R03-711 Opioid Maintenance Outpatient Treatment

A. Opioid Maintenance Outpatient Treatment includes the pharmacologic and therapeutic use of opioid or non opioid compounds to address opioid drug tolerance or addiction provided through:

1. Long term detoxification treatment, which means opioid or non opioid agonist treatment for a period of more than 30 days but not in excess of 180 days, or

2. Maintenance treatment, which means the dispensing of an opioid agonist treatment medication at dosage levels for a period in excess of 21days.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 A.

 

B. A program sponsor for an opioid maintenance outpatient treatment program shall designate a physician licensed by the State of Kansas to serve as the medical director and to have authority over all aspects of medical treatment including:

1. The dispensing and administration of opioid and non-opioid agonist medication, and

2. Procedures to prevent a client from receiving opioid treatment from more than one agency or physician concurrently.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 B.

 

C. A program sponsor for an opioid maintenance outpatient treatment program shall comply with:

1. The Substance Abuse and Mental health Services Administration,

2. The Drug Enforcement Agency, and

3. An approved accrediting body.

Approved by State Methadone Authority.

 

D. A program sponsor for an opioid maintenance outpatient treatment program shall ensure that written policies and procedures are developed, implemented, complied with, and maintained at the agency and include:

1. Procedures for relapse prevention,

2. Procedures for conducting a physical examination, assessment, and laboratory test,

3. A requirement that a client who is physiologically dependent as a result of chronic pain and has not previously been treated for that condition receives consultation with or a referral for consultation with a medical professional who specializes in chronic pain,

4. Procedures for performing the following laboratory tests:

a. Monthly drug screens for opiates, amphetamines, cocaine, and benzodiazepines,

b. Drug screens for methadone, as indicated,

c. Weekly drug screens for drugs with a potential for addiction such as, cannabis to determine illicit drug use or as indicated,

d. TB skin test or chest x-ray if the skin test result was previously positive,

e. Serology Reagent Screening,

f. A test for Hepatitis B and C, as indicated,

g. Chemistry profile to include liver and kidney functions, and

h. HIV testing, if requested by the client,

5. Procedures for pre-admission and annual medical evaluations,

6. Procedures to ensure client identification,

7. Procedures to minimize the following adverse events:

a. A client death,

b. A client’s loss of ability to function,

c. A medication error,

d. Harm to a client’s family member or another individual resulting from ingesting a client’s medication,

e. Sales of illegal drugs on the premises,

f. Diversion of a client’s medication,

g. Harassment or abuse of a client by a staff member or another client, and

h. Violence on the premises,

8. Procedures for addressing client absences,

9. Procedures to verify prescription medications when a client’s drug screen test results indicate drug use other than the prescribed opioid medication,

10. Procedures to register medications prescribed by another physician or medical professional not employed at the agency, to include the: a. Name of each medication, b. Prescription date and quantity of each medication, c. Name of the individual prescribing each medication, d. Name of the client for whom the medication is prescribed, e. Dosage of the medication of each medication, f. Length of prescription, and g. Name of the staff member registering the medication information, and

11. Procedures to verify prescription refills at 60 day intervals.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 D. 9. Review client file to ensure prescription medications have been verified as stated in R03-711 9, 10, & 11.

 

E. A program sponsor for an opioid maintenance outpatient treatment program shall ensure that a physician, physician assistant, or nurse practitioner conducts a physical examination of an individual who requests admission before the individual receives a dose of opioid or non-opioid agonist treatment and that the examination includes:

1. Reviewing the individual’s bodily systems,

2. Determining whether the individual shows signs of addiction, such as old and fresh needle marks, constricted or dilated pupils, an eroded or perforated nasal septum, or a state of sedation or withdrawal,

3. Evaluating the observable or reported presence of withdrawal signs and symptoms, such as yawning, chills, restlessness, irritability, perspiration, nausea, or diarrhea,

4. Obtaining a medical or family history and documentation of current information to determine chronic or acute medical conditions such as diabetes, renal diseases, Hepatitis B, C, or Delta, HIV infection, TB, sexually transmitted infections, pregnancy, or cardiovascular disease,

5. Obtaining a history of behavioral health issues and treatment, including any diagnoses or medications, and

6. The results of the individual’s examination are documented in the client record.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 E. 4. Review client files and verify documentation of R03-711 4, 5, 6.

 

F. A program sponsor for an opioid maintenance outpatient treatment program shall ensure that if the physical examination is completed by a physician assistant or nurse practitioner, a physician must sign the physical examination assessment within seven days after admission.

Review policy and procedure manual and verify it reflect the requirements as stated in R03-711 F. Review client file to verify physician’s signature and date on physical assessment.

 

G. A program sponsor shall assign one full time equivalent Kansas Department of Social and Rehabilitation Services Credentialed Alcohol and other Drug Abuse Counselor for every 50 clients.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 G. Verify ratio by reviewing assigned counselors and client list.

 

H. A program sponsor shall ensure two staff members, one of whom shall be a licensed nurse, are present on the premises during medication dispensing hours.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 H. Review staff schedule and verify two staff members are present, on the premises during medication dispensing hours.

