Patient Forms

Medical History Form
Patient Admission Form

Click on the forms and print them directly from your internet browser window. Fill the forms completely with all your information and bring them to the clinic.

Courtesy Dosing Form

While you’re away from your treatment clinic, You can receive your dose at one of our MAT clinics by filling out the above form.

Medication Assisted Treatment (MAT)

Trying to withdraw from a substance abruptly, without tapering or using safer replacement substances, may lead to relapse. The pain and stress of abrupt withdrawal may be overwhelming. NWIH offers Medication-Assisted Treatment (MAT) as a solution. Our Opioid Treatment Program (OTP) clinicians prescribe and administer medications to patients enrolled in the MAT program while closely monitoring their improvements.  

NWIH provides methadone, naltrexone, buprenorphine, naloxone, and suboxone for treating SUD. Here’s how these medications work:

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Methadone/Dolophine/Methadose:

This is an opioid agonist and should never be injected. Methadone pills and tablets contain talc. If injected, talc may cause blood clots throughout the body. These clots cause many other problems.

The following clinics offer Methadone,  Buprenorphine and Naltrexone products.

Tacoma South
3727 South Tacoma Way, Tacoma, WA 98409
Phone: 253-300-7474
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Lakewood South
9720 South Tacoma Way, Lakewood, WA 98499
Phone: 253-503-3666

You will only receive methadone if you are seeing both a mental healthcare provider and a chemical dependency counselor. NWIH methadone clinics administer methadone orally, as a liquid. 

NWIH co-prescribes naloxone with every methadone prescription.

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Naltrexone/Vivitrol/ReVia:

This is not an opioid. It is an opioid receptor antagonist. This means that it binds to opioid receptors without activating them and makes it more difficult for any other chemicals to bind to the receptors. This results in naltrexone decreasing the euphoria from any opioids or alcohol while naltrexone is in the body. It also reduces the intensity of cravings for opioids and alcohol.

Naltrexone can be taken as an oral tablet or an intramuscular depot injection. A depot injection is a combination of naltrexone and a lipid (fat), which causes the naltrexone to be taken up by receptors more slowly over a very long period.

Naltrexone is not naloxone. Naltrexone is available at every NWIH clinic. 

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Buprenorphine/Suboxone/subutex/Sublocade:

This is a long-lasting, relatively non-euphoric opioid. It reduces the intensity of any opioids which one takes on top of buprenorphine. 

NWIH clinics administer buprenorphine by injecting it under the skin where it’s slowly absorbed by the body for long-term treatment. This medication is available at every NWIH clinic.

NWIH co-prescribes naloxone with every buprenorphine prescription.

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Naloxone:

This is not an opioid. Naloxone is an opioid receptor antagonist. It binds to opioid receptors without activating them, prevents other chemicals from binding to the same receptors, and remove opioids from the body. Naloxone is injected during an opioid overdose. This medication is available at every NWIH clinic.

NWIH co-prescribes naloxone with every methadone and buprenorphine prescription.