2023 Edition

Opioid Treatment Definition

Purpose

Individuals who participate in Opioid Treatment Programs improve social, emotional, and vocational functioning, achieve optimal productivity, and attain the recovery they seek.

Definition

Opioid Treatment Programs (OTPs) provide opioid treatment and comprehensive medical, psychosocial, and addiction treatment for narcotic-dependent individuals in a therapeutic environment.

Note:Please see OTP Reference List for the research that informed the development of these standards.


Note:For information about changes made in the 2020 Edition, please see the OTP Crosswalk.


2023 Edition

Opioid Treatment (OTP) 1: Person-Centered Logic Model

The organization implements a program logic model that describes how resources and program activities will support the achievement of positive outcomes.
NotePlease see the Logic Model Template for additional guidance on this standard.  
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.

Logic models have been implemented for all programs and the organization has identified at least two outcomes for all its programs.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • Logic models need improvement or clarification; or
  • Logic models are still under development for some of its programs, but are completed for all high-risk programs such as protective services, foster care, residential treatment, etc.; or
  • At least one client outcome has been identified for all of its programs; or
  • All but a few staff have been trained on use of therapeutic interventions and training is scheduled for the rest; or
  • With few exceptions the policy on prohibited interventions is understood by staff, or the written policy needs minor clarification.
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
  • Logic models need significant improvement; or
  • Logic models are still under development for a majority of programs; or
  • A logic model has not been developed for one or more high-risk programs; or
  • Outcomes have not been identified for one or more programs; or
  • Several staff have not been trained on the use of therapeutic interventions; or
  • There are gaps in monitoring of therapeutic interventions, as required; or
  • There is no process for identifying risks associated with use of therapeutic interventions; or
  • Policy on prohibited interventions does not include at least one of the required elements.
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.,
  • Logic models have not been developed or implemented; or
  • Outcomes have not been identified for any programs; or
  • There is no written policy or procedures for the use of therapeutic interventions; or 
  • Procedures are clearly inadequate or not being used; or
  • Documentation on therapeutic interventions is routinely incomplete and/or missing; or
  • There is evidence that clients have been harmed by inappropriate or unmonitored use of therapeutic interventions.
Self-Study Evidence On-Site Evidence On-Site Activities
  • See program description completed during intake
  • Program logic model that includes a list of client outcomes being measured
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel

 

OTP 1.01

A program logic model, or equivalent framework, identifies:
  1. needs the program will address;
  2. available human, financial, organizational, and community resources (i.e. inputs);
  3. program activities intended to bring about desired results;
  4. program outputs (i.e. the size and scope of services delivered); 
  5. desired outcomes (i.e. the changes you expect to see in persons served); and
  6. expected long-term impact on the organization, community, and/or system.
Examples: Please see the W.K. Kellogg Foundation Logic Model Development Guide and COA’s PQI Tool Kit for more information on developing and using program logic models.  

Examples: Information that may be used to inform the development of the program logic model includes, but is not limited to: 
  1. needs assessments and periodic reassessments; and
  2. the best available evidence of service effectiveness.

 

OTP 1.02

The logic model identifies client outcomes in at least two of the following areas:
  1. change in clinical status;
  2. change in functional status;
  3. health, welfare, and safety;
  4. permanency of life situation; 
  5. quality of life; 
  6. achievement of individual service goals; and 
  7. other outcomes as appropriate to the program or service population.

Interpretation: Outcomes data should be disaggregated to identify patterns of disparity or inequity that can be masked by aggregate data reporting. See PQI 5.02 for more information on disaggregating data to track and monitor identified outcomes. 

2023 Edition

Opioid Treatment (OTP) 2: Personnel

Program personnel have the competency and support needed to provide services and meet the needs of persons served.
Interpretation: Competency can be demonstrated through education, training, or experience. Support can be provided through supervision or other learning activities to improve understanding or skill development in specific areas.
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.,  
  • With some exceptions, staff (direct service providers, supervisors, and program managers) possess the required qualifications, including education, experience, training, skills, temperament, etc., but the integrity of the service is not compromised; or
  • Supervisors provide additional support and oversight, as needed, to the few staff without the listed qualifications; or 
  • Most staff who do not meet educational requirements are seeking to obtain them; or 
  • With few exceptions, staff have received required training, including applicable specialized training; or
  • Training curricula are not fully developed or lack depth; or
  • Training documentation is consistently maintained and kept up-to-date with some exceptions; or
  • A substantial number of supervisors meet the requirements of the standard, and the organization provides training and/or consultation to improve competencies when needed; or
  • With few exceptions, caseload sizes are consistently maintained as required by the standards or as required by internal policy when caseload has not been set by a standard; or
  • Workloads are such that staff can effectively accomplish their assigned tasks and provide quality services and are adjusted as necessary; or
  • Specialized services are obtained as required by the standards.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards.  Service quality or program functioning may be compromised; e.g.,
  • A significant number of staff (direct service providers, supervisors, and program managers) do not possess the required qualifications, including education, experience, training, skills, temperament, etc.; and as a result, the integrity of the service may be compromised; or
  • Job descriptions typically do not reflect the requirements of the standards, and/or hiring practices do not document efforts to hire staff with required qualifications when vacancies occur; or 
  • Supervisors do not typically provide additional support and oversight to staff without the listed qualifications; or
  • A significant number of staff have not received required training, including applicable specialized training; or
  • Training documentation is poorly maintained; or
  • A significant number of supervisors do not meet the requirements of the standard, and the organization makes little effort to provide training and/or consultation to improve competencies; or
  • There are numerous instances where caseload sizes exceed the standards' requirements or the requirements of internal policy when a caseload size is not set by the standard; or
  • Workloads are excessive, and the integrity of the service may be compromised; or 
  • Specialized staff are typically not retained as required and/or many do not possess the required qualifications; or
  • Specialized services are infrequently obtained as required by the standards.
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.
Self-Study Evidence On-Site Evidence On-Site Activities
  • List of program personnel that includes:
    • Title
    • Name
    • Employee, volunteer, or independent contractor
    • Degree or other qualifications
    • Time in current position
  • See organizational chart submitted during application
  • Policy addressing employee health and vaccinations
  • Table of contents of training curricula
  • Procedures or other documentation relevant to continuity of care and case assignment
  • Sample job descriptions from across relevant job categories
  • Training curricula
  • Documentation tracking staff completion of required trainings and/or competencies
  • Caseload size requirements set by policy, regulation, or contract, when applicable
  • Documentation of current caseload size per worker
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files
  • Verify the employment of, or agreements with, qualified clinicians

