2022 Edition

Mental Health and/or Substance Use Services (CA-MHSU) 8: Outpatient Withdrawal Management

Withdrawal management is provided based on the needs of the service recipient.

Interpretation

 For individuals with opioid use disorder, withdrawal management without transitioning to ongoing medication-assisted treatment is not recommended. Medication-assisted treatment in combination with individualized psychosocial supports and services is the standard of care for treatment of opioid use disorder. Detoxification from opioids is not required to initiate maintenance medication. See CA-MHSU 8.04 for more information on providing withdrawal management to this population.
NA The organization does not provide withdrawal management.

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VIEW THE STANDARDS

Purpose

Individuals and families who receive Mental Health and/or Substance Use Services improve social, emotional, psychological, cognitive, and family functioning to attain recovery and wellness.
Note: Withdrawal management can occur at varying levels of intensity.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Criteria for determining the level of care
  • Sample job descriptions from across relevant job categories
  • Educational materials or other documentation of information provided to persons served
  • MOU(s) with MAT providers, when applicable
  • Interviews may include:
    1. Clinical/Medicaldirector
    2. Relevant personnel
    3. Persons served
  • Review case records

 

CA-MHSU 8.01

Qualified personnel determine the appropriate level of withdrawal management for the person using diagnostic criteria outlined in clinical decision support tools and clinical practice guidelines.

 

CA-MHSU 8.02

Withdrawal management services include:  
  1. assessment and evaluation; 
  2. monitoring and stabilization; and  
  3. engagement with substance use treatment to assist with relapse prevention following the discontinuation of substance use. 

 
Fundamental Practice

CA-MHSU 8.03

Withdrawal management is provided by a qualified team of trained and licensed professionals appropriate to the intensity of services offered.
Examples: Organizations providing medically-monitored withdrawal management may employ an interdisciplinary staff of nurses, counsellors, social workers, addiction specialists and/or other health and technical personnel, whom all work under the supervision of a licensed physician.

 

CA-MHSU 8.04

Prior to discharge, all individuals receive:  
  1. education about relapse, overdose, and mortality risk and prevention; and 
  2. information on relevant harm reduction activities. 

 
Fundamental Practice

CA-MHSU 8.05

Organizations providing withdrawal management to individuals withdrawing from opioids: 
  1. counsel individuals on the importance of medication-assisted treatment (MAT) and the risks of relapse, overdose, and death following detoxification without transitioning to maintenance medication; 
  2. offer MAT following withdrawal management either directly or through linkages with MAT providers; 
  3. clearly document when clients refuse MAT; and 
  4. provide a naloxone kit or prescription for any individual who refuses MAT.

Interpretation

Organizations that do not offer medication-assisted treatment should have MOUs with MAT providers to ensure timely initiation of treatment. Studies have shown the risk of relapse increases dramatically following withdrawal without ongoing treatment, with 25% of readmissions occurring within the first 7 days post discharge.