Pikesville Health Services
Pikesville Health Services
1209 Greenwood Rd
Pikesville, MD 21209
After Hours Emergency Phone Number:
Revised May 2016
Welcome to our facility. Pikesville Health Services is a private, outpatient clinic devoted to the treatment of chronic opioid dependence. Chronic opioid dependence is a long-term addiction to prescription opiates or heroin. Opiate addiction is a disease of the brain. It can be frightening for the individual and their loved ones. At Pikesville Health Services, treating opiate addiction is our specialty. We have found that “medication assisted treatment”, using medications such as methadone and Suboxone, is a safe, proven, and effective treatment for opiate addiction.
Our Role & Your Role
Our treatment center will help you by providing a confidential, positive, respectful, and welcoming environment. We will give you medical, psychological, and social support, along with education and specific tools and skills to help you make life-long, healthy decisions and to manage the chronic disease of addiction. Yes, your work will be difficult—perhaps the most difficult work you’ve ever encountered—and present you with many challenges. Be assured that we will be there supporting you and your loved ones each and every step of this journey. You can regain your hope, faith, and health, so you can realize your potential and accomplish your life dreams.
You may be worried about the outcome of your treatment and the years ahead, which frankly you should be. It should come as no surprise that treatment of any chronic medical disease or condition is difficult. For example:
What is a common theme regarding these poor treatment outcomes? Usually, such negative outcomes result from poor treatment compliance. Over time, there is a natural human tendency for people to not follow their treatment plans. There are similar results for addiction treatment:
How can you (with our support) improve your chances to succeed? First, we are going to give you and your family support system a comprehensive, detailed assessment in order fully to understand your addiction, treatment history, medical and psychological status, support systems, occupational/school history, current status, and legal problems, if any. Then we will work with you to design an individualized initial treatment plan to address issues identified; this will help stabilize your addiction and assist you in working through problems in your life that are likely to sabotage your recovery and potentially result in relapse. We will provide you and your support system with important education about addiction and what helps and hurts your recovery. With your input, we will continue monitoring your progress during the initial treatment phase and work with you to adjust your treatment plan along the way. After initial treatment helps you to stabilize your symptoms, we will assess your ongoing progress to ensure that the stage is set for your life-long recovery.
Medication Assisted Treatment
Medication assisted treatment is often the beginning of change for an individual who has been suffering from opiate addiction. However, recovery will not occur with medication alone. Individual and group counseling are required and integral components of treatment. Additionally, our clinical staff provide referrals for additional services beyond the scope of our practice to ensure all individual needs are met. Each person choosing treatment with Pikesville Health Services will be evaluated by our medical and clinical staff to ensure that they receive the best possible individualized treatment, as the length of time in treatment and program elements vary from person to person. Individuals are reevaluated frequently during the treatment process to ensure that the most appropriate level of care is provided.
In the beginning stages of treatment, daily attendance is required. Regular daily medication appointments normally take 10 minutes or less. Early morning dosing hours are available so that patients can maintain employment and other activities of daily living. Appointments for individual counseling are conveniently scheduled and normally last 45 minutes. Group counseling sessions are offered in a variety of topics and psycho-educational areas to provide opportunity for personal growth and sober support development. As you progress in treatment, attendance requirements may be reduced through earning take home medication privileges.
You will be assigned a primary counselor who will meet with you to look at needs and define goals for your treatment. During this meeting, you and your counselor will create a personalized Treatment Plan. This plan will form the road map for your treatment process.
Our goal for you is to develop a program of recovery from the effects of opiate addiction. To this end, we expect you to dedicate yourself to this goal as well. One of the most important ways you demonstrate your commitment to recovery is by attending all program functions and appointments as scheduled.
This patient handbook has been designed to assist you in understanding our program and what is expected of each patient. Please take some time to review it. Your counselor will also review the handbook with you as a part of your orientation.
In order for the program to work best, all patients are expected to follow established rules and regulations.
