Standards for public agencies

2020 Edition

Opioid Treatment (PA-OTP) 11: Dosage Requirements

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

PA-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

PA-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

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