DHS 75.59(14)(b)(b) Rationale for exception. The program physician or program personnel supervised by the program physician shall record the rationale for an exception to an applicable mandatory schedule in the patient’s case record. A patient may not be given more than a 14-day supply of narcotic drugs at one time. DHS 75.59(14)(c)(c) Exception criteria. The service physician’s judgment that a patient is responsible in handling narcotic drugs shall be supported by information in the patient’s case file that the patient meets all of the following criteria: DHS 75.59(14)(c)1.1. Absence of recent abuse of narcotic or non-narcotic drugs including alcohol. DHS 75.59(14)(c)5.5. Stability of the patient’s home environment and social relationships. DHS 75.59(14)(c)7.7. Assurance that take-home medication can be safely stored within the patient’s home. DHS 75.59(14)(c)8.8. The rehabilitative benefit to the patient derived from decreasing the frequency attendance outweighs the potential risks of diversion. DHS 75.59(14)(d)1.1. Any exception to the take-home requirements is subject to approval of the designated federal agency and the SOTA. Both the designated federal agency and the SOTA must approve the exception. If one does not approve then the exception is considered denied. DHS 75.59(14)(d)2.2. Service staff on receipt of notices of approval or denial of a request for an exception from the SOTA and the designated federal agency shall place the notices in the patient’s case record. DHS 75.59(14)(e)(e) Exception review. Service staff shall review an exception when the conditions of the request change or at the time of review of the treatment plan, whichever occurs first. DHS 75.59(14)(f)(f) Exception duration. An exception shall remain in effect only as long as the conditions establishing the exception remain in effect. DHS 75.59(15)(a)1.1. A service shall use drug tests and analyses to determine the presence of opiates, methadone, fentanyl, buprenorphine, amphetamines, benzodiazepines, methamphetamine, cocaine, and THC. Alcohol testing will occur for individuals with a history of alcohol use disorders and when concerns exist. Alcohol testing may occur via breathalyzer, urinalysis or blood testing. If any other drug has been determined by a service or the SOTA to be abused in that service’s locality, a specimen shall also be analyzed for that drug. A service shall receive a 30-day notice and opportunity to provide input before it must begin analyzing for any additional substances other than those listed above. Any laboratory that performs the testing shall comply with 42 CFR part 493. A patient’s specimen shall be tested for the medication they are receiving for their opioid use disorder as well as the appropriate metabolite for that medication. DHS 75.59(15)(a)2.2. A service shall use the results of a drug test or analysis on a patient as a guide to review and modify treatment approaches and not as the sole criterion to discharge the patient from treatment. If a patient tests positive for any illicit substance or alcohol, that substance must be specifically addressed in the patient’s treatment plan. DHS 75.59(15)(a)3.3. A service’s policies and procedures shall integrate testing and analysis into treatment planning and clinical practice. DHS 75.59(15)(b)(b) Drawing blood for testing. A service shall determine a patient’s methadone levels in plasma or serum via a peak and trough when medically indicated but no less frequently than annually for patients who receive methadone or whenever split dosing is requested. The trough blood level should be drawn immediately prior to that day’s dose and the peak blood level should be drawn 3-4 hours after the dose is administered. DHS 75.59(15)(c)(c) Obtaining urine specimens. A service shall obtain urine specimens for testing from a patient, unless a patient is medically unable to provide a urine specimen, in which case an exception to use another testing device may be requested from the Division of Quality Assurance and the SOTA. Specimens shall be collected in a clinical atmosphere that respects the patient’s confidentiality, as follows: DHS 75.59(15)(c)1.1. A urine specimen shall be collected on a random basis. During the first 90 days of treatment urine drug screens shall occur weekly. After that time period, urine drug screens shall occur at least once a month. DHS 75.59(15)(c)2.2. The patient shall be informed about how test specimens are collected and the responsibility of the patient to provide a specimen when asked. DHS 75.59(15)(c)3.3. The bathroom used for collection shall be clean and always supplied with soap, paper towels, and toilet articles. DHS 75.59(15)(c)4.4. Specimens shall be collected in a manner that minimizes the possibility of falsification. DHS 75.59(15)(c)5.5. When service staff must directly observe the collection of a urine sample, this task shall be done with respect for patient privacy. DHS 75.59(15)(d)1.1. Service staff shall discuss positive test results with the patient within one week of the sample being taken by the service and shall document them in the patient’s case record with the patient’s response noted.