Standards for private organizations

2020 Edition

Opioid Treatment (OTP) 9: Toxicology Testing for Continued Drug Use

Toxicology testing is an integral component of service planning and clinical practice to help monitor and evaluate the individual's progress in treatment.
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 for evaluating the quality of laboratories
  • Policies related to toxicology testing
  • Procedures for toxicology testing
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 9.01

Prior to establishing a contract, the organization evaluates the quality of the laboratory to perform drug screens, including use of equipment, methodology, and quality control.

 

OTP 9.02

Toxicology specimens are obtained:
  1. with respect for individual privacy; and
  2. in a safe treatment atmosphere.

 

OTP 9.03

After the individual's initial admission test, the timing and frequency of toxicology testing is clinically appropriate for each individual, and the opioid treatment program conducts:
  1. at least eight random drug tests per service recipient, per year;
  2. at least one initial and two subsequent tests for individuals in interim maintenance treatment; and
  3. tests, as appropriate, during medically supervised and other types of withdrawal.

Interpretation

Drug testing regimes should be determined based on individual assessment results and by analyzing community drug-use patterns. Testing may include, but not be limited to, opiates, benzodiazepines, barbiturates, cocaine, marijuana, methadone (and its metabolites), amphetamines, and alcohol.

 

OTP 9.04

Toxicology testing procedures include, and are not limited to:
  1. informing persons served about how specimens are collected and of their responsibility to provide a specimen when asked;
  2. discussing positive toxicology results with the individual;
  3. providing counseling, medical review, and other interventions if the person continues to test positive for illegal substance use;
  4. methods to minimize falsification during the drug testing sample collection;
  5. a process for reviewing false-positive and false-negative results; and
  6. documenting results in the case record along with the person’s response.

 

OTP 9.05

Following the receipt of toxicology test results, the organization:
  1. evaluates negative reports for opioid treatment medication and related metabolites;
  2. reviews dosage when positive toxicology reports for drugs are received;
  3. investigates the possibility of false positive results when persons served deny drug use;
  4. rapidly responds if the individual is found to be in danger of relapse; and
  5. uses the results to determine the need for additional interventions.

Interpretation

Immediate action should be taken to investigate possible diversion of opioid medication when toxicology tests indicate lack of opioids or related metabolites.

 
Fundamental Practice

OTP 9.06

Evidence of ongoing drug use is not considered grounds for discharge, unless the individual refuses to cooperate with treatment recommendations.