The road to recovery: a new approach to tackling Scotland's drug problem

Annex B

TREATMENT AGREEMENT - 4 WAY
SERVICE USER, DOCTOR, ADDICTION WORKER/NURSE & PHARMACIST

Service User ____________________________ Doctor ____________________________

Addictions worker/Nurse ____________________________ Pharmacist ____________________________

Please take time to read all sections of this agreement before signing it

Service User

254. I agree

To treat with respect all people I have contact with in connection with my treatment
To keep my appointments promptly and, unless absolutely necessary, unaccompanied
To accept responsibility for my prescription and medication, as they cannot be replaced
To my prescription being withheld if I am intoxicated or have missed two daily doses
To provide samples for drug screening
To allow sharing of relevant information by all professionals involved in my treatment

To store all 'Take Home' doses of methadone safely out of the reach of children

To participate in reviews every 3 months, or more frequently if required

Doctor

I agree

To ensure that I and other clinic staff treat the above named service user with respect
To provide high quality primary health care, as for any other service user
To provide adequate prescribing for the above named service user
To provide a clear and legible prescription that meets legal requirements for controlled drugs
To contact a community pharmacist and arrange dispensing
To share relevant information with all professionals involved in the treatment
To participate in reviews every 3 months, or more frequently if required

255. Addictions worker/nurse

I agree

To treat the above named service user with respect
To give the service user a regular counselling support session at the Shared Care Clinic
To provide a Care Plan to meet the needs of the service user
To facilitate access to other social work services as appropriate for the service user
To facilitate access to other external services as appropriate for the service user
To share relevant information with all professionals involved in the treatment
To participate in reviews every 3 months, or more frequently if required

Pharmacist

I agree

To ensure that I and other pharmacy staff treat the above named service user with respect
To provide the service user with information about medications
To ensure that supervised dispensing takes place in a private/'quiet' area of the pharmacy
To explain protocols for missed doses
To provide a pharmacy practice leaflet giving information about pharmacy services
To share relevant information with all professionals involved in the treatment
To participate in reviews every 3 months, or more frequently if required

256. Signatures

Service User ____________________________ Doctor ____________________________

Addictions worker/Nurse ____________________________ Pharmacist ____________________________

Date ____________________________ Date ____________________________

Addictions worker/Nurse ____________________________ Pharmacist ____________________________

Date ____________________________ Date ____________________________

Warning: Methadone can be dangerous, especially when taken with benzodiazepines and/or alcohol or by anyone who has no tolerance to it.