 

OTP 2.01

Direct service personnel are qualified by one of the following:
  1. an advanced degree in social work, medicine, psychology, pastoral counseling, marriage and family counseling, mental health or substance use counseling, or psychiatric nursing, and in-service or other training in the treatment of substance use conditions;
  2. a bachelor’s degree in social work or a related human service field with specialized training and experience in the area of substance use treatment;
  3. certification by the designated authority when the state has a mechanism for certifying addiction counselors;
  4. personal experience with drug use recovery and specialized training and demonstrated skills in the area of substance use treatment; or
  5. specific and relevant training in the treatment of substance use and a minimum of two years’ work experience in a substance use treatment service.

 

OTP 2.02

Personnel who administer and dispense opioid treatment medication are:
  1. practitioners licensed and registered under the appropriate federal and state laws; or
  2. supervised by a licensed practitioner.
Interpretation: In some states, practitioners other than licensed physicians are permitted to administer and dispense opioid treatment medications. An “agent” must be a pharmacist, registered nurse, licensed practical nurse, physician assistant, or a healthcare professional authorized by federal and/or state law to administer and dispense opioid treatment medication.

 

OTP 2.03

Supervisors are qualified by:
  1. an advanced degree in a human service field and a minimum of two years’ post-graduate professional experience; 
  2. specialized training and experience in substance use diagnosis and treatment and additional training in supervision; and/or
  3. certification by the designated authority in their state as an approved addiction counseling supervisor.

 

OTP 2.04

A licensed physician with at least one year of experience in addiction medicine or addiction psychiatry, acts as the  medical director responsible for supervising and administering medical services.

 

OTP 2.05

The clinical team, including social work, medical, psychological, and psychiatric professionals with specialized training in the treatment of substance use:
  1. are on staff or available through formal agreement to provide services and support needed to meet the needs of individuals; and 
  2. make level of care, treatment, and termination-of-service decisions with service recipients.

 

OTP 2.06

The medical director and program administrator or sponsor stay current with all applicable federal, state, and local laws and regulations applicable to opioid treatment programs, including those that address technology-based service delivery.

 
Fundamental Practice

OTP 2.07

All personnel and consulting providers are annually screened for tuberculosis and receive a hepatitis B vaccination if they are considered to be at risk for exposure to hepatitis.

 

OTP 2.08

Personnel are trained on, or demonstrate competency in:
  1. the concept of addiction as a disease;
  2. the goals of opioid treatment in regard to other drug use;
  3. the latest information, theories, and techniques in identification, diagnosis, and treatment of alcohol and other drug problems, including the harm reduction model;
  4. relapse prevention;
  5. recognition of co-occurring health and mental health conditions and integrated services available to meet them;
  6. management of drug overdose;
  7. special treatment needs of women;
  8. criminal justice issues, as appropriate;
  9. the benefits and limitations of tests that screen for drug use; and
  10. HIV/AIDS symptoms, risk-reduction and infection control guidelines, testing, and counseling.

 
Fundamental Practice

OTP 2.09

There is at least one person on duty at each program site any time the program is in operation that has received first aid and age-appropriate CPR training in the previous two years that included an in-person, hands-on CPR skills assessment conducted by a certified CPR instructor.

 

OTP 2.10

The organization minimizes the number of workers assigned to the individual over the course of their contact with the organization by:
  1. assigning a worker at intake or early in the contact; and
  2. avoiding the arbitrary or indiscriminate reassignment of direct service personnel.

 

OTP 2.11

Employee workloads support the achievement of client outcomes and are regularly reviewed.
Examples: Factors that may be considered when determining employee workloads include, but are not limited to:
  1. the qualifications, competencies, and experience of the worker, including the level of supervision needed;
  2. the work and time required to accomplish assigned tasks and job responsibilities; and
  3. service volume, accounting for assessed level of needs of persons served.
2023 Edition

Opioid Treatment (OTP) 3: Access to Service

The organization minimizes barriers to accessing services.
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 Evidence On-Site Evidence On-Site Activities
  • Access procedures
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review case records

 

OTP 3.01

The organization provides a welcoming environment that is conducive to rehabilitation, and services are available:
  1. during hours that are based on the needs of the service population; and
  2. 24 hours a day, seven days a week for emergencies.

 

OTP 3.02

Individuals under 18 years of age are eligible for treatment only if they have experienced two documented, unsuccessful attempts at short-term detoxification or drug-free treatment.
NA The organization does not provide treatment to service recipient under 18 years of age.

