West Virginia Code of State Rules › Agency 69 - Health And Human Resources › Title 69 - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 69-11 - Medication-Assisted Treatment - Opioid Treatment Programs › Section 69-11-34 - Laboratory Services; Drug Screens

Current through Register Vol. XLI, No. 28, July 12, 2024
34.1. All patients in the MAT program shall
				undergo monthly drug testing. Random drug testing of all patients shall be
				conducted during the course of treatment as required in paragraph
				34.2.d.1.
34.2. Collection and
				Testing.
34.2.a. MAT programs shall work
				carefully with toxicology laboratories to ensure valid, appropriate results of
				drug screens. Workplace testing standards are not appropriate for urine
				testing. Testing shall be done only by laboratories with appropriate federal
				certification.
34.2.b. Each MAT
				program shall have the capability of obtaining medication blood levels when
				clinically indicated or through random or monthly drug testing of all
				patients.
34.2.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.
34.2.d. Drug screening
				policies and procedures shall be determined on an individualized basis for each
				patient, subject to the following requirements:
34.2.d.1. A patient receiving
				medication-assisted treatment medication maintenance services must have at
				least 12 random drug screens per year. The patient shall be tested upon
				admission; at approximately 14 days of treatment; and then monthly through the
				remainder of the time the patient remains in the MAT program.
34.2.d.2. A patient undergoing
				medically-supervised or other types of withdrawal may be required to have more
				frequent collection and analysis of samples.
34.2.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.
34.2.d.4. MAT 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.
34.2.e. Drug
				screenings shall include toxicological analysis for drugs of abuse, including,
				but not limited to:
34.2.e.1. Buprenorphine,
				especially in ratio to Norbuprenorphine;
34.2.e.2. Opiates including oxycodone at
				common levels of dosing;
34.2.e.3.
				Methadone, medication-assisted treatment medications or any other medication
				used by the program as an intervention for that patient;
34.2.e.4. Benzodiazepines, including testing
				procedures that detect diazepam, clonazepam, alprazolam and
				lorazepam;
34.2.e.5.
				Cocaine;
34.2.e.6.
				Meth-amphetamine/amphetamines;
34.2.e.7. Tetrahydrocannabinol,
				delta-9-tetrahydrocannabinol, dronabinol or other similar substances;
				or
34.2.e.8. Other drugs or
				substances as determined by community standards, regional variation or clinical
				indication, such as carisoprodol or barbiturates.
34.2.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.
34.2.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 0.02. The individual may return to the
				program for dosing during the same day if the breathalyzer results reach
				acceptable limits.
34.2.h. Each MAT
				program shall document both the results of drug tests and the follow-up
				therapeutic action taken in the patient record.
34.2.i. Each MAT program shall ensure that
				program physician demonstrate competence in the interpretation of "false
				negative" and "false positive" laboratory results as they related to
				physiological issues, differences among laboratories and factors that impact
				the absorption, metabolism and elimination of opiates.
34.2.j. The program physician shall
				thoroughly evaluate a positive drug screen for any potentially licit substance
				such as benzodiazepines, carisoprodol, barbiturates and amphetamines. The
				program shall verify with appropriate releases of information that:
34.2.j.1. The patient has been prescribed
				these medications by a licensed physician for a legitimate medical purpose;
				and
34.2.j.2. The prescribing
				physician is aware that the patient is enrolled in a MAT program.
34.2.k. If a patient refuses the
				release of information to contact his or her physician but 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 a MAT 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.
34.2.l. Nothing contained in this rule shall
				preclude any MAT program from administering any additional drug test it
				determines are necessary.