Your care is delivered using a multidisciplinary team approach. Your team meets weekly at a team conference, to discuss your treatment needs and goals. The team continues to meet every week to talk about your progress and to adjust your plan as necessary.
Your treatment team consists of the Medical Director, Medical Staff, Nursing Staff, Clinical Staff, and Administrative Staff who work at our facility. Any team member can be reached by calling our office at 410-484-8500.
Code of Ethics
Pikesville Health Services has a written Code of Ethics which defines standards of conduct for personnel, business, marketing and professional ethics. A copy of the code is available upon request.
Monday through Friday 6:00 am to 10:00 am
Sunday 6:00 am to 10:00 am
The following holidays may be recognized by the clinic:
New Year’s Day
Martin Luther King Jr. Day
Independence Day (July 4)
Take-home doses will be provided to patients who are determined stable and where the benefits of take home medication outweigh the risks of diversion. The Pikesville Health Services Medical Director will determine what patients are appropriate for holiday take homes.
Pikesville Health Services has specific clinic plans and protocols that will be initiated and followed in the event of disaster. Diagram of the location of all exits, fire suppression equipment are located conspicuously throughout the clinic in public areas such as hallways, etc. In the event of a natural disaster emergency, please contact the after-hours emergency cell phone at (410)-484-8500 to determine whether our facility is open for medication dispensing.
During winter months, the clinic MAY close when hazardous driving conditions are forecasted more than 24 hours in advance. In cases of closure, take home medication will be provided to all patients. The clinic answers its emergency phone 24-hours a day, seven days a week. If you are in doubt about the clinic being open, call the clinic. During severe weather, the clinic will likely reduce its hours.
All current fees are posted in the Business Office. The program fee is charged even if you fail to come to the clinic. Our fees are based on a weekly charge and include required counseling and testing. Only excused absences (incarceration & overnight hospital stays) will not be charged.
General Information about Medication Assisted Treatment:
Medication Assisted Treatment utilizes federally approved synthetic opioids. Synthetic opioids and similar opioids are addictive. Federally approved synthetic opioids eliminate the physical reasons for the continued use of illegal opioids for the following reasons:
Medication assisted treatment during pregnancy may result in unknown risks to the patient and unborn child. Female patients are oriented and educated to inform a clinic staff member immediately if she becomes pregnant, or suspects that she may be pregnant. Female patients of child bearing age may be pregnancy tested at admission and appropriate intervals during treatment, as clinically indicated. In addition, female patients will be pregnancy tested immediately prior to initiating a voluntary or involuntary medically supervised withdrawal. If the result of the pregnancy test is positive, the patient must have a physical examination by the clinic physician or designee within 14 calendar days. The clinic physician must certify that the patient may remain on the Maintenance Program, and if the patient is currently undergoing Suboxone treatment, the Clinic Physician will immediately transition her to Methadone treatment.
Nausea or Sickness:
If you are experiencing nausea (upset stomach) either before or after ingesting medication, we ask that you remain in the Clinic area for 30 minutes for observation and medical monitoring. If you vomit after taking medication, please notify a staff member. In this event, the medical staff has the option to re-medicate if deemed safe and appropriate. You may be required to have a medical examination. We cannot re-medicate patients if vomiting occurs after leaving the clinic grounds.
Drug Analysis Specimen Collection:
Patients have the option to elect, at their cost, to undergo an oral swab drug screening instead of a urine drug screening.
Frequency of Drug Analysis Specimen Testing:
Pikesville Health Services does random urine drug testing monthly for all patients. Patients who consistently test positive for illicit drug use will be placed on weekly testing. These “extra urines” result in additional fees. To discontinue weekly UDS you must test free of illicit drugs three weeks in a row. If you are not able to submit a urine screen at time of request, mouth swabs will be given at a $25.00 fee for each, which is your responsibility to pay unless the request is made by Pikesville Health Services staff.
If you refuse a requested monthly drug screen, it will be documented as positive and another urine screen will be scheduled within that same month.
