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mythoughts2

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Posts: 331 Member Since: 09/08/11

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Dec 3 14 2:58 PM

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Hey guys. It's mythoughts. I haven't been here for a long time, so a lot of you may not remember me but I've been a doggers since 2000.  My dose has been 240mg for the last 15yrs, with ALL clean UAS. Today I go in to pick up my 2 weeks, and am told that due to a state audit, the clinic lost privledges for any take homes and all splits. So, not based on any medical reason, but based on the fact that they can't give a split, my dose was cut 50% OVERNIGHT - from 240 to 120mg. I can't transfer to a new clinic for weeks. I checked. I'm freaking out. I asked the doc to raise my dose at the window, and he said no, that "I'd be fine". Yeah...going from 240 to 120mg overnight and  I'll be fine. And I have to come in daily, which cost $10 in gas and bridge and I don't drive. They don't care.

Does anyone have the info for the CA state authority? I'm going to be SO SICK. And now that my dose is changed in the system, even when I transfer i wont get my whole dose. I'm freaking out guys! Help!!
 
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wayovermyhead

Posts: 4,350 Member Since:07/16/11

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#1 [url]

Dec 3 14 7:21 PM

OMG This don't sound right to me @mythoughts.....The BELOW IS BOTH CALIFORNIA RELATED and FEDERAL TOO.

First of all...I do not think the State would make such determinations to cut patients in half and change their formation of their treatment plans overnight.  They are behind the rules of Treatment plans being necessary and up to date.  I tend to wanna think it is bigger than what they are telling you...such as they are being shut down and they don't want to tell everyone the full truth yet if they don't have to so they can milk you all for the last penny they can...If the State is doing anything so big as what you have said then they are SHUTTING THEM DOWN FOR NEGLIGENCE OR SOMETHING....It just doesn't add up.  Clinics use that "Oh it's the State BS all the time to find out the State was never involved even....so yes I would call them and see what the eff is up.  Let me get you the contact info...

Methadone Laboratory Regulatory Program

Background

The methadone laboratory regulatory program supports the Department of Alcohol and Drug Programs, which licenses methadone treatment programs.. The program serves 147 narcotic treatment clinics and approximately 32,000 narcotic maintenance patients in California.

Program Activities

  • Proficiency testing of the laboratories. The Abused Substance Analysis Section (ASAS) conducts regular proficiency tests of licensed and applicant laboratories in order to evaluate the accuracy of the drug analyses performed by the laboratories. 
  • On-site inspections of the licensed laboratories. Each licensed laboratory's facility must be inspected regularly to ensure that all regulatory requirements are being met and that the laboratory is properly documenting its procedures and using properly trained staff. 
  • Review and approval of laboratory methods and procedures. ASAS reviews methods and procedures submitted by licensed and applicant laboratories to determine that they meet the required standards of procedure and standards of performance set forth in the regulations. 

Regulations

  • CALIFORNIA CODE OF REGULATIONS
  • TITLE 17., DIVISION 1., CHAPTER 2., SUBCHAPTER 1., GROUP 5.5. METHADONE DRUG ANALYSIS LABORATORIES, ARTICLES 1 – 8, SECTIONS 1160 – 1196
Organization
_________________________________________________________________________________________________________________________________________

The below is FEDERAL 

Opioid Treatment Regulation       HERE IS LINK   http://www.dpt.samhsa.gov/regulations/regindex.aspx

Overview

In the U.S., treatment of opioid dependence with opioid medications is governed by Federal Regulation 42 CFR Part 8, dated January 17, 2001. The regulation provides for an accreditation and certification-based system for Opioid Treatment Programs (OTPs), overseen by SAMHSA. The Administrator of SAMHSA has delegated certain of these oversight responsibilities to the Center For Substance Abuse Treatment (CSAT), and within CSAT, to the Division of Pharmacologic Therapies(DPT).

