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 69-7-37 - Unsupervised Take-Home Medications

Universal Citation: 69 WV Code of State Rules 69-7-37

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

37.1. Each opioid treatment program shall have policies and procedures regarding unsupervised take-home medication schedules that consider the best interests of each patient, as well as the interests of the public at large. The policies and procedures shall be developed in accordance with federal and state laws, rules and regulations and pursuant to guidelines and protocols from approved authorities. The policies and procedures should assist patients with treatment and recovery and simultaneously prevent diversion, ensure safe storage and security of medication and prevent overdoses. Policies and procedures shall not create unnecessary barriers for patients continuing in treatment.

37.2. Approved guidelines and protocols include those adopted by the American Society of Addiction Medicine (ASAM), the Center for Substance Abuse Treatment (CSAT), the National Institute on Drug Abuse (NIDA),), the American Association for the Treatment of Opioid Dependence (AATOD), and other authorities approved by the secretary. An opioid treatment program may submit a written request that the secretary approve another such program and shall provide all applicable documentation that supports such approval. The secretary has the sole discretion in determining whether to add another program to the list of approved authorities.

37.3. All opioid treatment program facilities that provide unsupervised approved use of medications shall be open seven days per week, except for eight holidays and two training days per year, when the clinics may be closed.

37.4. The interdisciplinary team shall make recommendations to the patient's program physician regarding take-home medications for each patient. The program physician shall make the final decision regarding approval of take-home medications in accordance with federal and state laws, rules and regulations and guidelines and protocols from approved authorities. The program physician shall document all approved changes in take-home privileges in the patient record and the individualized treatment plan of care.

37.5. In determining which patients may be permitted unsupervised use of medications, the physician shall consider the following criteria in determining whether a patient is responsible in handling opioid drugs for unsupervised use:

37.5.a. Cessation of illicit drug use;

37.5.b. Absence of recent abuse of drugs (opioid or non-narcotic), including alcohol;

37.5.c. Regularity of clinic attendance;

37.5.d. Absence of serious behavioral problems at the program;

37.5.e. Absence of known recent criminal activity, including drug dealing;

37.5.f. Stability of the patient's home environment and social relationships;

37.5.g. The length of time the patient has been in medication-assisted maintenance treatment;

37.5.h. Assurance that take-home medication can be safely stored within the patient's home;

37.5.i. Whether the rehabilitative benefit the patient derives from decreasing the frequency of clinic attendance outweighs the potential risks of diversion;

37.5.j. The ability of the patient to responsibly self-medicate;

37.5.k. Other special needs of the patient, such as split dosing, physical health needs, pain treatment, etc.;

37.5.l. Patient's work, school, or other daily-life activity schedule; and

37.5.m. Hardship experienced by the patient in traveling to and from the program.

37.6. The determination of whether to approve a patient for unsupervised take-home medications consistent with the criteria outlined in this section shall be documented in the patient's medical record.

37.7. Each opioid treatment program shall maintain current procedures adequate to identify the theft or diversion of take-home medications, including labeling containers with the opioid treatment program's name, address and telephone number. Programs must also ensure that take-home supplies are packaged in a manner that is designed to reduce the risk of accidental ingestion, including child-proof containers.

37.8. The number of doses of take-home medication shall be determined by the program physician in accordance with guidelines and protocols of approved authorities and after consultation with the interdisciplinary team and shall not exceed the recommended doses. The take-home medication treatment plans shall be for 90-day periods. The patient's individualized treatment plan of care may include permission for the patient to take home doses of medication subject to the following restrictions:

37.8.a. During the first 90-day period of treatment, no take-home doses shall be permitted during the first thirty days of treatment. Thereafter, the take-home supply is limited to a single dose each week except for holidays or days when the facility is closed. The patient shall ingest all other doses under appropriate supervision.

37.8.b. In the second 90-day period of treatment, the take-home supply is limited to two (2) doses per week.

37.8.c. In the third 90-day period of treatment, the take-home supply is limited to three (3) doses per week.

37.8.d. In the remaining months of the first year of treatment, a patient may be given a maximum six-day supply of take-home medication.

37.8.e. After one year of continuous treatment, a patient may be given a maximum two-week supply of take-home medication.

37.8.f. After two years of continuous treatment, a patient may be given a maximum one-month supply of take-home medication, contingent upon the patient making monthly visits to the opioid treatment program.

37.9. No medications shall be administered to patients in short-term detoxification treatment for unsupervised or take-home use.

37.10. Any patient in comprehensive maintenance treatment may receive a single take-home dose for a day that the opioid treatment program facility is closed for business, including Sundays and state and federal holidays.

37.11. Patients participating in the unsupervised take-home medication plan are subject to the provisions of §41 of this rule regarding positive drug test results. The failure to pass a drug test may result in a change to the individualized treatment plan of care, including a reduction of medication or a discharge from the program.

37.12. The program physician may approve temporary unsupervised take-home medication for documented family or medical emergencies or other exceptional circumstances, pursuant to authorized guidelines and protocols approved by the state opioid treatment authority. Patterns of emergency take-home provisions shall be tracked and monitored by the opioid treatment program, included in the patient records and be made available for review by regulatory bodies.

37.13. Guest dosing at a nearby clinic is preferred whenever possible and shall be documented in the patient's chart and individualized treatment plan of care of care. Each opioid treatment program shall have policies and procedures that address the transfer of patients from one opioid treatment clinic to another.

37.14. The state authority may approve exceptional unsupervised-medication dosages, including alternative medications, on a case-by-case basis upon application for an exemption by the program physician. Any authorization for exceptions shall be consistent with guidelines and protocols of approved authorities, provided that the authority may not grant any exceptions during a calendar month which exceed three (3) exceptions or ten (10) percent of the number of patients enrolled in the program on the last day of the previous month, whichever is greater: Provided, That the state authority may grant additional exceptions for inclement weather or clinic closure.

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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