Rule 24-2-53.6 - Withdrawal ManagementA. Medically supervised withdrawal management from a synthetic narcotic with a continuum of care must be a part of the treatment protocol for the OTP. The program must develop, implement, maintain, and document implementation of written policies and procedures that include, at a minimum:1. A process for voluntary medically supervised withdrawal that shall: (a) Acknowledge that participation in the OTP is voluntary and that the person is free to leave treatment at any time;(b) Identify the steps to be taken by the program when a person and program employee agree on a need to initiate the withdrawal procedures;(c) Identify the steps to be taken by the program when a person requests withdrawal against the medical advice of the program employee; and(d) Ensure availability of a variety of supportive options to improve the chances of a successful episode of medically supervised withdrawal.2. A process for involuntary medically supervised withdrawal that shall:(a) Identify the circumstances under which involuntary administrative withdrawal procedures will be implemented;(b) Identify the steps to be taken to delineate the responsibilities of program employees in implementation of involuntary administrative withdrawal procedures;(c) Ensure availability of a variety of supportive options to improve the chances of a successful episode of medically supervised withdrawal; and(d) Provide for the referral or transfer of the person to an appropriate treatment program upon completion of the withdrawal process.3. The program Medical Director shall approve all requests for voluntary and involuntary withdrawal from an OTP.4. The Medical Director shall establish a person's withdrawal dosage schedule in accordance with sound medical treatment and ethical considerations and based on an objective assessment of each person's unique needs.5. Each person's withdrawal schedule shall be for a time period of not less than 30 days, unless otherwise clinically contraindicated with supporting documentation from the Medical Director.6. Take-home medication shall NOT be allowed during medically supervised withdrawal.7. A history of one (1) year of physiological dependence shall not be required for admission to an Opioid Treatment Program for supervised withdrawal.8. People who have two (2) or more unsuccessful detoxification episodes within a 12-month period shall be assessed by the program Medical Director for other forms of treatment.9. A service shall not admit a person for more than two (2) detoxification episodes in one (1) year.10. Drug screens during detoxification shall be performed as follows:(a) An initial drug screen shall be performed at the beginning of the detoxification process.(b) At least one (1) random drug screen shall be performed monthly during the detoxification process.11. Decreasing the dose of the synthetic narcotic to accomplish gradual, but complete withdrawal, within the tolerance level of the person.12. Therapy of the type and quantity designed to motivate the continuation of the withdrawal process.13. Assurance that voluntary withdrawal would be discontinued, and maintenance resumed in the event of impending relapse.14. Provisions for the continuance of care after the completion of withdrawal.B. Documentation must be maintained regarding the person's condition during the total withdrawal process to include: 1. Signs and symptoms of medical and emotional distress;2. Actions taken to avoid discharge; and3. Progress of the person served.