Standards for public agencies

2020 Edition

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

The agency 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 (PA-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
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
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

PA-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.

PA-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

PA-OTP 10.03

For each person provided with take-home medication, the agency:
  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.

PA-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

PA-OTP 10.05

The agency labels take-home medication with the agency'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 (PA-PRG) for standards regarding Medication Control and Administration.