W. Va. Code R. § 69-11-31 - Detoxification Program

31.1. In addition to recovery-oriented medication-assisted treatment services, each MAT program shall provide both long-term and short-term detoxification recovery treatment services, either onsite or by referral. The program physician or a physician extender shall provide onsite medical supervision and oversight of the detoxification treatment program. If detoxification treatment is provided by referral, the program physician shall maintain documentation and communication with the referred detoxification program and keep such documentation in the patient's record.

31.2. All potential patients shall be offered the opportunity to participate in either a recovery-oriented long-term detoxification treatment services plan or a short-term detoxification services plan of varying durations. A detoxification treatment services plan shall be implemented only if agreed upon by the patient and deemed appropriate by the physician or physician extender through utilizing and applying established diagnostic criteria.

31.3. Patients with two or more unsuccessful detoxification episodes within a 12-month period must be assessed by the MAT program physician for other forms of treatment. A program shall not admit a patient for more than two detoxification treatment episodes in one year. One year of physiologic dependence is not required for detoxification treatment although documentation of current dependency is required.

31.4. The patient's individualized treatment plan of care shall state whether the patient chose detoxification treatment services and, if so, whether the patient selected the short-term or long-term detoxification treatment program. If the patient selected the option for detoxification treatment services, the patient's chart shall include a consent form signed by the patient reflecting selection of such an option. The consent form shall include the patient's acknowledgement that under the detoxification protocol the strength of maintenance doses of medication-assisted treatment medications should decrease over time; that the treatment period should be in accordance with national guidelines; and that the patient is required to work toward a recovery-oriented lifestyle.

31.5. The estimated time of detoxification required to reach the point of elimination of the medication shall be specified by the physician and documented in the patient's individualized treatment plan of care. The titration schedule may be modified at any time. Any extension or modification of the titration schedule shall be documented in the patient's individualized treatment plan of care and chart.

31.6. The program physician shall determine on an individualized basis the appropriate dosage of medication-assisted treatment medication to ensure stabilization during detoxification. The determination shall be based upon individual clinical data in accordance with guidelines and protocols established by approved authorities.

31.7. Exceptions to treatment guidelines or a patient's refusal to participate in the program shall be documented and tracked by the program.

31.8. Urine or other toxicological screening instruments shall be used by the MAT program staff during detoxification treatment in order to demonstrate the absence of use of alternative licit or illicit drugs.

31.9. The MAT program shall develop and implement a policy regarding recovery-oriented detoxification treatment from medication-assisted treatment medication that shall include:

31.9.a. Individualized determination of a schedule of detoxification that is well tolerated by the patient and consistent with approved national guidelines and sound medical practices;

31.9.b. Implementation of a higher stabilizing dose in the event of impending relapse as appropriate and possible;

31.9.c. Assurances that voluntary detoxification shall be discontinued in the event of relapse and that provisions for maintenance treatment shall be made;

31.9.d. Evaluation or testing for pregnancy prior to detoxification; and

31.9.e. Provision for continuing care after the last dose of methadone or other medication-assisted treatment medication.

31.10. The MAT program shall have procedures for providing detoxification treatment services to persons prior to their incarceration in criminal justice system facilities if possible and foreseeable. When appropriate, the MAT program shall have cooperative agreements with the criminal justice system to encourage detoxification treatment services to persons who are incarcerated or on probation or parole and are required to become abstinent.

31.11. Short-Term Detoxification Treatment Services.

31.11.a. Short-term detoxification treatment services are those services projected to last fewer than 30 days.

31.11.b. Unsupervised doses of medication may not be administered to patients admitted for short-term detoxification unless the patient qualifies under a federal or state-approved exemption and, at the physician's discretion, there is a verifiable emergency. If there is a verifiable exemption or emergency, the MAT program shall not allow the patient more than one unsupervised or take-home medication dose per week. If the program operates on a seven-days-per-week basis, no unsupervised take-home medications shall be allowed except on permitted holidays or closures or pursuant to an authorized exemption.

31.11.c. For a patient admitted for detoxification treatment services for 14 days or less, the program must offer a minimum of four counseling sessions per week.

31.12. Long-Term Detoxification Treatment Services.

31.12.a. Long-term detoxification treatment services are those services projected to last more than 30 and up to 180 or more days, depending on the patient's clinical need.

31.12.b. Frequency of access to unsupervised medications shall be determined by the program physician in accordance with federal law and guidelines and protocols from an approved authority.

31.12.c. In a detoxification program of more than 30 days' duration, the MAT program shall have a policy that grants the patient the opportunity to receive take-home medications. No unsupervised take-home medications may be administered or prescribed for a patient during the first 30 days of treatment unless the patient qualifies under an approved exemption or emergency. Thereafter, based upon federal law, approved national guidelines and the clinical judgment of the program physician, the quantity of unsupervised medication shall not exceed the following doses:

31.12.c.1. One unsupervised dose per week for the remaining 60 days of the first 90-day treatment plan. Provided, that in a week in which a holiday causes the MAT program to be closed, two doses may be allowed.

31.12.c.2. Two unsupervised doses per week during third 90 days of treatment.

31.12.c.3. Three unsupervised doses per week during third 90 days of treatment.

31.12.c.4. A maximum six-day supply of take-home medication in the remaining months of the first year of treatment.

31.13. Counseling Services.

31.13.a. Counseling services provided in conjunction with detoxification treatment services shall be designed to:

31.13.a.1. Explore other modalities of care, including drug and alcohol treatment following detoxification or discharge;

31.13.a.2. Motivate the patient to continue to receive services or to develop a plan for recovery following discharge; and

31.13.a.3. Identify triggers for relapse and a coping plan for dealing with each, detailed and in writing and given to the patient prior to discharge.

31.13.b. The counseling plan shall be developed in conjunction with the patient and included with the individualized treatment plan of care.

31.13.c. For a patient projected to be involved in detoxification treatment services for six months or less, the MAT program must offer the patient a minimum of three counseling sessions per week for the first month and a minimum of two counseling sessions each month thereafter.

31.14. Maintenance treatment shall be discontinued within two continuous years after the treatment is begun unless, based upon the clinical judgment of the medical director or program physician and staff which shall be recorded in the client's record, the client's status indicates that the treatment should be continued for a longer period of time because discontinuance from treatment would lead to a return to illicit opiate abuse or dependence, or increased psychiatric, behavioral or medical symptomology.

Notes

W. Va. Code R. § 69-11-31