415-020-0060 Medically Supervised Withdrawal (1) This section contains special provisions that apply to medically supervised withdrawal. Except as otherwise noted in this section, all requirements in the other sections of this rule apply to medically supervised withdrawal as well as comprehensive maintenance treatment patients. (2) Admission Criteria: The opioid treatment program must establish current physical dependence on narcotics or opiates by way of grade 2 withdrawal symptoms. A one year history of dependence is not required for medically supervised withdrawal. (3) Readmissions: Patients with two or more unsuccessful medically supervised withdrawal episodes within a 12 month period must be assessed by the Opioid Treatment Program physician for other forms of treatment. A program shall not admit a patient for more than two medically supervised withdrawal episodes in one year. (4) Medically Supervised Withdrawal Contract: Before initial dosing of the patient, the program shall develop a contract with the patient that shall be dated and signed by the counselor and the patient, and shall specify: (a) Maximum length of medically supervised withdrawal treatment, which may not exceed 180 days, and a rationale for the length chosen. Subsequent changes in length of medically supervised withdrawal must also be accompanied by a rationale. (b) Required abstinence from alcohol and other drugs during medically supervised withdrawal treatment; (c) Required counseling contacts; (d) Take-out dose limits; (e) Consequences regarding missed doses; (f) Urine drug screening procedures; (g) Consequences of failure to carry out the medically supervised withdrawal contract including involuntary termination; (h) Criteria for involuntary termination (5) Assessment: The program shall develop and implement a written procedure for assessing each patient's medically supervised withdrawal needs following initial dosing. The procedure shall specify that the assessment and evaluation is the responsibility of a member of the treatment staff, shall be recorded in the patient record, and shall include: (a) Alcohol and drug use and problems history; (b) Psychological history; (c) Presenting problems) and (d) History of previous treatment. (6) Planning: Individualized medically supervised withdrawal planning shall occur and be documented in the patient's record within seven working days to include: (a) Initial dose level and a planned reduction schedule that shall be completed within 180 days; (b) Referral to appropriate agencies for needs identified during the intake assessment and procedure; and (c) Monthly review by the medical director. (7) Treatment: Each patient shall be assigned a counselor who shall: (a) Meet at least weekly with the patient; (b) Monitor the patient's response to the withdrawal schedule; (c) Make and monitor referrals; (d) Maintain the patient's record; and (e) Monitor patient compliance with the medically supervised withdrawal contract. (8) Take-Out Doses: Take-home medication is not allowed for medically supervised withdrawal treatment planned for 30 days or less. For medically supervised withdrawal treatment planned for longer than 30 days the program shall use the time frames and criteria established for maintenance patients. (9) Discharge: An opioid treatment program shall discharge a patient who misses two consecutive doses unless an adequate explanation for the absences has been reviewed and approved by the medical director. (10) Urinalysis: The program shall collect and test one random urine drug screen for each patient per week. Documentation of a specific clinical intervention shall accompany documentation of any positive urine sample and shall be followed by documentation of the effectiveness of the intervention in subsequent progress notes. Statutory/Other Authority: ORS 430.256 Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590 History: ADS 5-2013, f. & cert. ef. 6-7-13 ADS 2-2008, f. & cert. ef. 11-13-08 ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03 ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96 HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0060 HR 4-1988, f. & cert. ef. 5-10-88