 

OTP 3.03

The organization does not serve individuals receiving services from other OTPs, except in extenuating circumstances, and the case record contains:
  1. results of a review to determine if the person is enrolled in another OTP; and
  2. justification of extenuating circumstances as determined by the medical director or physician, when they exist.

 

OTP 3.04

At admission, a physician, or another qualified medical practitioner, documents that opioid treatment is medically necessary based on a determination that the individual:
  1. has been dependent on opiates for at least one year before admission, except in extenuating circumstances set forth in federal, state, and local law or regulation; and/or
  2. is physically dependent upon a narcotic drug, using accepted medical criteria, such as those listed in the Diagnostic and Statistical Manual for Mental Disorders.
Examples: Extenuating circumstances may include release from penal institutions, pregnancy, and prior treatment history.

 

OTP 3.05

A physician assesses each service recipient to ensure that he or she has voluntarily chosen opioid treatment and understands all relevant facts concerning the use of opioid treatment medication.
2023 Edition

Opioid Treatment (OTP) 4: Intake and Assessment

The organization's intake and assessment practices ensure that individuals receive prompt and responsive access to appropriate services.
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
  • In a few rare instances, urgent needs were not prioritized; or
  • For the most part, established timeframes are met; or
  • Culturally responsive assessments are 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
  • Urgent needs are often not prioritized; or 
  • Services are frequently not initiated in a timely manner; or
  • Applicants are not receiving referrals, as appropriate; or 
  • Assessment and reassessment timeframes are often missed; or
  • Assessments are sometimes not sufficiently individualized; 
  • Culturally responsive assessments are not the norm, and this is not being addressed in supervision or training; or
  • Several client records are missing important information; or
  • Client participation is inconsistent; or
  • Intake or assessment is done by another organization or referral source and no documentation and/or summary of required information is present in case record. 
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.,
  • There are no written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing.  
Self-Study Evidence On-Site Evidence On-Site Activities
  • Screening and intake procedures
  • Assessment procedures
  • Copy of assessment tool(s)
  • Community resource and referral list
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 4.01

Individuals are screened and informed about:
  1. how well their request matches the organization's services; and
  2. what services will be available and when.
NA Another organization is responsible for screening, as defined in a contract.

 
Fundamental Practice

OTP 4.02

Prompt, responsive intake practices:
  1. gather information necessary to identify critical service needs and/or determine when a more intensive service is necessary;
  2. give priority to pregnant women, and individuals with urgent needs and emergency medical or psychiatric situations;
  3. facilitate the identification of individuals and families with co-occurring conditions and multiple needs;
  4. support timely initiation of services; and
  5. provide placement on a waiting list or referral to appropriate resources when individuals cannot be served or cannot be served promptly.

 

OTP 4.03

Persons served participate in an individualized, culturally and linguistically responsive assessment that is:
  1. completed within established timeframes;  
  2. updated as needed based on the needs of persons served; and
  3. focused on information pertinent for meeting service requests and objectives.

Interpretation: The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA’s Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design.


 
Fundamental Practice

OTP 4.04

Each person admitted to the program receives a medical evaluation by a physician, or a qualified medical practitioner under the supervision of the medical director, within 14 days of admission that includes, but is not limited to, the following baseline information:
  1. medical history, including history of narcotic dependence;
  2. evidence of current physical dependence;
  3. laboratory examinations, including a serological test for syphilis, a tuberculin skin test, and a toxicology test to analyze drug dependence;
  4. determination of the presence of infectious diseases or organ abnormalities;
  5. determination of vital signs, general appearance, and condition; and
  6. family, economic, occupational, and housing needs.

 
Fundamental Practice

OTP 4.05

Persons served are screened for:
  1. high-risk behaviors related to HIV/AIDS, sexually transmitted diseases, multi drug-resistant tuberculosis, and other infectious diseases;
  2. patterns of other drug use, including Benzodiazepines;
  3. presence of co-occurring health and mental health conditions; and
  4. issues related to criminal activities.
Interpretation: Individuals known to use Benzodiazepines, even when prescribed, should be counseled as to their risk and provided with overdose prevention education and medication to counter the effects in the event of opioid overdose.

Interpretation: Individuals identified as having mental health needs should receive integrated treatment directly or through referral to a cooperating service provider.
2023 Edition

Opioid Treatment (OTP) 5: Service Planning and Monitoring

Each person participates in the development and ongoing review of a service plan that is the basis for delivery of appropriate services and support.
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
  • In a few instances, client or staff signatures are missing and/or not dated; or
  • With few exceptions, staff work with persons served, when appropriate, to help them receive needed support, access services, mediate barriers, etc.; 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
  • In several instances, client or staff signatures are missing and/or not dated; or
  • Quarterly reviews are not being done consistently; or
  • Level of care for some clients is clearly inappropriate; or
  • Service planning is often done without full client participation; or
  • Appropriate family involvement is not documented; or  
  • Documentation is routinely incomplete and/or missing; or
  • Individual staff members work with persons served, when appropriate, to help them receive needed support, access services, mediate barriers, etc., but this is the exception.
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 Evidence On-Site Evidence On-Site Activities
  • Service planning and monitoring procedures
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 5.01

An assessment-based service plan is developed in a timely manner with the full participation of persons served, and their family when appropriate, and includes:
  1. agreed upon goals, including education, vocational, and employment goals, desired outcomes, and timeframes for achieving them;
  2. recommendations for medical, psychosocial, economic, legal, or other support services and by whom they will be provided;
  3. possibilities for maintaining and strengthening family relationships and other informal social networks; 
  4. procedures for expedited service planning when crisis or urgent need is identified; and
  5. the individual’s signature.

