Ensure that patients receive adequate doses of narcotic medication based on their individual needs.
Ensure that the attitude of staff is accepting of narcotic addiction treatment.
Ensure that patients understand that they are responsible for complying with all aspects of their treatment, including participating in counseling sessions.
Since treatment duration and retention are directly correlated to rehabilitation success, a service shall make a concerted effort to retain patients within the first year following admission. Evidence of this concerted effort shall include written documentation of all of the following:
Continued treatment is medically necessary in the professional judgement of the service physician.
A service shall refer an individual discharged from the service to a more suitable treatment modality when further treatment is required or is requested by that person and cannot be provided by the service.
For services needed by a patient but not provided by the service, the service shall refer the individual to an appropriate service provider.
(15) Multiple substance use and dual diagnosis treatment. DHS 75.15(15)(a)(a)
A service shall assess an applicant for admission during the admission process and a patient, as appropriate, to distinguish substance use, abuse and dependence, and determine patterns of other substance use and self-reported etiologies, including non-prescription, non-therapeutic and prescribed therapeutic use and mental health problems.
A service shall provide a variety of services that support cessation by a patient of alcohol and prescription and non-prescription substance abuse as the desired goal.
Service objectives shall indicate that abstinence by a patient from alcohol and prescription and non-prescription substance abuse should extend for increasing periods, progress toward long-term abstinence and be associated with improved life functioning and well-being.
Service staff shall instruct multiple substance use patients about their vulnerabilities to cross-tolerance, drug-to-drug interaction and potentiation and the risk of dependency substitution associated with self-medication.
A service shall have the ability to provide concurrent treatment for a patient diagnosed with both a mental health disorder and a substance use disorder. The service shall arrange for coordination of treatment options and for provision of a continuum of care across the boundaries of physical sites, services and outside treatment referral sources.
When a dual diagnosis exists, a service shall develop with the patient a treatment plan that integrates measures for treating all alcohol, drug and mental health problems. For the treatment of a dually-diagnosed patient, the service shall arrange for a mental health professional to help develop the treatment plan and provide ongoing treatment services. The mental health professional shall be available either as an employee of the service or through a written agreement.
A service that provides narcotic addiction treatment to pregnant women shall provide that treatment within a comprehensive treatment service that addresses medical, prenatal, obstetrical, psychosocial and addiction issues.
A diagnosis of opioid addiction and need of the patient to avoid use of narcotic antagonists shall be based on the same factors, such as medical and substance abuse history, psychosocial history, physical examination, test toxicology and signs and symptoms of withdrawal, that are used in diagnosing opiate addiction in non-pregnant opioid-dependent women. In this paragraph, "narcotic antagonist" means a drug primarily used to counter narcotic-induced respiratory depression.
A pregnant woman seeking narcotic addiction treatment shall be referred to a perinatal specialist or obstetrician as soon as possible after initiating narcotic addiction treatment with follow up contact, to coordinate care of the woman's prenatal health status, evaluate fetal growth and document physiologic dependence.
When withdrawal from narcotic medication is the selected treatment option, withdrawal shall be conducted under the supervision of a service physician experienced in perinatal addiction, ideally in a perinatal unit equipped with fetal monitoring equipment.
Withdrawal shall not be initiated before the 14th week of pregnancy or after the 32nd week of pregnancy.
Pregnant women shall be monitored and their dosages individualized, as needed.
A service shall not change the methadone dose that a pregnant woman was receiving before her pregnancy unless necessary to avoid withdrawal.
A service shall increase the methadone dose for a patient, if needed, during the later stages of the patient's pregnancy to maintain the same plasma level and avoid withdrawal.
A service shall arrange for appropriate assistance for pregnant patients, including education and parent support groups, to improve mother-infant interaction after birth and to lessen the behavioral consequences of poor mother-infant bonding.
A narcotic treatment service for opiate addiction shall screen patients immediately following admission and annually thereafter for tuberculosis (TB). Tuberculosis treatment may be provided by referral to an appropriate public health agency or community medical service.
A service shall screen prospective new staff for TB, and shall annually test all service staff for TB.
A service shall screen all patients at admission and annually thereafter for viral hepatitis and sexually transmitted diseases (STDs) and shall ensure that any necessary medical follow-up occurs, either on-site or through referral to community medical services.
A service shall ensure that all service staff have been immunized against hepatitis B. Documentation of refusal to be immunized shall be entered in the staff member's case record.
A service shall provide a setting that is conducive to rehabilitation of the patients and that meets all of the following requirements:
Waiting areas, dosing stations and all other areas for patients shall be provided with adequate ventilation and lighting.
Dosing stations and adjacent areas shall be kept sanitary and ensure privacy and confidentiality.
Patient counseling rooms, physical examination rooms and other rooms or areas in the facility that are used to meet with patients shall have adequate sound proofing so that normal conversations will be confidential.
Adequate security shall be provided inside and outside the facility for the safety of the patients and to prevent loitering and illegal activities.
Separate toilet facilities shall be provided for patient and staff use.
The facility and areas within the facility shall be accessible to persons with physical disabilities.
