Standards for private organizations

2020 Edition

Opioid Treatment (OTP) 10: Take-Home Privileges for Unsupervised Use of Medication

The organization establishes criteria to determine when take-home privileges can become part of an individual’s service plan and how medications are provided in accordance with applicable federal regulations concerning the prescription and distribution of controlled substances.
2020 Edition

Currently viewing: OPIOID TREATMENT (OTP)

VIEW THE STANDARDS

Purpose

Individuals who participate in Opioid Treatment Programs improve social, emotional, and vocational functioning, achieve optimal productivity, and attain the recovery they seek.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures regarding take-home medication
  • Criteria regarding take-home privileges
  • Material that is given to persons served that addresses safe storage of take-home medication
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 10.01

Direct service personnel, medical and other appropriate personnel, persons served, and, whenever possible, family members, participate in determining if the individual meets criteria for take-home medication.

 

OTP 10.02

To support the initiation of take-home privileges, the medical director considers:
  1. length of time in treatment;
  2. consistency of clinic attendance;
  3. clinical status;
  4. progress in rehabilitation;
  5. medical necessity;
  6. behavioral factors;
  7. geographic considerations;
  8. employment schedules that create hardship for an individual to meet limited clinic hours;
  9. results of toxicology tests; and
  10. other special needs.

Interpretation

All elements should be considered collectively in determining whether take home privileges are appropriate for an individual. Decisions should not be based solely on toxicology test reports.

Interpretation

Time in treatment should not be a factor for patients prescribed buprenorphine for take-home use.
Examples: “Other special needs" may include, and are not limited to, emergency circumstances, split dosing, and pain treatment.

 
Fundamental Practice

OTP 10.03

For each person provided with take-home medication, the organization:
  1. schedules toxicology tests to ensure he or she consumes the opioid treatment medication provided and remains free of substance use;
  2. implements measures to help avoid diversion of controlled substances;
  3. has a physician review his or her status at least every 90 days, or more frequently if clinically indicated; and
  4. periodically reviews the benefits and drawbacks of continued take-home privileges.

 

OTP 10.04

The medical director uses established criteria to decide when take-home medication is contraindicated, including:
  1. signs or symptoms of withdrawal;
  2. evidence of continued alcohol and drug use;
  3. the absence of laboratory evidence of the opioid treatment medication in toxicology samples;
  4. participation in short-term detoxification or interim maintenance treatment programs;
  5. potential complications from concurrent disorders;
  6. ongoing criminal behavior; and
  7. absence of stable social relationships or a stable home environment.

 
Fundamental Practice

OTP 10.05

The organization labels take-home medication with the organization’s name, address, and telephone number and provides individuals with guidance on how to safely secure medication.

Interpretation

The medical director should consider whether the medication can be safely stored in the person’s place of residence when determining if the individual may be permitted unsupervised use of medication.
Note: See also Program Administration (PRG) for standards regarding Medication Control and Administration.