 

OTP 5.02

The organization works in active partnership with persons served to:
  1. assume a service coordination role, as appropriate, when the need has been identified and no other organization has assumed that responsibility;
  2. ensure that they receive appropriate advocacy support;
  3. assist with access to the full array of services to which they are eligible; and
  4. mediate barriers to services within the service delivery system.

 

OTP 5.03

The worker and a supervisor, or a clinical, service, or peer team, review the case quarterly or more frequently depending on the needs of persons served, to assess:
  1. service plan implementation;
  2. progress toward achieving goals and desired outcomes; and
  3. the continuing appropriateness of the agreed upon service goals.
Interpretation: When experienced workers are conducting reviews of their own cases, the worker’s supervisor must review a sample of the worker’s evaluations as per the requirements of the standard.

 

OTP 5.04

The worker and individual, and his or her family when appropriate:  
  1. review progress toward achievement of agreed upon goals; and 
  2. sign revisions to service goals and plans.
2023 Edition

Opioid Treatment (OTP) 6: Community Services

The organization informs the community about its services, remains informed about community needs and resources, and identifies the mutual benefits of supporting individuals in their recovery.
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 Evidence On-Site Evidence On-Site Activities
No Self-Study Evidence
  • Public education and community relations informational materials
  • Examples of public relations efforts used to solicit community views and input
  • Interviews may include:
    1. Program director
    2. Relevant personnel

 

OTP 6.01

A public education and community relations service component:
  1. educates the public about the value of opioid treatment;
  2. builds community support; and
  3. provides information about the organization.

 

OTP 6.02

A public education and community relations service component also:
  1. serves as a community resource for substance use and related health, mental health, and social issues;
  2. establishes mechanisms to hear community views and issues about opioid treatment and the organization’s presence in the community; and
  3. aims to address and resolve community concerns.
2023 Edition

Opioid Treatment (OTP) 7: Service Elements

Services are responsive to individual strengths, needs, and goals.
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 Evidence On-Site Evidence On-Site Activities
  • Procedures for referring individuals for services
  • Service agreements and formal referral arrangements
  • Educational materials or other documentation of information provided to persons served
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 7.01

The organization provides, directly or by formal arrangement:
  1. substance use counseling that is coordinated with other counseling and services;
  2. access to physicians with knowledge of appropriate prescribing practices for individuals with addiction;
  3. activities that address the importance of drug and alcohol-free lifestyles and de-emphasize the role of intoxicants; and
  4. activities that address issues of particular concern to women, including intimacy, intimate partner violence, physical trauma, sexual trauma, prevention of exposure to and transmission of HIV/AIDS and other STDs, child care, pregnancy, and family planning.
Examples: Formal arrangements can include service agreements and formal referral arrangements.

 

OTP 7.02

Persons served, and adults with whom they live, are educated about:
  1. program guidelines, rules, and regulations;
  2. the nature of addictive disorders;
  3. signs and symptoms of overdose and when to seek emergency assistance;
  4. the dangers of cross-tolerance;
  5. dependency substitution and self-medication;
  6. therapeutic effects of opioid treatment medication;
  7. common myths about opioid treatment medication;
  8. the benefits of treatment and the recovery process;
  9. dispensing medication; and
  10. toxicology testing procedures.

 

OTP 7.03

Persons served receive:
  1. infectious disease prevention and risk reduction information and education;
  2. counseling on the importance of treatment adherence and honest communication with the provider;
  3. counseling on HIV infection and other infectious diseases and referral for testing;
  4. intensive clinical support for continued active use of alcohol and other drugs, including tobacco;
  5. supplemental psychotherapy services or referrals for co-occurring mental health disorders;
  6. support, information, and referral when seeking alternative therapies;
  7. access to vocational rehabilitation, evaluation, education, and training services; 
  8. access to parenting workshops;
  9. access to support and specialized recovery groups if the person and his/her family is affected by HIV/AIDS; and
  10. noncompliance and discharge procedures.

 

OTP 7.04

The organization uses multiple models of care in the treatment process to meet individual needs and embraces a recovery-oriented system of care framework that is: 
  1. person-centered;
  2. strengths-based;
  3. culturally-responsive;
  4. facilitative and self-directed;
  5. supported by formal and informal resources; and
  6. ongoing.
Examples: The organization may organize treatment in a group format based on the characteristics of a particular population, for example, by gender, age, sexual orientation, or racial, ethnic, and cultural background.

 

OTP 7.05

The organization provides, either directly or by referral, peer support and self-help services.
Examples: Peer support refers to services provided by individuals who have shared, lived experience. Peer support workers may be part of the treatment team. Services promote resiliency and recovery and can include peer recovery groups, peer-to-peer counseling, peer mentoring or coaching, family and youth peer support, or other consumer-run services.

 

OTP 7.06

Individuals diagnosed as having co-occurring health, mental health, and substance use conditions receive integrated treatment directly or through active involvement with a cooperating service provider.
Note: An organization that has a specialized outpatient co-occurring disorder treatment program must also complete Mental Health and/or Substance Use Services (MHSU), recognizing that the mental health standards may need to be adapted for specialized core services provided within the context of services for substance use conditions.

 

OTP 7.07

The organization coordinates with the criminal justice system to advocate for continuous treatment for individuals who are incarcerated, or on probation or parole.
NA The organization does not serve any individual involved in the criminal justice system.