Drug Analysis Specimen – Confirmation Request
False positives and false negatives are very rare, but do occur. For this reason it is essential that you obtain the results of your last urine screen as soon as they are available. If you question the results, the lab can run a confirmation test if there was sufficient urine in the sample provided. This request may only be requested under the following conditions:
1. The request is made within two weeks of sampling.
2. The patient is willing to pay a re-test fee of $25.00 in the event that the original results are confirmed. There is no charge in the event that the lab erred on the initial test.
Prescription/ Over the Counter Medication
It is your responsibility to report All Medications you are currently taking or that are prescribed at any time during your treatment. The purchase of any non-prescription medications at any time during your treatment must also be reported. This includes prescription medication that is prescribed by a physician, over-the-counter medications (these are medications you must purchase by obtaining from behind the counter at a pharmacy), and any non-prescription medications (such as cold medicines, cough syrups, herbal supplements, vitamins, etc…). All medications should be reported to nursing and to your counselor on the next visit to the clinic.
We advise that you first check with our MD or nursing staff for any possible side-effects before purchasing any medications. Legitimate prescription medications present in urines are considered negative for illicit use. In order to be legitimate, documentation must be presented before the medication is taken stating the need for each prescription. Even with a prescription, the Medical Director reserves the right to disallow any prescription determined to be inappropriate, regardless of documentation provided. Misuse of prescription drugs is considered the same as illicit drug use.
Benzodiazepine medications, such as Diazepam (valium), alprazolam (xanax), Clonazepam (klonopin), and Lorazepam (ativan), can interfere with methadone and have serious side effects, including accidental overdose or death. It is critical that all use of benzodiazepines be reported to the program staff so that we may monitor you to ensure an appropriate and safe dose of methadone.
In addition to prescription medication, you should report the use of any over-the-counter medication to the dosing nurses to ensure that the medication does not have any negative interaction with methadone or Suboxone.
Illness or Hospitalization
You are encouraged to report any illness to the clinic staff. When appropriate, an appointment will be made with the clinic physician. In the event of a medical emergency, staff will assist with any referrals necessary.
If you will be hospitalized for any reason, we encourage you to inform the Clinic staff in advance. In case of an emergency hospitalization, you should try to have a physician or hospital staff member contact the clinic for continuity of care. Upon discharge from the hospital, please be prepared to present discharge paperwork that includes diagnoses, treatments received, length of stay and medications administered and/or prescribed.
Federal and state laws protect the confidentiality of patient records maintained by each CTC Program. Staff will neither divulge nor confirm your status to any person or entity; neither will they disclose any information identifying you as having associated alcohol or drug abuse problems, unless:
See 42 U.S.C. 290dd-2 for federal laws and 42 CFR Part 2 for federal regulations.
At Pikesville Health Services, all patients are expected to arrive on time for all scheduled appointments including counseling and medication appointments. Any absence without prior permission is considered an unexcused absence.
Please ensure you park in designated parking areas.
The following are examples of items considered contraband and are not permitted on the premises
We expect that you will attend appointments in casual attire suitable for visiting a professional office. However, the following guidelines are enforced:
All pets, with the exception of service animals, are prohibited on facility grounds.
Smoking is not permitted on the property at any time under any circumstance. PLEASE do not litter the outside areas with cigarette butts or other items.
Patients are not permitted to use Pikesville Health Services phones unless with a counselor in accomplishment of treatment goals. Please refrain from using your cell phone within the building.
Due to the nature of our work, please do not bring visitors/guests to the building without an appointment. All individuals visiting our facility are required to sign the facility confidentiality log and agree to our confidentiality policies.
Violation of Program Rules
Violating the rules and expectations of the program creates problems for the staff as well as other patients. Each patient is reminded that the road to recovery begins with compliance, which can mean many things. While in treatment with Pikesville Health Services, compliance begins with following program rules and expectations, and it is your responsibility to know what these are.
Discharge planning begins as soon as you enter treatment to facilitate thinking toward long-term goals as you settle in to the daily structure to revamp your life. During treatment, skills are taught to increase your ability to manage life’s challenges and joys without the use of alcohol or drugs. Your primary counselor will meet with you to help plan for discharge. Lists of community resources that may be helpful are also made available.
