West Virginia Code of State Rules
Agency 69 - Health And Human Resources
Title 69 - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES
Series 69-07 - Regulations of Opioid Treatment Programs
Section 69-7-27 - Pre-Admission Assessment; Admission Criteria

Universal Citation: 69 WV Code of State Rules 69-7-27

Current through Register Vol. XLI, No. 38, September 20, 2024

27.1. Each opioid treatment program shall maintain current procedures designed to ensure that patients are admitted to maintenance treatment only after assessment by qualified personnel who have determined that the person meets the qualifications for admission.

27.2. Any person seeking admittance to the opioid treatment program shall undergo a pre-admission initial assessment in order to determine whether the person meets the criteria for admission to an opioid treatment program. The initial assessment, consisting of a physical examination and an intake screening, shall be conducted by the medical director, an approved program physician or a supervised physician extender. The initial assessment shall focus on the individual's eligibility and need for treatment and shall provide indicators for initial dosage level, if required and if admission is determined appropriate. The determination of admission eligibility shall be made using accepted medical criteria such as those listed in the Diagnostic and Statistical Manual for Mental disorders (DSM-IV).

27.3. The initial physical examination shall include documentation of:

27.3.a. A brief physical examination;

27.3.b. The patient's immediately relevant health history (e.g., determination of chronic or acute medical conditions such as diabetes, renal disease, hepatitis, sickle cell anemia, tuberculosis, HIV exposure, sexually transmitted disease, chronic cardiopulmonary disease and pregnancy);

27.3.c. A determination of currently prescribed medications;

27.3.d. An evaluation of other substances of abuse;

27.3.e. Determination of current opioid dependence;

27.3.f. Determination of length of addiction;

27.3.g. A toxicology screen to determine immediate use of opiates;

27.3.h. An initial drug test and full toxicology screen to identify whether the patient is using other drugs, including opiates, methadone, amphetamines, cocaine, barbiturates, benzodiazepines, marijuana, or other drugs or substances as determined by community standards, regional variation or clinical indication (e.g., carispodol); to determine whether the individual is opioid addicted; and to determine whether the patient is presently receiving methadone for an opioid addiction from another opioid treatment program;

27.3.i. An inquiry to and report from the Controlled Substances Monitoring Program; and.

27.3.j. An inquiry whether the patient is enrolled in any other opioid treatment program.

27.4. The person desiring admission for treatment through the use of an opioid treatment medication must be at least eighteen years of age. Exceptions may be made on extremely rare occasions by application to the state authority.

27.5. All admissions shall include documentation regarding medical necessity and program eligibility for opioid treatment that includes:

27.5.a. Objective evidence, such as a positive drug test, of current physical dependence or tolerance to opioids or methadone; or

27.5.b. Objective symptoms of withdrawal, with documentation of the signs and symptoms of withdrawal; or both; or

27.5.b. Evidence of an onset of opioid physical dependence of at least one year prior to admission with continuous use the greater part of the year; and

27.5.c. Evidence of multiple and daily self-administration of an opioid.

27.6. The following behavioral signs which support the diagnosis of opioid addiction shall be discussed and documented, although none are considered required for admission:

27.6.a. Unsuccessful efforts to control use;

27.6.b. Time spent obtaining drugs or recovering from the effects of abuse;

27.6.c. Continual use despite harmful consequences;

27.6.d. Obtaining opiates illegally;

27.6.e. Inappropriate use of prescribed opiates;

27.6.f. Giving up or reducing important social, occupational or recreational activities;

27.6.g. Continuing use of the opiate despite known adverse consequences to self, family or society; and

27.6.h. One or more unsuccessful attempts at gradual removal of physical dependence on opioids (detoxification) using methadone or other appropriate medications.

27.7. The absence of physiological dependence should not be an exclusion criterion, and admission may be clinically justified. The initial assessment may recognize that individuals in some populations may be susceptible to relapse to opioid addiction, leading to high-risk behaviors with potentially life threatening consequences.

27.8. After thorough review of the information acquired through the initial assessment, an individual may be admitted to the opioid treatment program if, using accepted medical criteria, a determination is made that one or more of the following factors are met:

27.9.a. The person is currently addicted to an opioid drug, as evidenced by a positive test for either opioids or methadone, and the person became addicted at least one year before admission for treatment; or

27.9.b. There are objective symptoms of withdrawal, or both; or

27.9.c. There is objective evidence that the individual qualifies under the provisions of §27.9 of this rule.

27.9. Admission to the opioid treatment program may be allowed to the following groups with a high risk of relapse without the necessity of a positive test or the presence of objective symptoms:

27.9.a. The person is a pregnant woman with a history of opioid abuse.

27.9.b. The person is a prisoner or has been released from a correctional facility within six months.

27.9.c. The person is a former clinic patient who successfully completed treatment but believes that he or she is at risk of imminent relapse.

27.9.d. The person is an HIV patient with a history of intravenous drug use.

27.10. A patient enrolled in an opioid treatment program shall not be permitted to obtain treatment in any other opioid treatment program except in exceptional circumstances and only as provided in §28 of these rules.

27.11. The admission and initial dosing of the patient may take place only after the patient is seen by a program physician, or an experienced medical professional working within the scope of his or her license who:

27.11.a. Has consulted by telephone or in person with the program physician;

27.11.b. Is approved by the medical director; and

27.11.c. Has completed a plan of development.

27.12. Whenever possible, the patient shall be admitted only after observation by and an interview with the program physician. Under unusual circumstances, an experienced medical professional working within the scope of his or her license may conduct the interview and observation and obtain telephone or fax orders from the physician to initiate treatment. Any patient admitted under those circumstances must be seen by the physician within three working days of admission for verification of appropriate admission and treatment. All unusual circumstances and their outcomes shall be reviewed by the admissions committee.

27.13. The program physician or physician extender shall review the accumulated data directly with the individual and confirm a diagnosis of opioid addiction of sufficient severity to warrant admission to the opioid treatment program. The program physician shall document that treatment is medically necessary. The admission and initial dosing decisions ultimately rest with the medical director or the designated program physician.

27.14. The program physician shall ensure that each patient voluntarily chooses maintenance treatment and that all relevant facts concerning the use of opioid treatment drugs are clearly and adequately explained to the patient. The program physician shall ensure that each newly admitted patient provides informed written consent to treatment.

27.15. Every individual shall be given the opportunity to enter into a detoxification program and shall be fully informed of the protocol, goals and procedures for detoxification. The individual shall specifically consent to participation in the detoxification program in writing. The consent form shall be maintained in the patient chart and with the patient's individualized treatment plan of care.

27.16. Admission of individuals with no opioid tolerance shall require careful monitoring during the induction phase of treatment.

27.17. The physician or physician extender and patient shall each sign and date verification that the initial assessment and review occurred and that the patient received all applicable information, policies and procedures.

27.18. Exceptions to admission policy shall be reviewed and tracked by the admissions committee and be made available to regulatory bodies.

Disclaimer: These regulations may not be the most recent version. West Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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