 

OTP 7.08

The organization provides, or makes referrals for, relapse prevention services including counseling, support, and education for individuals who want to discontinue opioid treatment.
2023 Edition

Opioid Treatment (OTP) 8: Medical Services

Medical services are provided, directly or by referral, according to individual needs.
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 Evidence On-Site Evidence On-Site Activities
  • Procedures for making referrals to medical, psychiatric, or pain management services
  • Procedures for obtaining medication blood levels
  • Procedures for evaluating the benefits derived from treatment
  • PDMP procedures
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 8.01

The organization provides or makes referrals to medical and psychiatric services for necessary screening and follow-up.

 
Fundamental Practice

OTP 8.02

The organization obtains medication blood levels and conducts other medical and diagnostic procedures when clinically indicated.

 

OTP 8.03

The organization uses opioid agonist treatment medications approved by the U.S. Food and Drug Administration in the treatment of opioid addiction.
Examples: Opioid addiction treatment medications include: buprenorphine, methadone and naltrexone.

 

OTP 8.04

Individuals are maintained on opioid treatment medication as long as they desire, and derive benefit from treatment.

 
Fundamental Practice

OTP 8.05

The organization makes referrals for consultation with a specialist in pain medicine for individuals with chronic pain disorder.
Interpretation: Generally, individuals with chronic pain disorder should not be admitted to receive opioids only for pain, but there are exceptions if the program is the only available resource in the community. Individuals with both chronic pain and addiction should receive integrated treatment from appropriate medical specialists.

 

OTP 8.06

The organization queries the state prescription drug monitoring program (PDMP):  
  1. prior to initiating dosing for new patients;
  2. at clinical decision points, such as ordering take home medication; and
  3. routinely for all patients.
NA There is no PDMP available in the state.
2023 Edition

Opioid Treatment (OTP) 9: Toxicology Testing for Continued Drug Use

Toxicology testing is an integral component of service planning and clinical practice to help monitor and evaluate the individual's progress in treatment.
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 Evidence On-Site Evidence On-Site Activities
  • Procedures for evaluating the quality of laboratories
  • Policies related to toxicology testing
  • Procedures for toxicology testing
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 9.01

Prior to establishing a contract, the organization evaluates the quality of the laboratory to perform drug screens, including use of equipment, methodology, and quality control.

 

OTP 9.02

Toxicology specimens are obtained:
  1. with respect for individual privacy; and
  2. in a safe treatment atmosphere.

 

OTP 9.03

After the individual's initial admission test, the timing and frequency of toxicology testing is clinically appropriate for each individual, and the opioid treatment program conducts:
  1. at least eight random drug tests per service recipient, per year;
  2. at least one initial and two subsequent tests for individuals in interim maintenance treatment; and
  3. tests, as appropriate, during medically supervised and other types of withdrawal.
Interpretation: Drug testing regimes should be determined based on individual assessment results and by analyzing community drug-use patterns. Testing may include, but not be limited to, opiates, benzodiazepines, barbiturates, cocaine, marijuana, methadone (and its metabolites), amphetamines, and alcohol.

 

OTP 9.04

Toxicology testing procedures include, and are not limited to:
  1. informing persons served about how specimens are collected and of their responsibility to provide a specimen when asked;
  2. discussing positive toxicology results with the individual;
  3. providing counseling, medical review, and other interventions if the person continues to test positive for illegal substance use;
  4. methods to minimize falsification during the drug testing sample collection;
  5. a process for reviewing false-positive and false-negative results; and
  6. documenting results in the case record along with the person’s response.

 

OTP 9.05

Following the receipt of toxicology test results, the organization:
  1. evaluates negative reports for opioid treatment medication and related metabolites;
  2. reviews dosage when positive toxicology reports for drugs are received;
  3. investigates the possibility of false positive results when persons served deny drug use;
  4. rapidly responds if the individual is found to be in danger of relapse; and
  5. uses the results to determine the need for additional interventions.
Interpretation: Immediate action should be taken to investigate possible diversion of opioid medication when toxicology tests indicate lack of opioids or related metabolites.

 
Fundamental Practice

OTP 9.06

Evidence of ongoing drug use is not considered grounds for discharge, unless the individual refuses to cooperate with treatment recommendations.
2023 Edition

Opioid Treatment (OTP) 10: Take-Home Privileges for Unsupervised Use of Medication

The organization establishes criteria to determine when take-home privileges can become part of an individual’s service plan and how medications are provided in accordance with applicable federal regulations concerning the prescription and distribution of controlled substances.
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 Evidence On-Site Evidence On-Site Activities
  • Procedures regarding take-home medication
  • Criteria regarding take-home privileges
  • Material that is given to persons served that addresses safe storage of take-home medication
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 10.01

Direct service personnel, medical and other appropriate personnel, persons served, and, whenever possible, family members, participate in determining if the individual meets criteria for take-home medication.

 

OTP 10.02

To support the initiation of take-home privileges, the medical director considers:
  1. length of time in treatment;
  2. consistency of clinic attendance;
  3. clinical status;
  4. progress in rehabilitation;
  5. medical necessity;
  6. behavioral factors;
  7. geographic considerations;
  8. employment schedules that create hardship for an individual to meet limited clinic hours;
  9. results of toxicology tests; and
  10. other special needs.
Interpretation: All elements should be considered collectively in determining whether take home privileges are appropriate for an individual. Decisions should not be based solely on toxicology test reports.

Interpretation: Time in treatment should not be a factor for patients prescribed buprenorphine for take-home use.
Examples: “Other special needs" may include, and are not limited to, emergency circumstances, split dosing, and pain treatment.

