Md. Code Regs. 10.63.03.19

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.63.03.19 - Opioid Treatment Service

An opioid treatment service is one that:

A. Complies with the requirements of 42 CFR § 8 ;

B. Is under the direction of a medical director who is a physician and:

(1) Has at least 3 years of documented experience providing services to persons with sub stance-related disorders and opioid use disorders, including at least 1 year of experience in the treatment of opioid use disorder with opioid maintenance therapy and is board-certified in addiction medicine or addiction psychiatry; or

(2) Is certified in added qualifications in addiction psychiatry by the American Board of Psychiatry and Neurology, Inc.;

C. Uses pharmacological interventions, including full and partial opiate aganist treatment medications as part of treatment, support, and recovery services to an individual with an opioid addiction;

D. Provides clinical services to each patient at a frequency based on the patient's clinical stability level, not to exceed an overall program average of 50:1 patient-to-counselor ratio;

E. Arranges for any opioid maintenance medication dispensed to a patient to be transported to the following service sites:

(1) Residential programs at Levels 3.3, 3.5, and 3.7, as described in Regulations .12-.14 of this chapter;

(2) Withdrawal management services at ASAM levels 3.2-WM and 3.7-WM as described in Regulation .18 of this chapter; or

(3) Residential programs at levels 3.1, when the patient, because of a developmental or physical disability, or lack of access to transportation, cannot obtain or transport the patient's take-home opioid maintenance medication;

F. In accordance with 21 CFR § 1300, et seq., arranges transportation of opioid maintenance medication from the program sites identified in §E of this regulation or confirms the disposal of such medication when a patient leaves residential levels of care

G. Conducts random drug testing on each patient at least monthly, according to the provisions of COMAR 10.10.03.02;

H. Conducts random drug testing, at a minimum, for the following substances:

(1) Benzodiazepines;

(2) Marijuana;

(3) Cocaine;

(4) Opiates;

(5) Alcohol;

(6) Methadone or buprenorphine, whichever is appropriate; and

(7) Oxycodone;

I. Develops a taper schedule at least 21 days long with daily dosage reductions less than 5 percent of the original total dose, regardless of the patient's ability to pay;

J Nonvoluntarily tapers or transfers a patient only if the:

(1) Patient's behavior on program premises is abusive, violent, or illegal;

(2) Patient fails to pay fees and has been informed in writing and counseled as to responsibility and possible sanctions, including taper;

(3) Patient misses 3 consecutive medication days, and the program physician, after reevaluation, has determined that nonvoluntary taper is warranted; or

(4) Clinical staff documents therapeutic reasons for taper, which may include continued use of illicit drugs or an unwillingness to follow appropriate clinical interventions;

K. Requires that a patient show evidence of the availability of locked storage before a patient may take home any dose of medication; and

L. Provides clinical services addressing any substance-use disorders to each patient.

Md. Code Regs. 10.63.03.19

Regulation .19 adopted effective 43:10 Md. R. 585, eff.7/1/2016; amended effective 44:4 Md. R. 255, eff. 2/27/2017