W. Va. Code R. § 69-11-30

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 69-11-30 - Unsupervised Take-Home Medications

30.1. Each MAT program shall develop and implement policies and procedures regarding unsupervised take-home medication schedules that consider the best interests of each patient, as well as the interests of the public at large. The policies and procedures shall be developed and implemented in accordance with federal and state laws, rules and regulations and pursuant to guidelines and protocols from approved authorities. The policies and procedures should assist patients with treatment recovery and simultaneously prevent diversion, ensure sage storage and security of medication and prevent overdoses. Policies and procedures shall address the granting and rescinding of take-home medication privileges.

30.2. Approved guidelines and protocols include those adopted by the American Society of Addiction Medicine (ASAM), the Center for Substance Abuse Treatment (CSAT), the National Institute on Drug Abuse (NIDA), the American Association for the Treatment of Opioid Dependence (AATOD) and other authorities approved by the Secretary. A MAT program may submit a written request that the Secretary approve another such program and shall provide all applicable documentation that supports such approval. The Secretary has the sole discretion in determining whether to add another program to the list of approved authorities.

30.3. All MAT program facilities that provide unsupervised approved use of medications shall be open seven days per week, except for eight holidays and two training days per year, when the programs may be closed.

30.4. The interdisciplinary team shall make recommendations to the patient's program physician regarding take-home medications for each patient. The program physician shall make the final decision regarding approval of take-home medications in accordance with federal and state laws, rules and regulations and guidelines and protocols from approved authorities. The program physician shall document all approved changes in take-home privileges in the patient record and the individualized treatment plan of care.

30.5. In determining which patients may be permitted unsupervised use of medications, the program physician shall ensure the patient demonstrates a level of current lifestyle stability as evidenced by the following in determining whether a patient is responsible in handling medication-assisted treatment medications for unsupervised use:

30.5.a. Cessation of illicit drug use;

30.5.b. Absence of recent abuse of drugs, including opioid and non-narcotic drugs, and alcohol;

30.5.c. Regular program attendance, including dosing and participation in counseling and group sessions;

30.5.d. Absence of significant behavioral problems;

30.5.e. Absence of recent criminal activity, including, but not limited to, charges and convictions;

30.5.f. Stability of the patient's home environment and social relationships;

30.5.g. Demonstrated satisfactory adherence to MAT program rules, policies and procedures for at least three months;

30.5.h. Assurance that take-home medication can be safely stored within the patient's home, taking into account the patient's current living situation and other members of the household;

30.5.i. Whether the rehabilitative benefit the patient derives from decreasing the frequency of program attendance outweighs the potential risks of diversion;

30.5.j. The ability of the patient to responsibly self-medicate;

30.5.k. Other special needs of the patient, including, but not limited to, split dosing, physical health needs and pain treatment;

30.5.l. The patient's work, school or other daily-life activity schedule; and

30.5.m. Hardship experienced by the patient in traveling to and from the program.

30.6. The determination of whether to approve a patient for unsupervised take-home medications consistent with the criteria outlines in this section shall be documented in the patient's medical record.

30.7. The program physician and counselor shall educate the patient on the safe transportation and storage of take-home medications.

30.8. Each MAT program shall maintain current procedures adequate to identify the theft or diversion of take-home medications, including labeling containers with the MAT program's name, address and telephone number. Programs must also ensure that take-home supplies are packaged in a manner that is designed to reduce the risk of accidental ingestion, including child-proof containers.

30.9. The number of doses of take-home medication shall be determined by the program physician in accordance with guidelines and protocols of approved authorities and after consultation with the interdisciplinary team and shall not exceed the recommended doses. The take-home medication treatment plan shall be for 90-day periods. The patient's individualized treatment plan of care may include permission for the patient to take-home doses of medication subject to the following restrictions:

30.9.a. During the first 90-day period of treatment, no take-home doses shall be permitted during the first 30 days of treatment. Thereafter, the take-home supply is limited to a single dose each week, except for holidays or days when the facility is closed. The patient shall ingest all other doses under appropriate supervision.

30.9.b. In the second 90-day period of treatment, the take-home supply is limited to two doses per week;

30.9.c. In the third 90-day period of treatment, the take-home supply is limited to three doses per week;

30.9.d. In the remaining months of the first year of treatment, a patient may be given a maximum six-day supply of take-home medication.

30.9.e. After one year of continuous treatment, a patient may be given a maximum two-week supply of take-home medication.

30.9.f. After two years of continuous treatment, a patient may be given a maximum one-month supply of take-home medication, contingent upon the patient making monthly visits to the MAT program.

30.10. No medications shall be administered to patients in short-term detoxification treatment for unsupervised or take-home use.

30.11. Any patient in comprehensive maintenance treatment may receive a single take-home dose for a day that the MAT program facility is closed for business, including Sundays and holidays.

30.12. Patients participating in the unsupervised take-home medication plan are subject to the provisions of section 34 of this rule regarding positive drug test results. The failure to pass a drug test may result in a change to the individualized treatment plan of care, including a loss of unsupervised take-home medication privileges or discharge from the program.

30.13. The program physician may approve temporary unsupervised take-home medication for documented family or medical emergencies or other exceptional circumstances, pursuant to authorized guidelines and protocols approved by the state opioid treatment authority. Patterns of emergency take-home provisions shall be tracked and monitored by the MAT program, included in the patient records and be made available for review by regulatory bodies and the designated state oversight authority.

30.14. Guest dosing at a nearby program is preferred whenever possible and shall be documented in the patient's chart and individualized treatment plan of care.

30.15. Each MAT program shall develop and implement policies and procedures that address the transfer of patients from one MAT program to another.

30.16. The state opioid treatment authority may approve exceptions to the requirements of this section, including alternative medications, on a case-by-case basis upon application for an exemption by the program physician, relating to the length of time of satisfactory adherence to program rules, policies and procedures and the number of days of take-home medication when a patient has provided documentation, which shall be included in the patient's record, of the following:

30.16.a. The patient has a permanent physical disability;

30.16.b. The patient has a temporary disability; or

30.16.c. The patient has an exceptional circumstance such as illness, personal or family crisis, or travel which interferes with the patient's ability to conform to the applicable mandatory attendance schedules.

30.17. An exemption granted under subdivision 30.16.a. of this rule shall be reviewed at least annually to determine whether the need for the exception still exists.

30.18. An exemption granted under subdivision 30.16.b. of this rule shall continue only for so long as the temporary disability or exceptional circumstance exists.

30.19. With an exemption granted under subdivision 30.16.c. of this rule, the program may not permit a patient to receive more than a two-week take-home supply of medication.

W. Va. Code R. § 69-11-30