No one will be forced to remain in the program. However, should you determine that you wish to leave the program before a time the staff has determined is appropriate, you MUST see the physician before any taper will begin.
The following can result in involuntary termination from the Clinic:
* Violations 1 and 6 can result in immediate discharge from the treatment program.
Patient Fair Hearing Procedure:
Every patient who has received a notice of involuntary termination from the Clinic has the right to request a Fair Hearing. If, at any time during your treatment, you desire a Fair Hearing, a written request for a hearing must be submitted to the Executive Director / designee within 48 hours of receiving a notice of termination. A Fair Hearing request form may be obtained from the clinic staff. Your treatment will continue uninterrupted pending the outcome of the Fair Hearing decision.
Hearings will be held within seven (7) business days from the time you request a hearing. The Executive Director / designee and treatment team will conduct the hearing. At the hearing, you may be represented by a lawyer or other person of your choice. You may call witnesses on your behalf and may question witnesses presented by the Clinic. In such instances the you have the right to use an Advocate (National Alliance of Methadone Advocates - “NAMA”) or other representatives and witnesses. The clinic will provide treatment information upon request to you or your representative with appropriate signed consent. This information will be provided 48 hours prior to the hearing. You must present a signed consent for release of information. The treatment information to be released needs to have the approval of the clinic physician and/or Executive Director.
In order to terminate a patient, the Fair Hearing Panel must conclude that the reason for termination is true and accurate and coincides with the reason for termination given in the notice to the patient. The Fair Hearing panel's decision will be rendered no later than one (1) working day following the hearing. The decision will be in writing and a copy of the decision, as well as, the record of the proceedings will be maintained in the designated clinic administrative records and made available to the patient upon request.
While you are a patient at Pikesville Health Services, it is your responsibility to:
We would like to assure you that we will do everything possible to make your treatment experience as comfortable and productive as possible. To this end, we have adopted a Patient’s Bill of Rights. You can expect that you will always be treated with dignity and respect by all of those who work at this clinic and you may be assured that your human rights will be protected.
Pikesville Health Services values advocating for and protecting the rights of patients and will adhere to all applicable Federal and State Regulations regarding the rights of the patients. We do not discriminate in the provision of services on the basis of age, gender status, race, creed, sex, ethnicity, color, national origin, marital status, sexual orientation, handicap, or religion. You will be informed, in writing, at the time of admission of the following rights in a language you understand. A copy of these rights is being provided to you in this patient handbook. These rights will be discussed during orientation and will be posted in the clinic, and read as follows:
As a recipient of services at Pikesville Health Services, I have the right:
Should you feel that your rights have been violated or that the clinic has in someway treated you unfairly, you have the right to file a grievance.
The grievance procedure is as follows:
National Alliance of Methadone Advocates (NAMA)
435 Second Avenue, New York, NY 10010
Advocates For Recovery Through Medicine (ARM)
P.O. Box 90337, Burton, MI 48509
We include input from those we serve by keeping a SUGGESTION BOX in the lobby and by regularly soliciting feedback through SATISFACTION SURVEYS. Please use the Suggestion Box without fear of reprisal or other negative consequences. We also hope you will provide critical feedback on each SATISFACTION SURVEY.
Take Home Policy
Take-home privileges are only permitted when they provide rehabilitative benefit to the patient, either by allowing the patient to more easily attend school or maintain employment or to serve as incentive to continued work in treatment. Patients must have attended the clinic for a minimum of three consecutive months before consideration of take-home status.
Based on counselor recommendation, take home doses can be less than the maximum number approved for a phase. Negative UDS must be consecutive time frames.