 
Fundamental Practice

OTP 10.03

For each person provided with take-home medication, the organization:
  1. schedules toxicology tests to ensure he or she consumes the opioid treatment medication provided and remains free of substance use;
  2. implements measures to help avoid diversion of controlled substances;
  3. has a physician review his or her status at least every 90 days, or more frequently if clinically indicated; and
  4. periodically reviews the benefits and drawbacks of continued take-home privileges.

 

OTP 10.04

The medical director uses established criteria to decide when take-home medication is contraindicated, including:
  1. signs or symptoms of withdrawal;
  2. evidence of continued alcohol and drug use;
  3. the absence of laboratory evidence of the opioid treatment medication in toxicology samples;
  4. participation in short-term detoxification or interim maintenance treatment programs;
  5. potential complications from concurrent disorders;
  6. ongoing criminal behavior; and
  7. absence of stable social relationships or a stable home environment.

 
Fundamental Practice

OTP 10.05

The organization labels take-home medication with the organization’s name, address, and telephone number and provides individuals with guidance on how to safely secure medication.
Interpretation: The medical director should consider whether the medication can be safely stored in the person’s place of residence when determining if the individual may be permitted unsupervised use of medication.
Note: See also Program Administration (PRG) for standards regarding Medication Control and Administration.
2023 Edition

Opioid Treatment (OTP) 11: Dosage Requirements

The organization follows procedures for administration of opioid treatment medication to ensure that an adequate, individually-determined dose is dispensed.
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 Evidence On-Site Evidence On-Site Activities
  • Procedure for dosing and administration of opioid treatment medication
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 
Fundamental Practice

OTP 11.01

Opioid treatment medication is administered as follows:
  1. a physician makes all dosage decisions within the medically accepted dosage range for effective treatment;
  2. conditions for use are documented in the person’s case record;
  3. medications are administered and dispensed in accordance with approved product labeling;
  4. the initial dose of methadone does not exceed 30 milligrams, and 40 milligrams as a total dose for the first day; and
  5. methadone is dispensed in oral form.
Interpretation: The initial dose of methadone must be determined by an OTP physician familiar with the most up-to-date product labeling, who considers factors, such as body weight, size, other substance-use and abuse, diet, co-occurring disorders, medical diseases, genetic factors, and tolerance. Although the initial dose is indicated not to exceed 30 milligrams, this dose is not appropriate for everyone, and some individuals may require much lower doses. All individuals should be closely monitored during the induction phase and the increases in dosage should be under the close supervision of the physician. It must be documented in the case record when the 40 milligrams total dose is exceeded based on the physician's determination that the previous dosage did not suppress the person's withdrawal symptoms.

 
Fundamental Practice

OTP 11.02

When a physician determines a person is eligible to receive take-home medication, the dose is limited to no more than:
  1. one dose per week in the first 90 days of treatment;
  2. two doses per week in the second 90 days of treatment;
  3. three doses per week in the third 90 days of treatment;
  4. a six-day supply in the remaining months of the year;
  5. a two-week supply after one year of continuous treatment; and
  6. a one-month supply after two years of continuous treatment.

 
Fundamental Practice

OTP 11.03

Persons served receive the appropriate dosage of opioid treatment medication for days when the clinic is closed, for weekends, holidays, and travel.
Interpretation: The organization should inform persons served of its plan for administration of medication in the event that the program is temporarily closed due to an emergency.
2023 Edition

Opioid Treatment (OTP) 12: Detoxification Treatment

Detoxification treatment is provided based on the needs of the individual.
NA The organization does not provide detoxification treatment.

Currently viewing: DETOXIFICATION TREATMENT

VIEW THE STANDARDS

Note: In these standards, the term “detoxification” refers to detoxification from opioid drugs and not medical or administrative withdrawal from opioid treatment medication, which is addressed in OTP 15.
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 Evidence On-Site Evidence On-Site Activities
  • Procedures related to detoxification
  • Service recipient/personnel care and supervision ratios and scheduling criteria (residential detoxification programs only)
  • Privacy policy (residential detoxification programs only)
  • Coverage schedules for the past six months in residential detoxification programs, if applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 12.01

Qualified personnel determine if short- or long-term detoxification treatment is appropriate for the individual using diagnostic criteria found in the Diagnostic and Statistical Manual for Mental Disorders.

 

OTP 12.02

Persons served are placed in the appropriate level of care and have access to all components of the detoxification process, including:  
  1. evaluation;
  2. stabilization; and
  3. preparation for entry into substance use treatment.
Examples: Organizations can utilize the American Society of Addiction Medicine (ASAM) criteria to determine the appropriate level of care.

 

OTP 12.03

The organization conducts an initial drug test for individuals in short-and long-term detoxification treatment and monthly random tests for individuals receiving long-term detoxification treatment.

 

OTP 12.04

The organization limits individuals to two detoxification treatment episodes per year.

 
Fundamental Practice

OTP 12.05

Individuals who have had two or more unsuccessful detoxification episodes are assessed by a physician to determine the need for other forms of treatment.

 

OTP 12.06

The organization provides 24-hour-a-day supervision, observation, and care tailored to meet the individual’s assessed needs and goals.
Interpretation: Staffing requirements and care ratios can vary depending on the age, developmental level, and service needs of the population, organizations must meet state licensing requirements.
NA The organization does not provide detoxification treatment in a residential setting.

