrive Mental Health Services provider may refer you to other specialists or healthcare providers for further evaluation of your symptoms or to seek additional relief. Failure to follow through with these referrals will be considered a breach of this agreement.

By signing below, I acknowledge my understanding of the information provided, and I am aware that I can access a copy of my consent forms anytime through my patient portal or request one from the office staff. Thank you for being an important part of our Thrive community; we look forward to supporting you!