The physical environment within the facility shall be conducive to promoting improved functioning and a drug free lifestyle.
Each staff member of the narcotic treatment service for opiate addiction is responsible for being alert to potential diversion of narcotic medication by patients and staff.
Service staff shall take all of the following measures to minimize diversion:
Doses of narcotic medication shall be dispensed only in liquid form.
Bottles of narcotic medication shall be labeled with the patient's name, the dose, the source service, the prescribing physician and the date by which the dose is to be consumed.
The service shall require a patient to return all empty take-home bottles on the patient's next day of service attendance following take-home dosing. Service staff shall examine the bottles to ensure that the bottles are received from the appropriate patient and in an intact state.
The service shall discontinue take-home medications for patients who fail to return empty take-home bottles in the prescribed manner.
If a service receives reliable information that a patient is diverting narcotic medication, the patient's primary counselor shall immediately discuss the problem with the patient.
Based on information provided by the patient or continuing reports of diversion, a service may revoke take-home privileges of the patient.
The state methadone authority may, based on reports of diversion, revoke take-home privileges, exceptions or exemptions granted to or by the service for all patients.
The state methadone authority may revoke the authority of a narcotic treatment service for opiate addiction to grant take-home privileges when the service cannot demonstrate that all requirements have been met in granting take-home privileges.
A narcotic treatment service for opiate addiction shall have a written policy to discourage the congregation of patients at a location inside or outside the service facility for non-programmatic reasons, and shall post that policy in the facility.
Approval of primary service.
An applicant for approval to operate a narcotic treatment service for opiate addiction in Wisconsin with the intent of administering or dispensing a narcotic drug to narcotic addicts for maintenance or detoxification treatment shall submit all of the following to the state methadone authority:
A copy of the request for registration with the U.S. drug enforcement administration for the use of narcotic medications in the treatment of opiate addiction.
A narrative description of the treatment services that will be provided in addition to chemotherapy.
A copy of the policy and procedures manual for the service, detailing the operation of the service as follows:
A description of the service's use of testing or analysis to detect substances and the purposes for which the results of testing or analysis are used as well as the frequency of use.
Documentation that there are adequate physical facilities to provide all necessary services.
Documentation that the service will have ready access to a comprehensive range of medical and rehabilitative services that will be available if needed.
The name, address, and a description of each hospital, institution, clinical laboratory or other facility available to provide the necessary services.
A list of persons working in the service who are licensed to administer or dispense narcotic drugs even if they are not responsible for administering or dispensing narcotic drugs.
Approval of service sites.
Only service sites approved by the FDA, the U.S. drug enforcement administration and the state methadone authority may be used for treating narcotic addicts with a narcotic drug.
To operate a medication unit, a service shall apply to the department for approval to operate the medication unit. A separate approval is required for each medication unit to be operated by the service. A medication unit is established to facilitate the needs of patients who are stabilized on an optimal dosage level. The department shall approve a medication unit before it may begin operation.
Approval of a medication unit shall take into consideration the distribution of patients and other medication units in a geographic area.
If a service has its approval revoked, the approval of each medication unit operated by the service is automatically revoked. Revocation of the approval of a medication unit does not automatically affect the approval of the primary service.
DHS 75.15 Note
Note: To apply for approval to operate a medication unit, contact the State Methadone Authority in the Bureau of Prevention, Treatment and Recovery at P.O. Box 7851, Madison, WI 53707-7851. Approvals of the Center for Substance Abuse Treatment and the U.S. Drug Enforcement Administration to operate a medication unit are also required. The State Methadone Authority will facilitate the application consideration by the Center for Substance Abuse Treatment and the U.S. Drug Enforcement Administration.
A person who sponsors a narcotic treatment service for opiate addiction and any personnel responsible for a particular service shall agree in writing to adhere to all applicable requirements of this chapter and 21 CFR Part 291
and 42 CFR Part 2
The service sponsor is responsible for all service staff and for all other service providers who work in the service at the primary facility or at other facilities or medication units.
The service sponsor shall agree in writing to inform all service staff and all contracted service providers of the provisions of all pertinent state rules and federal regulations and shall monitor their activities to ensure that they comply with those rules and regulations.
The service shall notify the designated federal agency and state methadone authority within 3 weeks after replacement of the service sponsor or medical director.
(22) Death reporting.
A narcotic treatment service for opiate addiction shall report the death of any of its patients to the state methadone authority within one week after learning of the patient's death.
DHS 75.15 History
Cr. Register, July, 2000, No. 535
, eff. 8-1-00; correction in (8) (b) 2. made under s. 13.92 (4) (b) 7.
, Stats., Register November 2008 No. 635
; CR 09-109
: am. (4) (d) and (e), cr. (4) (dm) Register May 2010 No. 653
, eff. 6-1-10; correction in (4) (dm), (e) made under s. 13.92 (4) (b) 7.
, Stats. Register November 2011 No. 671
Intervention services may include outreach; problem identification; referral; information; specialized education; case management; consultation; training; support or drop-in services; intensive supervision; alternative education; and intoxicated driver assessments under ch. DHS 62