 

OTP 12.07

Residential facilities contribute to a physically and psychologically safe, healthy, non-institutional environment by: 
  1. providing personal accommodations for individuals that are age, developmentally, gender, and culturally appropriate; 
  2. providing private areas for bathing, toileting, and personal hygiene;
  3. allocating rooms for occasional on-site services, as needed;
  4. ensuring accommodations for informal gathering of persons served, including during inclement weather;
  5. having adequate space for administrative support functions, food preparation, housekeeping, laundry, maintenance, and storage; and
  6. being maintained in good, clean condition.
Interpretation: Accommodations may be adjusted as appropriate to the service provided, therapeutic considerations, level of risk, or developmental appropriateness.
NA The organization does not provide detoxification treatment in a residential setting.

 

OTP 12.08

The organization ensures the comfort, dignity, privacy, and safety of persons served by: 
  1. implementing and communicating policies for searches of individuals or their property; 
  2. prohibiting the use of surveillance cameras or listening devices of persons in bedrooms; 
  3. maintaining doors on sleeping areas and bathroom enclosures; 
  4. providing one- or two-person rooms to individuals who need extra sleep, protection from sleep disturbance, or extra privacy for clinical reasons; and
  5. requiring employees to knock before entering a service recipient’s room unless there is a safety or clinical concern.
Interpretation: When organizations are required to employ alternate practices, documentation must be provided to justify the practice. Documentation may include a judicial order, law, contract, copy of the state's safety plan for a resident, or clear, clinical written justification for a resident. 

Sensitivity should be taken to ensure that all persons served, especially abuse or trauma survivors and the LGBTQ population, feel safe and not violated.
NA The organization does not provide detoxification treatment in a residential setting.
2023 Edition

Opioid Treatment (OTP) 13: Interim Maintenance Treatment

Interim maintenance treatment is provided to support individual functioning and to ensure continuity of care.
Interpretation: Interim maintenance treatment programs must meet the same requirements and standards of care as comprehensive maintenance treatment programs.
NA The OTP does not offer interim maintenance treatment.
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 Evidence On-Site Evidence On-Site Activities
  • Procedures for interim maintenance treatment
  • Criteria for transferring persons from interim to comprehensive maintenance treatment
  • Procedures for notifying state health officer when a personu2019s maintenance status changes
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 13.01

The program administrator or sponsor places a person in an interim maintenance treatment program:
  1. when the person cannot be placed in a comprehensive treatment program within 14 days of application;
  2. within a reasonable geographic area; and
  3. for a maximum of 120 days in any 12 month period.

 

OTP 13.02

The organization establishes written criteria for transferring persons served from interim maintenance to comprehensive maintenance treatment.

 

OTP 13.03

The organization notifies the state health officer when a person begins interim maintenance treatment, leaves interim maintenance treatment, or is transferred to comprehensive maintenance treatment.

 

OTP 13.04

In interim maintenance treatment programs, medication is administered daily under observation.
Interpretation: In interim maintenance treatment programs take-home medication is not permitted; service plans, rehabilitative, educational, and other counseling services are not required; and persons served are not assigned a primary counselor.  
2023 Edition

Opioid Treatment (OTP) 14: Opioid Treatment During Pregnancy

The organization provides comprehensive, coordinated treatment services that address medical, prenatal, obstetrical, psychosocial, and addiction concerns for pregnant women.
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 Evidence On-Site Evidence On-Site Activities
  • Procedures that address prenatal care for pregnant women
  • Procedures for withdrawal from methadone for pregnant women
  • Procedures for evaluating newborns
  • Information and education regarding potential risks for pregnant women
  • Information about education and support groups
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 14.01

The organization addresses the special needs of pregnant women, including: 
  1. maintenance at the pre-pregnancy medication dose for women who become pregnant during treatment; 
  2. dosing protocols for newly admitted pregnant women that are equivalent to those used for all other persons served;
  3. carefully monitoring the methadone dose, especially during the third trimester of pregnancy; and
  4. provision of treatment services for pregnant women with concurrent HIV infection.

 

OTP 14.02

The organization coordinates and provides prenatal care for pregnant women, either directly or by referral to outside medical services, to address their special needs including the need for a health evaluation.

 
Fundamental Practice

OTP 14.03

Pregnant women who receive opioid treatment are informed about the possible risks associated with:
  1. the effects of treatment on unborn children;
  2. continued use of drugs; and
  3. withdrawal from opioid treatment medication during pregnancy.

 
Fundamental Practice

OTP 14.04

When withdrawal from opioid treatment medication is initiated for pregnant women, such withdrawal:
  1. is conducted under the supervision of a physician;
  2. takes place, when possible, in a prenatal unit equipped with fetal monitoring equipment and with regular fetal assessments; and
  3. is not initiated before 14 weeks, nor after 32 weeks, gestation.

 

OTP 14.05

The organization provides parent education and support groups, directly or by referral, that address:
  1. healthy mother-infant interactions;
  2. signs, symptoms, and effects of neonatal abstinence syndrome; and
  3. resources to treat neonatal abstinence syndrome.
Examples: Parent education to improve mother-infant interactions can address topics related to maternal, physical, and dietary care, including for example the promotion of breast-feeding.

