West Virginia Code of State Rules › Agency 69 - Health And Human Resources › Title 69 - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 69-12 - Medication-Assisted Treatment - Office-Based Medication-Assisted Treatment › Section 69-12-28 - Laboratory Services; Drug Screens

Current through Register Vol. XLI, No. 28, July 12, 2024
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.