The new Regulation acknowledges that addiction is a medical disorder not amenable to one-size-fits-all treatment. It recognizes that different patients, at different times, could need vastly different services. The Regulation enables DPT to focus its oversight efforts on improving treatment rather than soley ensuring that programs are meeting regulatory criteria.

The Regulation preserves States' authority to regulate OTPs. Oversight of treatment medications remains a tripartite system involving States, DHHS/SAMHSA, and the U.S. Department of Justice/DEA.

OTP Accreditation

Accreditation is a peer-review process that evaluates an OTP against SAMHSA's opioid treatment standards and accreditation standards of SAMHSA-approved accrediting bodies. It includes site visits by specialists with experience in opioid pharmacotherapy and related activities. For more information on OTP accreditation and designation as a SAMHSA-approved OTP accrediting body, view the OTP Accreditation page. A discusson of and links to two studies of the impact of OTP accreditation is found on the OTP Accreditation Impact Studies page.

OTP Certification

Once an OTP is accredited by a SAMHSA-approved accrediting body, SAMHSA uses the accreditation results along with other data to determine whether the program is qualified to carry out treatment under the standards in the regulations. Qualified programs receive certification by SAMHSA.

OTPs apply to SAMHSA for certification using the SMA-162 form. The SMA-162 form should also be used by OTPs for the following purposes:

  • To apply to SAMHSA for renewal of certification of an OTP
  • To notify SAMHSA of change of Program Sponsor
  • To notify SAMHSA of change of Medical Director
  • To apply to SAMHSA for relocation
  • To apply to SAMHSA for addition of new medical unit (satellite clinic or mobile unit)

For more information on OTP certification and using the SMA-162 form, view the OTP Certification page.

Patient Exception Requests

Section 8.12 of the Federal regulation 42 CFR sets forth standards for the administration and management of opioid treatment under the regulations. Included in these standards are protocols for allowable take-home dosing, based on time in treatment and other factors. Additionally, protocols are set forth on the maximum number of allowable detoxification attempts within a one-year period.

On occasion, patients may need exceptions from the Federal opioid treatment standards due to transportation hardships, employment, vacation, medical disabilities, etc. In these instances, the physician must submit to SAMHSA and (where applicable) the State Opioid Treatment Authority an "exception request" for approval to change the patient care regimen from the requirements specified in Regulation 42 CFR part 8. Patient exception requests are submitted to SAMHSA using the SMA-168 form. SMA-168s can be submitted by fax or online.

Patient exception requests are reviewed for SAMHSA approval under the exemption provisions detailed in 42 CFR § 8.11(h). For more information on submitting patient exception requests, view theException Request page.

Buprenorphine

The Drug Addiction Treatment Act of 2000 expands the clinical context of medication-assisted opioid addiction treatment by allowing qualified physicians to dispense or prescribe specifically approved Schedule III, IV, and V narcotic medications for the treatment of opioid addiction in treatment settings other than the traditional OTP setting. In addition, DATA 2000 reduces the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting qualified physicians to apply for and receive waivers of the special registration requirements defined in the Controlled Substances Act. For more information about buprenorphine and office-based opioid treatment, view the SAMHSA Buprenorphine Web site.

Guidance to OTPs

View the Guidance to OTPs page for recent and past communications from SAMHSA to the opioid treatment community regarding opioid treatment clinical and regulatory issues.

Regulations and Legislation

View the Regulations and Legislation page for links to federal opioid treatment regulations, legislation, and federal register notices.

OTP Directory

View the OTP Directory page for a list of all active opioid treatment programs, searchable by state and territory.

State Opioid Treatment Authority Directory

View the State Opioid Treatment Authorities page for contact information for State Opioid Treatment Authorities.

Methadone

Methadone is a synthetic opioid that blocks the effects of heroin and other prescription drugs containing opiates. Used successfully for more than 40 years, methadone has been shown to eliminate withdrawal symptoms and relieve drug cravings from heroin and prescription opiate medications.