 
Fundamental Practice

OTP 14.06

The program is responsible for ensuring that newborns are medically evaluated if signs or symptoms of neonatal abstinence syndrome appear following hospital discharge.
Interpretation: Programs that do not have responsibility for the care and treatment of newborns should provide education, information, and referral to ensure that mothers who have infants that may be susceptible to health issues seek comprehensive evaluation and treatment for the infant.
2023 Edition

Opioid Treatment (OTP) 15: Withdrawal

Persons served participate in the development of an appropriate withdrawal schedule and receive the necessary support to prevent relapse.
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 Evidence On-Site Evidence On-Site Activities
  • Procedures for medical withdrawal
  • Procedures for administrative discharge
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 15.01

Medical withdrawal from opioid treatment medication is:
  1. a voluntary and therapeutic process planned for by the individual and a physician; or 
  2. conducted in response to an individual's request, but against medical advice (AMA).

 

OTP 15.02

Medical withdrawal practices include:
  1. dose reduction at a rate well tolerated by the person and in accordance with accepted medical practices;
  2. periodic assessments of mental status;
  3. an assessment for pregnancy for women of childbearing age;
  4. availability of counseling and other support services; and
  5. discontinuation of withdrawal and resumed maintenance therapy, in the event of impending relapse.

 

OTP 15.03

Individuals that undergo medically supervised withdrawal AMA:
  1. are provided with information about the risks of discontinuing treatment and information about and referral to alternative treatment programs;
  2. can be readmitted to the program within 30 days without repeating the initial assessment; and
  3. are considered for maintenance treatment when withdrawal fails.
Interpretation: In the case of a pregnant individual the organization should keep the agency providing prenatal care informed of the individual's status consistent with privacy standards.

Interpretation: Reason for seeking discharge and steps taken to avoid discharge should be noted in the case record.

 
Fundamental Practice

OTP 15.04

When other interventions were proven unsuccessful, a program may determine that administrative withdrawal is necessary, including: 
  1. a humane withdrawal schedule based on sound clinical judgement; and
  2. referral or transfer to a suitable, alternative treatment program, whenever possible.
Interpretation: The organization must determine on a case-by-case basis its responsibility to continue providing services to persons whose third-party benefits are denied or have ended and who are in critical situations.

Interpretation: A suggested schedule for medically supervised administrative withdrawal is a minimum of 30 days with adjustments made depending on clinical factors. Since administrative withdrawal is conducted over a short timeframe and associated with poor prognosis connecting individuals to alternative treatment programs is critical.
Examples: Administrative discharges are usually involuntary and may occur for reasons such as nonpayment of fees, incarceration, or disruptive conduct or behavior such as violence, dealing drugs, repeated loitering, and flagrant noncompliance.
2023 Edition

Opioid Treatment (OTP) 16: Case Closing and Aftercare

The organization works with persons served and family members, when appropriate, to plan for case closing and, when possible, to develop aftercare plans.
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
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • In a few instances, the organization terminated services inappropriately; or  
  • Active client participation occurs to a considerable extent; or
  • A formal case closing evaluation is not consistently provided to the public authority per the requirements of the standard.
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
  • Services are frequently terminated inappropriately; or  
  • Aftercare planning is not initiated early enough to ensure orderly transitions; or
  • A formal case closing summary and assessment is seldom provided to the public authority per the requirements of the standard; 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 Evidence On-Site Evidence On-Site Activities
  • Case closing procedures
  • Aftercare planning and follow-up procedures
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

OTP 16.01

Planning for case closing:
  1. is a clearly defined process that includes assignment of staff responsibility;
  2. begins at intake; and
  3. involves the worker, persons served and others, as appropriate to the needs and wishes of the individual.

 

OTP 16.02

Upon case closing, the organization notifies any collaborating service providers, as appropriate.

 

OTP 16.03

When appropriate, the organization works with persons served and their family to develop an aftercare plan, sufficiently in advance of case closing, that: 
  1. identifies short- and long-term needs and goals; and 
  2. facilitates the initiation or continuation of needed supports and services.
Interpretation: The aftercare plan must include relapse prevention. The plan should also address re-entry into maintenance treatment in the event of relapse. Plans for meeting the individual’s physical and mental health needs following medically supervised withdrawal should also be indicated, as appropriate.

 

OTP 16.04

The organization follows up on the aftercare plan, as appropriate, when possible, and with the permission of the service recipient.
Examples: Reasons why follow-up may not be appropriate include, but are not limited to, cases where the person’s participation is involuntary, or where there may be a risk to the service recipient such as in cases of domestic violence.
2023 Edition

Opioid Treatment (OTP) 17: Diversion Control

The organization implements mechanisms to support diversion control and demonstrate accountability to persons served and the community.
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 Evidence On-Site Evidence On-Site Activities
  • Diversion control plan
  • Loitering policy
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Observe the security system

 

OTP 17.01

Medical and administrative personnel implement a plan to reduce the risk of diversion of controlled substances from legitimate treatment use that addresses:
  1. measures to reduce the possibility of diversion of controlled substances; 
  2. specific responsibilities assigned to personnel for plan implementation; 
  3. mechanisms for surveillance and continuous monitoring; and 
  4. a process for corrective action when problems are identified.

 

OTP 17.02

The organization prevents loitering by persons served and maintains a well-managed and fully operational security system.
2023 Edition

Opioid Treatment (OTP) 18: Program Administration

The organization’s administrative activities support program operations.
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 Evidence On-Site Evidence On-Site Activities
  • Record-keeping procedures
  • Documentation of annual policy and procedures review for the previous six months
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Observe record keeping system

 

OTP 18.01

The organization conducts annual reviews of program policies and procedures.

 

OTP 18.02

The organization’s record-keeping system:
  1. documents and monitors client care in conformity with all federal and state reporting requirements relevant to opioid treatment;
  2. complies with the approved central registry system, when available; and
  3. supports provision of PDMP reports, when applicable.
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