Standards for private organizations

2020 Edition

Opioid Treatment (OTP) 11: Dosage Requirements

The organization follows procedures for administration of opioid treatment medication to ensure that an adequate, individually-determined dose is dispensed.
2020 Edition

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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
  • Procedure for dosing and administration of opioid treatment medication
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 
Fundamental Practice

OTP 11.01

Opioid treatment medication is administered as follows:
  1. a physician makes all dosage decisions within the medically accepted dosage range for effective treatment;
  2. conditions for use are documented in the person’s case record;
  3. medications are administered and dispensed in accordance with approved product labeling;
  4. the initial dose of methadone does not exceed 30 milligrams, and 40 milligrams as a total dose for the first day; and
  5. methadone is dispensed in oral form.

Interpretation

The initial dose of methadone must be determined by an OTP physician familiar with the most up-to-date product labeling, who considers factors, such as body weight, size, other substance-use and abuse, diet, co-occurring disorders, medical diseases, genetic factors, and tolerance. Although the initial dose is indicated not to exceed 30 milligrams, this dose is not appropriate for everyone, and some individuals may require much lower doses. All individuals should be closely monitored during the induction phase and the increases in dosage should be under the close supervision of the physician. It must be documented in the case record when the 40 milligrams total dose is exceeded based on the physician's determination that the previous dosage did not suppress the person's withdrawal symptoms.

 
Fundamental Practice

OTP 11.02

When a physician determines a person is eligible to receive take-home medication, the dose is limited to no more than:
  1. one dose per week in the first 90 days of treatment;
  2. two doses per week in the second 90 days of treatment;
  3. three doses per week in the third 90 days of treatment;
  4. a six-day supply in the remaining months of the year;
  5. a two-week supply after one year of continuous treatment; and
  6. a one-month supply after two years of continuous treatment.

 
Fundamental Practice

OTP 11.03

Persons served receive the appropriate dosage of opioid treatment medication for days when the clinic is closed, for weekends, holidays, and travel.

Interpretation

The organization should inform persons served of its plan for administration of medication in the event that the program is temporarily closed due to an emergency.