PDF File*PDF formatted files require that Adobe Acrobat Reader® program. 
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wayovermyhead

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wayovermyhead

Posts: 4,350 Member Since:07/16/11

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#2 [url]

Dec 3 14 7:47 PM

These people too might help...they who govern over the physicians who work in the CALIFORNIA methadone programs...

Guideline for Physicians
Working in California
Opioid Treatment Programs
Editor: Deborah K. Stephenson, MD, MPH
for the CSAM Committee on Treatment of Opioid Dependence

California Society of Addiction Medicine
575 Market Street, Ste 2125, San Francisco, CA 94105
www.csam-asam.org

HERE IS THE LINK THESE APPEAR TO BE ONE IN  THE SAME TO THE CALIFORNIA STATE CLINIC RULES and REGULATIONS...

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wayovermyhead

Posts: 4,350 Member Since:07/16/11

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#3 [url]

Dec 3 14 7:49 PM

AND DONT FORGET ABOUT GRIEVANCE PROCESSES

BELOW YOU WILL FIND GRIEVANCE REPORTS IN SAMPLE FORM


National Alliance for Medication Assisted Recovery

"Just that you people who are involved in advocacy, keep up the work. I have seen 
changes come about because of people becoming involved. It is these who are the real heroes 
in all this. Without advocacy, changes will not come about within the present system." 
Dr. Vincent Dole

HERE IS THE LINK 

http://www.methadone.org/grievance_report.html

Grievance Report


   

Is Your Program Punitive?
Fill Out a Grievance Report -- It's Time To Educate Them!

Does Your Program Treat Patients With Dignity?
Fill Out a Compliment Report -- Let Them Know They are Appreciated!

The Grievance Report Project is an ongoing project used to educate the Medication Assisted Treatment (MAT) community about quality treatment. Programs can no longer hide behind a veil of patient confidentiality or call degrading policies quality treatment. The new accreditation organizations will be interested in these reports.

The Dole-Nyswander Program worked because it was a caring program with a sense of community and that is what needs to be brought back to MAT. NAMA Recovery will use the Grievance Report Process to report programs to various agencies for further investigation. This project will not work unless patients themselves tell us about their program. So NAMA Recovery needs you to participate.

Grievance Reports are Not Only for Programs!

A Grievance Report can be filed on any agency, institution, program or professional that does not treat you with common dignity and respect. Here are some examples of Grievance Reports that you can file.

hospitalinadequate pain medication
schoolwon't accept methadone patients
family courtany involvement because of your medication
probation or 
parole officer
have to withdraw from your medication
social worker or 
clinical psychologist
have to withdraw from your medication to receive treatment

There are two kinds of grievance reports: a General Report and an Incident Report.

General Report

A General Grievance Report details the situation at a program, service or agency and usually involves their policy. A General Report does not always require investigation or follow up. You are simply reporting the policy or a situation at a program, service, agency, etc. In some instances these policies are discriminatory towards patients. When a policy violates the constitution or law NAMA Recovery will notify any oversight agencies or institutions and begin procedures to end the policy. An example of this kind of General Report would be a homeless shelter that does not allow MAT patients. This is a direct violation of the Americans With Disabilities Act. 

When NAMA Recovery has collected several General Grievance Reports about a program an inquiry will be made to confirm if the policy has been changed or not. The program's reply will be shared with the patients that have made the reports and if necessary their will be further investigation. This type of report helps to change policy at your program because it makes program staff re-think policy that may not be doing what was originally intended. 

Incident Report

If you are having trouble with your program you can report a specific incident. Incident Reports are for specific problems that you are having with your programright now. Other examples of an Incident Grievance Report include take home medication schedule or dose change, either increase or decrease. Usually patients are having trouble because they do not know program policy, state or federal regulations, or resources that they can use to make the program work for them. NAMA Recovery believes in empowering patients with information that will help them achieve the recovery goals they have set for themselves. By filing an Incident Report you will be assisted in: (1) knowing the regulations that apply, and (2) how to use regulations and "resources" to get a positive result.

