Current through Register Vol. XLI, No. 50, December 13, 2024
Section 69-7-41 - Toxicology Screens41.1. All patients in the opioid treatment program shall undergo monthly drug testing. Random drug testing of all patients shall be conducted during the course of treatment at least monthly.41.2. Collection and Testing. 41.2.a. Opioid treatment programs shall work carefully with toxicology laboratories to ensure valid, appropriate results of toxicological screens. Workplace testing standards are not appropriate for urine testing. Testing shall be done only by laboratories with appropriate federal certification.41.2.b. Each opioid treatment program shall have the capability of obtaining medication blood levels when clinically indicated or through random or monthly drug testing of all patients.41.2.c. Urine drug screening and other adequately tested toxicological procedures shall be used as an aid in monitoring and evaluating a patient's progress in treatment.41.2.d. Drug screening procedures shall be determined on an individualized basis for each patient, subject to the following requirements: 41.2.d.1. A patient receiving methadone maintenance services must have at least twelve random drug screens per year. The patient shall be tested upon admission; at approximately fourteen days of treatment; and then monthly through the remainder of the time the patient remains in the treatment program.41.2.d.2. A patient undergoing medically-supervised or other types of withdrawal may be required to have more frequent collection and analysis of samples.41.2.d.3. When using urine as a screening mechanism, all patient drug testing shall be observed to minimize the chance of adulterating or substituting another individual's urine.41.2.e. Drug screenings shall include toxicological analysis for drugs of abuse, including, but not limited to: 41.2.e.1. Opiates including oxycodone at common levels of dosing;41.2.e.2. Methadone or any other medication used by the program as an intervention for that patient;41.2.e.3. Benzodiazepines (including testing procedures that detect diazepam, clonazepam, alprazolam and lorazepam);41.2.e.5. Meth-amphetamine/ amphetamines;41.2.e.6. Tetrahydrocannabinol, delta-9-tetrahydrocannabinol, dronabinol or other similar substances; or41.2.e.7 Other drugs or substances as determined by community standards, regional variation or clinical indication, such as carisoprodol or barbiturates.41.2.f. Collection and testing shall be done in a manner that assures a method of confirmation for positive results and documents the chain of custody of the collection.41.2.g. When necessary and appropriate, breathalyzers or other testing equipment may be used to screen for possible alcohol abuse. No individual shall receive a daily dose who has a breathalyzer result which is equal to or greater than .02. The individual may return to the clinic for dosing during the same day if the breathalyzer results reach acceptable limits.41.2.h. Each opioid treatment program shall document both the results of toxicological tests and the follow-up therapeutic action taken in the patient record.41.2.i. Each opioid treatment program shall ensure that physicians demonstrate competence in interpretation of "false negative" and "false positive" laboratory results as they relate to physiological issues, differences among laboratories, and factors that impact the absorption, metabolism and elimination of opiates.41.2.j. The program physician shall thoroughly evaluate a positive toxicological screen for any potentially licit substance such as benzodiazepines, carisoprodol, barbiturates and amphetamines. The program shall verify with appropriate releases of information that: 41.2.j.1. The patient has been prescribed these medications by a licensed physician for a legitimate medical purpose; and41.2.j.2. The prescribing physician is aware that the patient is enrolled in an opioid treatment program.41.2.k. If a patient refuses the release of information to contact his or her physician but can produce prescriptions and/or other evidence of legitimate prescription (such as current medication bottles, fully labeled), the interdisciplinary team shall consider the patient's individual situation and the possibility that he or she may be dismissed from the care of his or her physician if the physician discovers that the patient is in medication-assisted treatment. The program physician shall make the ultimate decision as to the patient's continuing care in the clinic and the circumstances of that care.41.2.l. Nothing contained in this rule shall preclude any opioid treatment program from administering any additional drug tests it determines are necessary.41.3. Test Results 41.3.a. A positive test is a test that results in the presence of any drug or substance listed in Subdivision 41.2.e of this rule, or any other drug or substance prohibited by the opioid treatment program. The presence of medication which is part of the patient's individualized treatment plan of care shall not be considered a positive test. Any refusal to participate in a random drug test shall be considered a positive drug test.41.3.b. A positive drug test result after the first six months in an opioid treatment program shall result in the following: 41.3.b.1. Upon the first positive drug test result, the opioid treatment program shall:41.3.b.2. Provide mandatory and documented weekly counseling to the patient of no less than thirty minutes, which shall include weekly meetings with a counselor who is licensed, certified or enrolled in the process of obtaining licensure or certification in compliance with the rules on staff at the opioid treatment program; and41.3.b.3. Immediately revoke the take-home methadone privilege for a minimum of thirty days;41.3.b.4. Upon a second positive drug test result within six months of a previous positive drug test result, the opioid treatment program shall:41.3.b.5. Provide mandatory and documented weekly counseling to the patient of no less than thirty minutes, which shall include weekly meetings with a counselor who is licensed, certified or enrolled in the process of obtaining licensure or certification in compliance with the rules on staff at the opioid treatment program;41.3.b.6. Immediately revoke the take-home methadone privilege for a minimum of sixty days; and41.3.b.7. Provide mandatory documented treatment interdisciplinary team meetings with the patient.41.3.c. Upon a third positive drug test result within a period of six months the opioid treatment program shall: 41.3.c.1. Provide mandatory and documented weekly counseling to the patient of no less than thirty minutes, which shall include weekly meetings with a counselor who is licensed, certified, or enrolled in the process of obtaining licensure or certification in compliance with the rules on staff at the opioid treatment program;41.3.c.2. Immediately revoke the take-home methadone privilege for a minimum of one hundred twenty days; and41.3.c.3. Provide mandatory and documented treatment interdisciplinary team meetings with the patient which will include, at a minimum: the need for continuing treatment; a discussion of other treatment alternatives; and the execution of a contract with the patient advising the patient of discharge for continued positive drug tests; and41.3.d. Upon a fourth positive drug test within a six month period, the patient shall be immediately discharged from the opioid treatment program, or, at the option of the patient, shall immediately be provided the opportunity to participate in a 21-day detoxification plan, followed by immediate discharge from the opioid treatment program. Testing positive solely for tetrahydrocannabionol, delta-9-tetrahydrocannabiol, dronabinol or similar substances shall not serve as a basis for discharge from the program.41.3.e. Positive screens for tetrahydrocannabionol, delta-9-tetrahydrocannabiol, dronabinol or similar substances shall be carefully clinically evaluated and shall in most cases result in reduction in take-home methadone privileges unless other action is considered appropriate by the medical director or program physician and primary counselor. Testing positive solely for tetrahydrocannabionol, delta-9-tetrahydrocannabiol, dronabinol or similar substances shall not serve as a basis for discharge from the program.41.3.f. Absence of methadone prescribed by the program for the patient is evidence of possible medication diversion. Whenever there is evidence of possible medication diversion, the patient shall be re-evaluated by the physician and interdisciplinary team and the individualized treatment plan of care shall be adjusted, if needed, accordingly.