Tom Waddell Urban Health Clinic: Patients Using Controlled Medicines* If you are taking controlled medicines, your safety is our highest priority! Our goal is to make sure that your medicines do not harm you more than they help you. Your healthcare team will watch for signs that there could be problems such as: Difficulty following your treatment plan Running out of medicines early Reporting lost or stolen medicines or prescriptions Requesting increases in dose often Missing appointments Coming to clinic under the influence of alcohol or drugs Coming to clinic with signs of withdrawal Not giving a urine sample when asked Not doing a pill count when asked Urine test shows no prescribed medicines Urine test shows street drugs or unprescribed controlled medicines Threatening or abusive behavior toward staff Getting controlled medicines from another provider and not telling our staff Changing or stealing a prescription for controlled medicines Overdose If any of these or other signs are noted, we will discuss our concerns with you and come up with a plan together to ensure your safety. This could involve changing or stopping controlled medicines. * Controlled medicines include pain medications like codeine, fentanyl, methadone, morphine, oxycodone, Percocet, Norco, and Vicodin, as well as medicines like Ativan, Klonopin, and others. Tom Waddell Urban Health Clinic Developed from San Francisco Health Network Policy 05/07/2014

Tom Waddell Urban Health Clinic: Urine Test for Controlled Medicines* If you are taking controlled medicines, your safety is our highest priority! For your benefit and safety, we have a new policy: Everyone will have a urine test when starting controlled medicines. Everyone will repeat the urine test at least once each year and more often if there are signs that there might be problems. Urine test should show controlled medicines that you take every day. Urine test should not show street drugs. o Street drugs found in a urine test puts you at high risk for harm. o If a urine test shows street drugs, the clinic policy requires your provider talk with you about your use of street drugs. o If street drug use continues, controlled medicines will be stopped. Urine test should not show controlled medicines not prescribed by your provider. o Unprescribed controlled medicine puts you at high risk for harm. o If you are prescribed controlled medicines by someone else, tell your provider right away. o If you continue to use unprescribed controlled medicine, your prescribed controlled medicines will be stopped. Combining alcohol and controlled medicines puts you at high risk for harm. o If you are drinking more than a safe amount, clinic policy requires that your provider talk with you about this. o If unsafe alcohol use continues, controlled medicines will be stopped. Urine samples that seem to have been altered (such as torn labels or watered-down urine) may not be accepted. * Controlled medicines include pain medications like codeine, fentanyl, methadone, morphine, oxycodone, Percocet, Norco, and Vicodin, as well as medicines like Ativan, Klonopin, and others. Tom Waddell Urban Health Clinic Developed from San Francisco Health Network Policy 05/07/2014