West Virginia Code of State Rules
Agency 69 - Health And Human Resources
Title 69 - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES
Series 69-11 - Medication-Assisted Treatment - Opioid Treatment Programs
Section 69-11-34 - Laboratory Services; Drug Screens

Universal Citation: 69 WV Code of State Rules 69-11-34

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

34.1. All patients in the MAT program shall undergo monthly drug testing. Random drug testing of all patients shall be conducted during the course of treatment as required in paragraph 34.2.d.1.

34.2. Collection and Testing.

34.2.a. MAT programs shall work carefully with toxicology laboratories to ensure valid, appropriate results of drug screens. Workplace testing standards are not appropriate for urine testing. Testing shall be done only by laboratories with appropriate federal certification.

34.2.b. Each MAT program shall have the capability of obtaining medication blood levels when clinically indicated or through random or monthly drug testing of all patients.

34.2.c. Urine drug screening and other adequately tested toxicological procedures shall be used as an aid in monitoring and evaluating a patient's progress in treatment.

34.2.d. Drug screening policies and procedures shall be determined on an individualized basis for each patient, subject to the following requirements:
34.2.d.1. A patient receiving medication-assisted treatment medication maintenance services must have at least 12 random drug screens per year. The patient shall be tested upon admission; at approximately 14 days of treatment; and then monthly through the remainder of the time the patient remains in the MAT program.

34.2.d.2. A patient undergoing medically-supervised or other types of withdrawal may be required to have more frequent collection and analysis of samples.

34.2.d.3. When using urine as a screening mechanism, all patient drug testing shall be observed to minimize the chance of adulterating or substituting another individual's urine.

34.2.d.4. MAT programs shall develop and implement policies and procedures to minimize misidentification of urine specimens and to ensure that the tested specimens can be traced to the donor patient.

34.2.e. Drug screenings shall include toxicological analysis for drugs of abuse, including, but not limited to:
34.2.e.1. Buprenorphine, especially in ratio to Norbuprenorphine;

34.2.e.2. Opiates including oxycodone at common levels of dosing;

34.2.e.3. Methadone, medication-assisted treatment medications or any other medication used by the program as an intervention for that patient;

34.2.e.4. Benzodiazepines, including testing procedures that detect diazepam, clonazepam, alprazolam and lorazepam;

34.2.e.5. Cocaine;

34.2.e.6. Meth-amphetamine/amphetamines;

34.2.e.7. Tetrahydrocannabinol, delta-9-tetrahydrocannabinol, dronabinol or other similar substances; or

34.2.e.8. Other drugs or substances as determined by community standards, regional variation or clinical indication, such as carisoprodol or barbiturates.

34.2.f. Collection and testing shall be done in a manner that assures a method of confirmation for positive results and documents the chain of custody of the collection.

34.2.g. When necessary and appropriate, breathalyzers or other testing equipment may be used to screen for possible alcohol abuse. No individual shall receive a daily dose who has a breathalyzer result which is equal to or greater than 0.02. The individual may return to the program for dosing during the same day if the breathalyzer results reach acceptable limits.

34.2.h. Each MAT program shall document both the results of drug tests and the follow-up therapeutic action taken in the patient record.

34.2.i. Each MAT program shall ensure that program physician demonstrate competence in the interpretation of "false negative" and "false positive" laboratory results as they related to physiological issues, differences among laboratories and factors that impact the absorption, metabolism and elimination of opiates.

34.2.j. The program physician shall thoroughly evaluate a positive drug screen for any potentially licit substance such as benzodiazepines, carisoprodol, barbiturates and amphetamines. The program shall verify with appropriate releases of information that:
34.2.j.1. The patient has been prescribed these medications by a licensed physician for a legitimate medical purpose; and

34.2.j.2. The prescribing physician is aware that the patient is enrolled in a MAT program.