Some Incident Grievance Reports are being filed at a critical point. An example of this is the patient that is being disharged from their program. If this is the case after filing the Incident Grievance Report send an email to Claude Hopkins, the Grievance Coordinator. The sooner that Claude Hopkins starts to intervene with a critical issue the more likely your chance at having a positive result. 


CONFIDENTIALITY POLICY

All information that is provided will be held strictly confidential in the same manner as the patient protections described in the U.S. Federal Confidentiality Regulations 42 CFR and the Standards for Privacy of Individually Identifiable Health Information (the Privacy Rule) as established by the Department of Health and Human Services (HHS) under the Health Insurance Portability and Accountability Act of 1996 (HIPPA). In order to assist you at the maximum level of follow-up and outcome, we do request certain personal information. However, if you do not want us to disclose your name for any reason, we will honor your wishes.


We offer three ways to obtain and/or file a Grievance Report: 

  1. You can print out a Grievance Report and Authorization to Release Information from our website. 
    Click Here to go there.

You can download a Grievance Report and Authorization to Release Information in pdf format. 
Click below to download:
Grievance Report and Medical Release PDF Logo
Grievance Report PDF Logo
Medical Release PDF Logo

You fill out the online Grievance Report. However we will still need an Authorization to Release Information to speak with a program or many agencies. 
Click below to download the Medical Release Form:
Medical Release PDF Logo

To go to the Online Grievance Report  Click Here.

Grievance Reports can be sent to:

Claude Hopkins, RMA CMA, Grievance Coordinator
ch.grievance@methadone.org 

Or mailed to:

National Alliance of Medication Assisted Recovery
435 Second Avenue
New York, NY 10010

Or faxed to:
(212) 595-nama/6262

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wayovermyhead

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sapphire76

Posts: 3,678 Member Since:02/22/10

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#4 [url]

Dec 5 14 5:21 AM

Wow, that doesn't sound right at all. Even if the clinic has lost the ability to give split doses, that should just mean that they give you the full 240mg, not suddenly decide to give you 120mg! Have you filed a grievance? Or spoken to anyone at NAMA or another advocacy agency?

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jaks1

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Posts: 67 Member Since:02/22/10

#5 [url]

Dec 5 14 9:08 AM

Taking you down like that overnite is cruel and inhuman

Who are these people? A doctor told you that you will be allright? Hell no you will not. This is what I would do and really if you are at least in your forties or over that it will
help more . When you begin to get real sick go to the hospital and fricken scream your head off or just lie there and tell them you cannot function and are in extreme pain
and you are afraid you might die withdrawing this quickly. Nothing helps but methadone. I am so sorry that you are dealing with this. When I lived in CA the darned clinics
in Orange County would only allow us to go up to 80 mgs. And now that i am in Oregon they are pretty understanding about allowing me to go up to 150 and since I am
also in pain management with my outside doctor he wants to talk to my clinic doc and put me up into the 200 mg range like you were on. Geez I feel so terrible for you.
I wish I could help but i have no real thing that i could do except suggestions. people have died from quick withdrawal on methadone and a lot of them died in jail so
the jails even hated taking a methadone patient to jail. I wish you all the best and hope you can connect with someone who can really hellp you. this is real real scary
stuff. Jax

 

Don't take life too seriously, you never get out alive.

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sapphire76

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#7 [url]

Dec 6 14 5:13 AM

Mythoughts, is it at all possible to transfer to a different clinic? I know that might mean more financial outlay or whatever, but it's got to be better than this crap? I really would try speaking with an advocate who could speak to the clinic on your behalf.

