Agreement for Methadone Prescriptions

Name:

Date:

The goals of treatment are:

Whilst aiming to achieve these goals, please note:

• We ask all the patients in this practice to be on time for their appointments and to let us know if they are unable to attend.
• That out of hours calls or home visits should not be used to discuss your prescription.

Please remember that:

• Methadone:
  • can cause serious harm, or death in overdose.
  • may cause drowsiness, and you must not drive or operate machinery if you are drowsy.
  • may be dangerous if taken with alcohol or other street drugs e.g. benzodiazepines.
• If you lose any scripts or medication they will not be replaced unless there are highly exceptional circumstances.
• You will be asked to give a urine sample at some appointments.

Any other points: