4th Bottles: A Case Study

3. The patient had informed this writer initially of his goals of wanting to return back to the Hartford Dispensary due to the length of time he has been with the clinic and his positive rapport with his prior counselor at the other facility. The patient was compliant with his individual sessions with this writer and provided cancellation if unable to attend the session in the meantime while he awaits on the process of completion with his intake at Hartford Dispensary.

D-This writer met with the patient upon her request to complete the dose change request form to lower her dose as the patient experience she wants to start tapering off methadone as the patient haven't used any illicit drugs for several months. This writer completed the dose change request form with the patient pressence and also, assessed the patient that she has not experience any withdrawals since prior increase based on her order history. The patient denies any cravings and withdrawals. Furthermore, while completing the request, this writer learned that the patient is prescribed with Albuterol inhaler and strongly urges the patient to bring in the RX script tomorrow. The patient complained that no one has ever told her of this and this

D-The patient was advised that her bottles are in fact suspended due to the incident that occurred on 02/08/2017 of which the patient needs to accountability of taking a second dose of her methadone even though she has taken her methadone at home. The patient admits her accountability of her actions of taking the second dose. The patient then asked about how she can regained her take home bottles of which this writer explained the policy of take home bottles, referring to the reinstatement process. The patient is referred to attend the Take Home Bottle Group on 03/9/2017 to have her bottles reinstated. Then the patient shared that she wrote a grievance letter and still plans to submit it for the Program Director to review. Furthermore, this

D-Spoke with the patient as she was being curbside dose. This writer reiterate about TEAM recommendation, at which the patient declines the notion of being placed in a skilled nursing facility due to her medical issues.This writer informed the patient that her level of care is inappropriate for this treatment and a high level of care would be more efficient. According to the patient, she's working with Chrysalis and is willing to sign an ROI for this writer to communicate with her case worker Anthony, aka Tony. Reported stable on her dose.

D-This writer agreed to meet with the patient as he was placed hold to attend group. Reported stability on his current dose and denies the need for a dose increase when offered by this writer. This writer reviewed the patient's record and learned that he obtained his 3rd take home bottle on 01/04/2017. The patient is aware that he in order for him to obtained the 4th take home bottle, he must attend the take home bottle group. Addressing his medication, this writer noticed that the patient has not refilled the following medications:

D-The patient arrived on time for her appointment. Reported stable on her new current dose. Deny craving and withdrawals. According to the patient, her weekend was good and again, happy to have her take home bottles. Then the patient reported, she continues to keep all appointments with her mental health provider and its going very well. This writer then discussed with the patient about the next step to her recovery. The patient reported, she wants to continue with her methadone until she's ready to start tapering off on the methadone. The patient has some fears to tapering off on her methadone because she does not want to experience any craving and have a relapse.

The patient arrived on time for her counseling session. Reported doing okay with her dose, but wishes she can have an increase as she still experiencing some cravings, but is trying not to relapse. The patient vented about her transportation issues with Logisticare and her ex-husband. Patient says, " I need my rides to be reinstated because I can't keeping back and forth with him.......Did you get my discharge summary?.... Please send it to Logisticare." This writer showed the patient about a recent fax from Hartford Dispensary, referring to her discharge summary and a statement on the clinic's letterhead stating the date of the patient discharge and when she was medically taper off on her dose. According to the patient, she does not want her previous counselor statement to be sent to Logisticare,

D- The patient arrived on time for her session and reports being stable on dose and haven't used any illicit drugs. This writer advised the patient that this writer was in fact in receipt of missed phone call about coming to the session at 10:30 am rather than 10 am due to her mother in the process of selling the house. This writer addressed with the patient about letter from CHR from her counselor, Jade Bray stating about the patient non-compliance with her appointment due transportation barrier. According to the patient, she is going through hardship as her mother is no longer taking her to her appointment as the patient says, " She's tired of bringing me everyone, Charlene. She complains about bringing me here and does not understand why I can't even get a bottle...:Like c'mon. What do I have to do?" This writer explained to the patient about TEAM decision, at which the patient disagree with the decision. This writer asked the patient about her "judgement." According to the patient, she feels she is making judgement by not engaging any further altercation with patient at the clinic, dosing daily, coming to her counseling session, and trying to get help from Chrysalis for

09-2 Pharmagen . Answer the questions that are given below, not as given in the case text.

D-According to the patient, she is excited to be admitted to the take home bottle group today. The patient thanks this writer in a joyful manner. During the course of the session, this writer commends the patient as she's been compliant with treatment, mental health services, and maintaining a negative UDS result. In addition, this writer and the patient completed the first take home application. This writer advised the patient that this writer will be monitoring her mental health services every quarter to ensure the patient is maintaining compliance with her mental health treatment.

D) Client met with his counselor for his 1x1 session discus his exited plan and what he needs to follow through with once he graduates the program. Client has completed his step work along with other objective that’s list on his treatment plan. He has been compliant with the Quest House and FSC program rules and regulation and he started opening up more in the group with his peers about his struggle in out of the program. A) Client appears to be more stable in his recovery as time goes by, he seems happier and can’t wait to start his journey in recovery. P) Counselor will continue to encourage client to keep working and on himself and to stay strong his efforts to maintain a life without the use of any mind altering chemicals.

The patient reports, " I am stable with my dose." However, this writer addressed with the patient about her UDS and dosing history. This writer addressed concerns about this patient results of testing postive for opiates and cocaine. The patient

" When I missed my dose, I did not have any withdrawals. I felt fine, Charlene.....I am just tired of having to come there everyday and its affecting my work schedule. I tried to call you and I know you were busy as you just returned from vacation.....I have a lot going on. I do not need doctor to tell me that I cannot go down because I am still using." This writer explained to the patient as to why the doctor made the comment due to past consultation over the summer. The patient is aware of the clinic's concern, but does not feel to continue due to the risk

D-The patient arrived on time for his counseling session. Reported stable thus far and he recently accepted a dose increase. According to the patient, he tends to feel the withdrawals-difficulties sleeping and yawning. Denies any recent relapse, at which this writer provided a positive feedback. The patient is confident that his UDS result will be negative for this month and moving forward, if not, the patient will be referred to the clinic's self-help group, mainly the cocaine group.

A-Based on this writer's assessment, the patient appears to be alert and oriented. No evidence of SI/HI.