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wayovermyhead

Posts: 4,350 Member Since:07/16/11

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#8 [url]

Dec 6 14 8:45 AM

@mythoughts...I am extremely worried about you please respon

This is just terrible and an injustice that makes me feel ashamed of some of these providers.  The withdrawals are one scary thought but so is RELAPSE...Do they not realize they are playing with someone's life.  Some people die and never make it back from a relapse.  

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wayovermyhead

Last Edited By: wayovermyhead Dec 6 14 9:00 AM. Edited 1 time.

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sapphire76

Posts: 3,678 Member Since:02/22/10

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#9 [url]

Dec 7 14 6:43 AM

@Way - I know, what I cannot understand is, if they are not allowed to carry on doing split doses, why Mythoughts cannot just have the full dose of 240, why are they making her suffer on half of her dose? Doesn't make sense to me.

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briton32

Senior Member

Posts: 287 Member Since:02/23/10

#10 [url]

Dec 8 14 2:20 PM

Mythoughts I remember you fondly from the dog. I joined myself in 2004 so I have been a member for awhile myself. please let us know how your doing.. I am EXTREMELY worried about you.. and I am with the others in that none of this sounds right on their end.. Even if they took takehomes and split doses away your full daily dose is 240mg which is what they should have given you.. I mean your body would need some adjusting because it wasnt used to taking the whole thing at one time but you wouldnt be in severe withdrawals due to it being cut in half.. PLEASE PLEASE PLEASE let us know whats going on

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sapphire76

Posts: 3,678 Member Since:02/22/10

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#11 [url]

Dec 9 14 5:57 AM

@Mythoughts - what is the situation now? Have you managed to speak to anyone about this? Please just let us know that you're OK.

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xjunkie4jesus

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Posts: 235 Member Since:06/09/13

#12 [url]

Dec 12 14 5:56 AM

@Mythoughts-I would call Dept of Health

@Mythoughts: Here in Maine, it's called DHHS-Department of Health and Human Services. Whatever the state licensing board is, PLEASE try to call and get info/complain about your safety being put at-risk!!

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sapphire76

Posts: 3,678 Member Since:02/22/10

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#13 [url]

Dec 12 14 6:00 AM

I think I would be either calling an advocacy agency, or the state opioid treatment authority. Cutting your dose by 50% in one go is just unacceptable.

Please let us know how you're doing @Mythoughts! I'm worried about you!! x

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wayovermyhead

Posts: 4,350 Member Since:07/16/11

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#14 [url]

Dec 14 14 11:07 PM

Damn I was hoping we would have heard back from @mythoughts

Anybody know anything??

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wayovermyhead

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the elephantman

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Posts: 802 Member Since:08/30/11

#15 [url]

Dec 14 14 11:25 PM

@mythoughts: OMG this is INSANE!! Im with everyone else, this does NOT sound right AT ALL. There is something else going on here, it has too be. I'll be honest, i've heard of clinics doing some CRAZY things but this, THIS takes the cake. I"ve never heard of a clinic revoking ALL takehomes from EVERYONE. And then cutting your dose completely in half. Did they cut everybodys dose completely in half??? Im inclined to agree with what someone else said that maybe they are about too be shut down and they are just milking you all for every last penny. SOMETHING MUST BE DONE HERE AS THIS IS NOT OKAY!!

And yes, PLEASE @mythoughts, PLEASE let us know whats going on here and if you are okay???

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mythoughts2

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Posts: 331 Member Since:09/08/11

#17 [url]

Jul 2 16 1:34 PM

I'm here guys. Been going through it. Divorce, health issues, love, life. I ended up reporting the schmuck to the state and switching clinics. Thank Dawg my advocacy work paid off and I was moved up a 4mth waiting list to get into a decent clinic. Down to 10mg now. Can you guys believe it?!!!!

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mythoughts2

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Posts: 331 Member Since:09/08/11

#20 [url]

Jul 2 16 1:38 PM

Anyone heard from Canadian Tweety?

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