34.2.k. If a patient refuses the release of information to contact his or her physician but can produce prescriptions or other evidence of a legitimate prescription, such as current medication bottles that are fully labeled, the interdisciplinary team shall consider the patient's individual situation and the possibility that he or she may be dismissed from the care of his or her physician if the physician discovers that the patient is in a MAT program. The program physician shall make the ultimate decision as to the patient's continuing care in the program and the circumstances of that care.

34.2.l. Nothing contained in this rule shall preclude any MAT program from administering any additional drug test it determines are necessary.

34.3. Test Results.

34.3.a. A positive test is a test that results in the presence of any drug or substance listed in subdivision 34.2.e. of this rule, or any other drug or substance prohibited by the MAT program. The presence of a drug or substance which is part of the patient's individualized treatment plan of care shall not be considered a positive test. Any refusal to participate in a random drug test shall be considered a positive drug test.

34.3.b. A positive drug test result after the first six months in a MAT program shall result in the following:
34.3.b.1. Upon the first positive drug test result, the MAT program shall:
34.3.b.1.A. Provide mandatory and documented weekly counseling to the patient of no less than 30 minutes, which shall include weekly meetings with a counselor or other professional as described in subsection 26.8 of this rule who is licensed, certified or enrolled in the process of obtaining licensure or certification in compliance with the rules on staff at the MAT program or by formal referral agreement; and

34.3.b.1.B. Immediately revoke the take-home medication privilege for a minimum of 30 days;

34.3.b.2. Upon a second positive drug test result within six months of a previous positive drug test result, the MAT program shall:
34.3.b.2.A. Provide mandatory and documented weekly counseling to the patient of no less than 30 minutes, which shall include weekly meetings with a counselor or other professional as described in subsection 26.8. of this rule who is licensed, certified or enrolled in the process of obtaining licensure or certification in compliance with the rules on staff at the MAT program;

34.3.b.2.B. Immediately revoke the take-home medication privilege for a minimum of 60 days; and

34.3.b.2.C. Provide mandatory documented treatment to interdisciplinary team meetings with the patient.

34.3.b.3. Upon a third positive drug test result within a period of six months the MAT program shall:
34.3.b.3.A. Provide mandatory and documented weekly counseling to the patient of no less than 30 minutes, which shall include weekly meetings with a counselor or other professional as described in subsection 26.8. of this rule who is licensed, certified or enrolled in the process of obtaining licensure or certification in compliance with the rules on staff at the MAT program;

34.3.b.3.B. Immediately revoke the take-home medication privilege for a minimum of 120 days, if applicable; and

34.3.b.3.C. Provide mandatory and documented treatment to interdisciplinary team meetings with the patient which will include, at a minimum: the need for continuing treatment; a discussion of other treatment alternatives; and the execution of a contract with the patient advising the patient of discharge for continued positive drug tests.

34.3.b.4. Up on any subsequent positive drug test(s) within a six-month period, the patient may be immediately discharged from the MAT program, or, at the option of the patient, may immediately be provided the opportunity to participate in a detoxification plan, followed by immediate discharge from the MAT program. If the patient remains in treatment with the OPT, the program physician and primary counselor must meet with the patient and revise the individual treatment plan of care and revise the coordination of care agreement.

34.3.c. Positive screens for tetrahydrocannabinol, delta-9-tetrahydrocannabinol, dronabinol or similar substances shall be carefully clinically evaluated and shall in most cases result in reduction in take-home medication privileges unless other action is considered appropriate by the medical director or program physician and primary counselor. Testing positive solely for tetrahydrocannabinol, delta-9-tetrahydrocannabinol, dronabinol or similar substances shall not serve as a basis for discharge from the program.

34.3.d. Absence of medication-assisted treatment medication prescribed by the program for the patient is evidence of possible medication diversion. Whenever there is evidence of possible medication-assisted treatment medication diversion, the patient shall be re-evaluated by the program physician and interdisciplinary team and the individualized treatment plan of care shall be adjusted, if needed, accordingly.

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