Standards for public agencies

2020 Edition

Opioid Treatment (PA-OTP) 12: Detoxification Treatment

Detoxification treatment is provided based on the needs of the individual.
NA The agency does not provide detoxification treatment.
2020 Edition

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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.
Note: In these standards, the term “detoxification” refers to detoxification from opioid drugs and not medical or administrative withdrawal from opioid treatment medication, which is addressed in PA-OTP 15.
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 related to detoxification
  • Service recipient/personnel care and supervision ratios and scheduling criteria (residential detoxification programs only)
  • Privacy policy (residential detoxification programs only)
  • Coverage schedules for the past six months in residential detoxification programs, if applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

PA-OTP 12.01

Qualified personnel determine if short- or long-term detoxification treatment is appropriate for the individual using diagnostic criteria found in the Diagnostic and Statistical Manual for Mental Disorders.

PA-OTP 12.02

Persons served are placed in the appropriate level of care and have access to all components of the detoxification process, including:  
  1. evaluation;
  2. stabilization; and
  3. preparation for entry into substance use treatment.
Examples: Agencies can utilize the American Society of Addiction Medicine (ASAM) criteria to determine the appropriate level of care.

PA-OTP 12.03

The agency conducts an initial drug test for individuals in short-and long-term detoxification treatment and monthly random tests for individuals receiving long-term detoxification treatment.

PA-OTP 12.04

The agency limits individuals to two detoxification treatment episodes per year.

Fundamental Practice

PA-OTP 12.05

Individuals who have had two or more unsuccessful detoxification episodes are assessed by a physician to determine the need for other forms of treatment.

PA-OTP 12.06

The agency provides 24-hour-a-day supervision, observation, and care tailored to meet the individual’s assessed needs and goals.

Interpretation

Staffing requirements and care ratios can vary depending on the age, developmental level, and service needs of the population, agencies must meet state licensing requirements.
NA The agency does not provide detoxification treatment in a residential setting.

PA-OTP 12.07

Residential facilities contribute to a physically and psychologically safe, healthy, non-institutional environment by: 
  1. providing personal accommodations for individuals that are age, developmentally, gender, and culturally appropriate; 
  2. providing private areas for bathing, toileting, and personal hygiene;
  3. allocating rooms for occasional on-site services, as needed;
  4. ensuring accommodations for informal gathering of persons served, including during inclement weather;
  5. having adequate space for administrative support functions, food preparation, housekeeping, laundry, maintenance, and storage; and
  6. being maintained in good, clean condition.

Interpretation

Accommodations may be adjusted as appropriate to the service provided, therapeutic considerations, level of risk, or developmental appropriateness.
NA The agency does not provide detoxification treatment in a residential setting.

PA-OTP 12.08

The agency ensures the comfort, dignity, privacy, and safety of persons served by: 
  1. implementing and communicating policies for searches of individuals or their property; 
  2. prohibiting the use of surveillance cameras or listening devices of persons in bedrooms; 
  3. maintaining doors on sleeping areas and bathroom enclosures; 
  4. providing one- or two-person rooms to individuals who need extra sleep, protection from sleep disturbance, or extra privacy for clinical reasons; and
  5. requiring employees to knock before entering a service recipient’s room unless there is a safety or clinical concern.

Interpretation

When agencies are required to employ alternate practices, documentation must be provided to justify the practice. Documentation may include a judicial order, law, contract, copy of the state's safety plan for a resident, or clear, clinical written justification for a resident. 

Sensitivity should be taken to ensure that all persons served, especially abuse or trauma survivors and the LGBTQ population, feel safe and not violated.
NA The agency does not provide detoxification treatment in a residential setting.