Narcotic treatment service for opiate addiction. DHS 75.15(1)(1)
A narcotic treatment service for opiate addiction provides for the management and rehabilitation of selected narcotic addicts through the use of methadone or other FDA-approved narcotics and a broad range of medical and psychological services, substance abuse counseling and social services. Methadone and other FDA-approved narcotics are used to prevent the onset of withdrawal symptoms for 24 hours or more, reduce or eliminate drug hunger or craving and block the euphoric effects of any illicitly self-administered narcotics while the patient is undergoing rehabilitation.
To receive certification from the department under this chapter, a narcotic treatment service for opiate addiction shall comply with all requirements included in s. DHS 75.03
and all requirements included in s. DHS 75.13
that apply to a narcotic treatment service for opiate addiction, as shown in Table 75.03, and, in addition, a narcotic treatment service for opiate addiction shall comply with the requirements of this section. If a requirement in this section conflicts with an applicable requirement in s. DHS 75.03
, the requirement in this section shall be followed.
“Biochemical monitoring" means the collection and analysis of specimens of body fluids, such as blood or urine, to determine use of licit or illicit drugs.
“Central registry" means an organization that obtains from 2 or more methadone programs patient identifying information about individuals applying for maintenance treatment or detoxification treatment for the purpose of preventing an individual's concurrent enrollment in more than one program.
“Clinical probation" means the period of time determined by the treatment team that a patient is required to increase frequency of service attendance.
“Initial dosing" means the first administration of methadone or other FDA-approved narcotic to relieve a degree of withdrawal and drug craving of the patient.
“Mandatory schedule" means the required dosing schedule for a patient and the established frequency that the patient must attend the service.
“Medication unit" means a facility established as part of a service but geographically separate from the service, from which licensed private practitioners and community pharmacists are:
Authorized to conduct biochemical monitoring for narcotic drugs.
“Objectively intoxicated person" means a person who is determined through a breathalyzer test to be under the influence of alcohol.
“Opioid addiction" means psychological and physiological dependence on an opiate substance, either natural or synthetic, that is beyond voluntary control.
“Patient identifying information" means the name, address, social security number, photograph or similar information by which the identity of a patient can be determined with reasonable accuracy and speed, either directly or by reference to other publicly available information.
“Service physician" means a physician licensed to practice medicine in the jurisdiction in which the program is located, who assumes responsibility for the administration of all medical services performed by the narcotic treatment service including ensuring that the service is in compliance with all federal, state and local laws relating to medical treatment of narcotic addiction with a narcotic drug.
“Service sponsor" means a person or a representative of an organization who is responsible for the operation of a narcotic treatment service and for all service employees including any practitioners, agents or other persons providing services at the service or at a medication unit.
“Take-homes" means medications such as methadone that reduce the frequency of a patient's service visits and with the approval of the service physician, are dispensed in an oral form and are in a container that discloses
the treatment service name, address and telephone number and the patient's name, the dosage amount and the date on which the medication is to be ingested.
“Treatment contracting" means an agreement developed between the primary counselor or the program director and the patient in an effort to allow the patient to remain in treatment on condition that the patient adheres to service rules.
“Treatment team" means a team established to evaluate the progress of a patient and consisting of at least the primary counselor, the service staff nurse who administers doses and the program director.
A narcotic treatment service for opiate addiction shall designate a physician licensed under ch. 448
, Stats., as its medical director. The physician shall be readily accessible and able to respond in person in a reasonable period of time, not to exceed 45 minutes.
The service shall have a registered nurse on staff to supervise the dosing process and perform other functions delegated by the physician.
The service may employ nursing assistants and related medical ancillary personnel to perform functions permitted under state medical and nursing
practice statutes and administrative rules.
The service shall employ substance abuse counselors, substance abuse counselors-in training, or clinical substance abuse counselors who are under the supervision of a clinical supervisor on a ratio of at least one to 50 patients in the service or fraction thereof.
A narcotic treatment services for opiate addiction shall provide for ongoing clinical supervision of the counseling staff. Ongoing clinical supervision shall be provided as required as required in s. SPS 162.01
DHS 75.15 Note
Section SPS 162.01 (1)
states that a clinical supervisor shall provide a minimum of:
DHS 75.15 Note
1. Two hours of clinical supervision for every 40 hours of work performed by a substance abuse counselor-in-training.
DHS 75.15 Note
2. Two hours of clinical supervision for every 40 hours of counseling provided by a substance abuse counselor.
DHS 75.15 Note
3. One hour of clinical supervision for every 40 hours of counseling provided by a clinical substance abuse counselor.
DHS 75.15 Note
4. One in person meeting each calendar month with a substance abuse counselor-in-training, substance abuse counselor, or clinical substance abuse counselor. This meeting may fulfill a part of the requirements above.
The clinical supervisor shall provide supervision and performance evaluation of substance abuse counselors in the areas identified in s. SPS 162.01 (5)
DHS 75.15 Note
Section SPS 162.01 (5)
states that the goals of clinical supervision are to provide the opportunity to develop competency in the transdisciplinary foundations, practice dimensions and care functions, provide a context for professional growth and development and ensure a continuance of quality patient care.
For admission to a narcotic addiction treatment service for opiate addiction, a person shall meet all of the following criteria as determined by the service physician:
The person is physiologically and psychologically dependent upon a narcotic drug that may be a synthetic narcotic.
The person has been physiologically and psychologically dependent upon the narcotic drug not less than one year before admission.
In instances where the presenting drug history is inadequate to substantiate such a diagnosis, the material submitted by other health care professionals indicates a high degree of probability of such a diagnosis, based on further evaluation.
