Standards for public agencies

2020 Edition

Opioid Treatment (PA-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 (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 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

PA-OTP 9.01

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

PA-OTP 9.02

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

PA-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.

PA-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.

PA-OTP 9.05

Following the receipt of toxicology test results, the agency:
  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

PA-OTP 9.06

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