Standards for private organizations

2020 Edition

Opioid Treatment (OTP) 15: Withdrawal

Persons served participate in the development of an appropriate withdrawal schedule and receive the necessary support to prevent relapse.
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
  • Procedures for medical withdrawal
  • Procedures for administrative discharge
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

OTP 15.01

Medical withdrawal from opioid treatment medication is:
  1. a voluntary and therapeutic process planned for by the individual and a physician; or 
  2. conducted in response to an individual's request, but against medical advice (AMA).

OTP 15.02

Medical withdrawal practices include:
  1. dose reduction at a rate well tolerated by the person and in accordance with accepted medical practices;
  2. periodic assessments of mental status;
  3. an assessment for pregnancy for women of childbearing age;
  4. availability of counseling and other support services; and
  5. discontinuation of withdrawal and resumed maintenance therapy, in the event of impending relapse.

OTP 15.03

Individuals that undergo medically supervised withdrawal AMA:
  1. are provided with information about the risks of discontinuing treatment and information about and referral to alternative treatment programs;
  2. can be readmitted to the program within 30 days without repeating the initial assessment; and
  3. are considered for maintenance treatment when withdrawal fails.

Interpretation

In the case of a pregnant individual the organization should keep the agency providing prenatal care informed of the individual's status consistent with privacy standards.

Interpretation

Reason for seeking discharge and steps taken to avoid discharge should be noted in the case record.

Fundamental Practice

OTP 15.04

When other interventions were proven unsuccessful, a program may determine that administrative withdrawal is necessary, including: 
  1. a humane withdrawal schedule based on sound clinical judgement; and
  2. referral or transfer to a suitable, alternative treatment program, whenever possible.

Interpretation

The organization must determine on a case-by-case basis its responsibility to continue providing services to persons whose third-party benefits are denied or have ended and who are in critical situations.

Interpretation

A suggested schedule for medically supervised administrative withdrawal is a minimum of 30 days with adjustments made depending on clinical factors. Since administrative withdrawal is conducted over a short timeframe and associated with poor prognosis connecting individuals to alternative treatment programs is critical.
Examples: Administrative discharges are usually involuntary and may occur for reasons such as nonpayment of fees, incarceration, or disruptive conduct or behavior such as violence, dealing drugs, repeated loitering, and flagrant noncompliance.