 

I. A program sponsor shall ensure only licensed medical staff or approved staff are:

1. Responsible for the administering and dispensing of medications, and

2. Allowed in the dispensing area during dispensing hours.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 I. Review staff schedule to verify medical staff are present during dispensing hours.

 

J. A program sponsor, in coordination with the medical director’s designee, shall inform a client at the time of admission of the agency’s requirement for the registration of medications prescribed by another physician or medical professional who is not employed by the agency.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 J.

 

K. A program sponsor for an opioid maintenance outpatient treatment program shall ensure face-to-face counseling sessions are conducted:

1. On an individual or group basis according to the client’s treatment plan,

2. No less than once every two weeks for the first year of treatment,

3. No less than once a month in the second year of treatment, and

4. As indicated by client’s progress in treatment for subsequent years.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 K . Review client files (progress notes) and verify services and number of counseling hours are provided.

 

L. A program sponsor for an opioid maintenance outpatient treatment program shall ensure that:

1. A dose of opioid agonist treatment medication is administered only after an order from a medical professional,

2. A client's dosage of opioid agonist treatment medication is individually determined,

3. A dose of opioid agonist treatment medication is sufficient to produce the desired response in a client for the desired duration of time and with consideration for client safety,

4. A client receives subsequent doses of opioid agonist treatment medication:

a. Based on the client's individual needs and the results of the physical examination and assessment,

b. Sufficient to achieve the desired response for at least 24 hours, with consideration for day-to-day fluctuations and elimination patterns,

c. That are not used to reinforce positive behavior or punish negative behavior,

d. As long as the client benefits from and desires comprehensive maintenance treatment, and

e. That are adjusted if an agency changes from one type of opioid agonist treatment medication to another.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 L. 1. Review client file and/or medication log.

 

M. A program sponsor for an opioid maintenance outpatient treatment program shall ensure that policies and procedures are developed implemented and complied with for the use of take-home medication and includes:

1. Criteria for determining when a client is ready to receive take-home medication,

2. Criteria for when a client's take-home medication is increased or decreased,

3. A requirement that take-home medication be dispensed according to federal and state law,

4. A requirement that a medical professional review a client's take-home medication regimen at intervals established in the client's treatment plan and adjust the client's dosage, as needed,

5. Procedures for safe handling and secure storage of take-home medication in a client's home, and

6. Criteria and duration of allowing a physician to prescribe a split medication regimen.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 M.

 

N. Except as provided in subsection (L), a program sponsor for an opioid maintenance outpatient treatment program shall ensure that a client is permitted to have take-home medication only upon the determination and written permission of the agency medical director, based upon the following:

1. Absence of abuse of drugs, including alcohol,

2. Regularity of agency attendance,

3. Length of time in comprehensive maintenance treatment,

4. Absence of criminal activity,

5. Absence of serious behavioral problems at the agency,

6. Special needs of the client such as physical health needs,

7. Assurance that take-home medication can be safely stored in the client's home,

8. Stability of the client's home environment and social relationships,

9. The client's work, school, or other daily activity schedule,

10. Hardship experienced by the client in traveling to and from the agency, and

11. Whether the benefit the client would receive by decreasing the frequency of agency attendance outweighs the potential risk of diversion of medication.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 N.

 

O. When the client does not meet the criteria in subsection (L), the medical director shall submit an exception notification document to the Center for Substance Abuse Treatment and State Methadone Authority according to state protocols.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 O.

 

P. A client in an opioid maintenance outpatient treatment program may receive a single dose of take-home medication for each day that an agency is closed for business, including Sundays and state and federal holidays. er termination period, or 3. A transfer to another program is completed.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 P.

 

Q. A program sponsor of an opioid maintenance outpatient treatment program shall ensure that a client receiving take-home medication receives:

1. Take-home medication in a child-proof container, and

2. Written and verbal information on the client's responsibilities in protecting the security of take-home medication.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 Q.

 

R. A program sponsor of an opioid maintenance outpatient treatment program shall ensure that a medical director's determination made under subsection (L) and the reasons for the determination are documented in the client record.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 R.

 

S. A program sponsor of an opioid maintenance outpatient treatment program shall permit a client to voluntarily terminate participation in a program even though termination may be against the advice of the medical director.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 S.

 

T. A program sponsor of an opioid maintenance outpatient treatment program shall develop, implement, and comply with policies and procedures for voluntary, involuntary, and administrative discharge to include:

1. An explanation to the client of when participation may be terminated for cause such as physically threatening staff or other clients,

2. Client notification of termination,

3. Client’s right to hearing, and

4. Client’s right to representation.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 T.

 

U. A program sponsor of an opioid maintenance outpatient treatment program shall ensure voluntary or involuntary discharge is individualized, under the direction of the medical director, and takes place not less than a period of 10 days, unless:

1. The medical director or program administrative personnel deems it clinically necessary to terminate participation sooner and documents the reason in the client’s record,

2. The client requests in writing a shorter termination period, or

3. A transfer to another program is completed.

Review policy and procedure manual and verify it reflects the requirements as stated in R03-711 U.