Take-home medication will only be given when the following 8 point criterion is met:
Orientation - 4 groups
****Required contacts are based on individual patient needs and can be increased at any time.
Take Home Medication and Lock Boxes
Be sure that you have a locked box to use for any take home medication doses you receive from our facility. Patients are not permitted to share lockboxes; this can result in the removal of take home privileges. If an accidental poisoning occurs, call the POISON HOTLINE at 1-800-222-1222. This hotline will give directions on what to do if an accidental taking of the medicine occurs.
When take home medication is dispensed, we require that all bottles are returned next appointment day. Take home bottles should be returned to the facility utilizing your lockbox. While we recognize this is an inconvenience, it is one of the ways we assure federal and state authorities that we prevent diversion. Failure to bring your empty bottles may result in your being sent home to retrieve them. Additionally, failure to return take home bottles may result in a loss of take home privileges.
Take Home Call Back Policy:
The following call-back procedures have been implemented for those patients receiving take home medication.
Failed call backs are classified in two different categories, and can result in the loss of take home privileges as follows:
1. Diversion: manipulating medication, tampering with
bottles in any way, drinking bottle before coming in and/or altering bottle with other substance
a. 90 days
2. Not returning a message left by staff or the patient did not update contact information
a. 30 days the first occurrence
b. 60 days the second occurrence
The Pikesville Health Services treatment team reviews all patients who receive take home medication on a regular basis. Issues related to drug or alcohol use, current employment and educational status, compliance with fee payments, attendance and participation in counseling sessions, safety of his/her home environment, criminal involvement, involvement with drug users, stability of home life, etc., are examined at this time. If there are significant concerns with any of the above criteria or if there are any other elements of concern, take home privileges can be suspended or revoked as appropriate based upon your need.
For Exceptional Take Home Privileges
1. If you are certified to have a physical disability found to interfere with your ability to conform to the applicable mandatory schedule, a temporary or permanent reduced schedule of attendance may be granted.
2. In cases of exceptional circumstances, such as illness, personal or family crisis, travel, or other hardship found to interfere with applicable mandatory schedule, a temporary reduced schedule of clinic attendance may be granted.
In both cases, the rationale for an exception to a mandatory schedule, based on the reasonable clinical judgment of the program physician, must be entered into the record. In order to be certain take-home medication is needed and is handled responsibly, we will require that the need for each take-home dose be fully documented. Failure to adequately document the need for an exceptional take-home dose will jeopardize future requests. Travel related doses will be documented with gas, restaurant, hotel and similar receipts; work related doses by pay stub, etc.
Requests for vacation and other travel related take out medication must be presented to the counselor AT LEAST TWO WEEKS IN ADVANCE.
Common Causes To Restrict Take Home Medication Privileges:
Foremost, there MUST be a negative UDS before any take-home privileges can be returned
If you lose all take homes due to noncompliance with 8 point criteria, you must wait 30 days before being able to be presented for re-evaluation of take-home privileges. In those 30 days, you must demonstrate compliance with all criteria including negative UDS and counseling compliance. Patient reinstatement of Phase levels will be based on treatment team recommendation and state and federal regulations
***Although these are guidelines, the treatment team has final discretion on rescinding and reinstating take home privileges.
Acknowledgement of Receipt of Patient Handbook
I acknowledge that I had all the contents of the Pikesville Health Services Patient Handbook explained to me and that I was also informed that if any questions arise during the intake process or anytime during treatment thereafter that a member of the Pikesville Health Services team will be made available to me upon request.
I further acknowledge that I have read, understand and have received a copy of the Pikesville Health Services Patient Handbook.
All patients have the right to fair and equal treatment without discrimination. Patients are informed of their right to take any complaint that they may have to a counselor or to the program’s Executive Director without fear of any negative consequences. Should I find it difficult to file a complaint, I understand that I can ask for assistance from any Pikesville Health Services employee or a advocate (NAMA or ARM) or with any other person who will further explain the process to me and/or will help me file my complaint. I have also been advised as to how I can contact the human rights advocate.
National Alliance of Methadone Advocates (NAMA)
435 Second Avenue, New York, NY 10010
Advocates For Recovery Through Medicine (ARM)
P.O. Box 90337, Burton, MI 48509