W. Va. Code R. § 69-12-28

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

Section 69-12-28 - Laboratory Services; Drug Screens

28.1. All patients in the OBMAT program shall undergo monthly drug testing. Random drug testing of all patients shall be conducted during the course of treatment as required in this rule.

28.2. Collection and Testing.

28.2.1. OBMAT programs shall work carefully with toxicology testing kits or federally certified laboratories to ensure valid, appropriate results of toxicological screens.

28.2.2. Each OBMAT program shall have the capability of obtaining medication blood levels when clinically indicated or through random or monthly drug testing of all patients.

28.2.3. 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.

28.2.4. Drug screening policies and procedures shall be determined on an individualized basis for each patient, subject to the following requirements:

28.2.4.a. A patient receiving medication-assisted treatment medication maintenance services must have at least two random urine drug screens per month for the first 12 months of medication-assisted treatment. After 12 months of medication-assisted treatment, and if the patient is compliant with program rules and treatment requirements, a patient is required to have one random urine drug screen every 90 days. After 36 months of medication-assisted treatment, and if the patient is compliant with program rules and treatment requirements, random drug screens shall be at the discretion of the provider but at least once per year.

28.2.4.b. A record of urine drug screens shall be kept in the patient record.

28.2.4.c. When using urine as a screening mechanism, each OBMAT program shall develop and implement policies and procedures which may include observed testing to minimize the chance of patient adulterating or substituting another individual's urine.

28.2.4.d. OBMAT programs shall develop and implement policies and procedures to minimize misidentification of urine specimens and to ensure that the tested specimens can be traced to the donor patient.

28.2.5. Drug screenings shall include toxicological analysis for drugs of abuse, including but not limited to:

28.2.5.a. Buprenorphine, including in ratio to Norbuprenorphine, as clinically indicated;

28.2.5.b. Opiates including oxycodone at common levels of dosing;

28.2.5.c. Methadone, medication-assisted treatment medications or any other medication used by the program as an intervention for that patient;

28.2.5.d. Benzodiazepines;

28.2.5.e. Cocaine, including its metabolites, if clinically indicated;

28.2.5.f. Meth-amphetamine/amphetamines;

28.2.5.g. Tetrahydrocannabinol, delta-9-tetrahydrocannabinol, dronabinol, including its metabolites, if clinically indicated, or other similar substances; or

28.2.5.h. Other drugs or substances as determined by community standards, regional variation or clinical indication, such as carisoprodol or barbiturates.

28.2.6. 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.

28.2.7. When necessary and appropriate, breathalyzers or other testing equipment may be used to screen for possible alcohol abuse.

28.2.8. Each OBMAT program shall document both the results of toxicological tests and the follow-up therapeutic action taken in the patient record.

28.2.9. Each OBMAT program shall ensure that program physicians demonstrate competence in the 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 substances.

28.2.10. The program physician or physician extender shall thoroughly evaluate a positive toxicological screen for any potentially licit substance such as benzodiazepines, carisoprodol, barbiturates, and amphetamines. The program shall verify that the patient has been prescribed these medications by a licensed physician of physician extender for a legitimate medical purpose; and

28.2.11. If a patient can produce prescriptions or other evidence of a legitimate prescription, such as current medication bottles that are 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 an OBMAT program. The program physician shall make the ultimate decision as to the patient's continuing care in the program and the circumstances of that care.

28.2.12. Nothing contained in this rule shall preclude any OBMAT program from administering any additional drug tests it determines necessary.

28.3. Test Results.

28.3.1. Absence of medication-assisted treatment medication prescribed by the program for the patient is evidence of possible medication diversion. Whenever there is evidence of possible medication-assisted treatment medication diversion, the patient shall be re-evaluated by the program physician at the OBMAT program, and the individualized plan of care or treatment strategy shall be adjusted accordingly.

28.3.2. Special precautions shall be taken when a patient has both sedatives and buprenorphine in his or her urine. This requires immediate discussion with the patient about the dangers and shall be noted in the patient's record.

W. Va. Code R. § 69-12-28