When the person receives health care services from outside the service, the person has provided names, addresses and written consents for release of information from each health care provider to allow the service to contact the providers, and agrees to update releases if changes occur.
Participation in narcotic addiction treatment shall be voluntary.
Service staff shall clearly and adequately explain to the person being admitted all relevant facts concerning the use of the narcotic drug used by the service.
The service shall require a person being admitted to complete the most current version of FDA form 2635, “Consent to Narcotic Addiction Treatment."
DHS 75.15 Note
Note: For copies of FDA Form 2635, Consent to Narcotic Addiction Treatment, a service may write to Commissioner, Food and Drug Administration, Division of Scientific Investigations, 5600 Fishers Lane, Rockville, MD 20857.
For each applicant eligible for narcotic addiction treatment, the service shall arrange for completion of a comprehensive physical examination, clinically indicated laboratory work-up prescribed by the physician, psycho-social assessment, initial treatment plan and patient orientation during the admission process.
If a person meets the admission criteria under par. (a)
, an initial dose of narcotic medication may be administered to the patient on the day of application.
Distance of service from residence.
A person shall receive treatment at a service located in the same county or at the nearest location to the person's residence, except that if a service is unavailable within a radius of 50 miles from the patient's residence, the patient may, in writing, request the state methadone authority to approve an exception. In no case may a patient be allowed to attend a service at a greater distance to obtain take-home doses.
A self-pay person who is not a resident of Wisconsin may be accepted for treatment only after written notification to the Wisconsin state methadone authority. Permission shall be obtained before initial dosing.
The service shall participate in a central registry, or an alternative acceptable to the state methadone authority, in order to prevent multiple enrollments in detoxification and narcotic addiction treatment services for opiate addiction. The central registry may include services and programs in bordering states.
The service shall make a disclosure to the central registry whenever any of the following occurs:
A disclosure shall be made with the patient's written consent that meets the requirements of 42 CFR Part 2
, relating to alcohol and drug abuse patient records, except that the consent shall list the name and address of each central registry or acceptable alternative and each known detoxification or narcotic treatment service for opiate addiction to which a disclosure will be made.
The service shall have a written admissions protocol that accomplishes all of the following:
Identifies the person on the basis of appropriate substantiated documents that contain the individual's name and address, date of birth, sex and race or ethnic origin as evidenced by a valid driver's license or other suitable documentation such as a passport.
Determines the person's current addiction, to the extent possible, the current degree of dependence on narcotics or opiates, or both, including route of administration, length of time of the patient's dependence, old and new needle marks, past treatment history and arrest record.
Determines the person's age. The patient shall verify that he or she is 18 years or older.
Identifies the substances being used. To the extent possible, service staff shall obtain information on all substances used, route of administration, length of time used and amount and frequency of use.
Obtains information about past treatment. To the extent possible, service staff shall obtain information on a person's treatment history, use of secondary substances while in the treatment, dates and length of time in treatment and reasons for discharge.
Obtains personal information about the person. Personal information includes history and current status regarding employment, education, legal status, military service, family and psychiatric and medical information.
Identifies the person's reasons for seeking treatment. Reasons shall include why the person chose the service and whether the person fully understands
the treatment options and the nature and requirements of narcotic addiction treatment are fully understood.
Completes an initial drug screening or analysis of the person's urine to detect use of opiates, methadone, amphetamines, benzodiazepines, cocaine or barbiturates. The analysis shall show positive for narcotics, or an adequate explanation for negative results shall be provided and noted in the applicant's record. The primary counselor shall enter into the patient's case record the counselor's name, the content of a patient's initial assessment and the initial treatment plan. The primary counselor shall make these entries immediately after the patient is stabilized on a dose or within 4 weeks of admission, whichever is sooner.
If the service is at capacity, immediately advises the applicant of the existence of a waiting list and providing that person with a referral to another treatment service that can serve the person's treatment needs.
Refers a person who also has a physical health or mental health problem that cannot be treated within the service to an appropriate agency for appropriate treatment.
Obtains the person's written consent for the service to secure records from other agencies that may assist the service with treatment planning.
Arranges for hospital detoxification for patients seriously addicted to alcohol or sedatives or to anxiolytics before initiating outpatient treatment.
A service shall offer priority admission either through immediate admission or priority placement on a waiting list in the following order:
Persons identified by the service through screening as having an infectious or communicable disease, including screening for risk behaviors related to human immunodeficiency virus infection, sexually transmitted diseases and tuberculosis.
Appropriate and uncoerced treatment.
Service staff shall determine through a screening process that narcotic addiction treatment is the most appropriate treatment modality for the applicant and that treatment is not coerced.
Correctional supervision notification.
A service shall require a person who is under correctional supervision to provide written information releases that are necessary for the service to notify and communicate with the patient's probation and parole officer and any other correctional authority regarding the patient's participation in the service.
(6) Orientation of new patients.
A service shall provide new patients with an orientation to the service that includes all of the following:
Provision of a copy of a patient handbook that covers treatment policies and procedures, and patient rights and responsibilities. The service shall require a new patient to acknowledge, in writing, receipt of the handbook.
(7) Research and human rights committee.
A narcotic treatment service conducting or permitting research involving human subjects shall establish a research and human rights committee in accordance with s. 51.61 (4)
, Stats., and 45 CFR Part 46
No patient may be subjected to any experimental diagnostic or treatment technique or to any other experimental intervention unless the patient gives written informed consent and the research and human rights committee established under s. 51.61 (4)
, Stats., has determined that adequate provisions are made to do all of the following:
Ensure that no patient may be approached to participate in the research unless the patient's participation is approved by the person responsible for the patient's treatment plan.
The medical director of a service is responsible for all of the following: