DHS 75.59(13) (13) Take-home medication practices.

DHS 75.59(13)(a) (a) Granting take-home privileges. During treatment, a patient may benefit from less frequent required visits for dosing. This shall be based on an assessment by the treatment staff. Time in treatment is not the sole consideration for granting take-home privileges. After consideration of treatment progress, the service physician shall determine if take-home doses are appropriate or if approval to take-home doses should be rescinded. Federal and State requirements that shall be adhered to by the SOTA and the service are as follows:

DHS 75.59(13)(a)1. 1. Take-home doses are not allowed during the first 30 days of treatment. Patients are expected to attend the service daily. Exception requests may be submitted for review when extenuating circumstances (i.e. pandemic) arise and will be reviewed and a determination made by the SOTA.

DHS 75.59(13)(a)2. 2. Take-home doses shall not be granted if the patient continues to use illicit drugs and if the primary counselor and the treatment team determine that the patient is not making progress in treatment and has continued drug use or legal problems.

DHS 75.59(13)(a)3. 3. Take-home doses shall only be provided when the patient is clearly adhering to the requirements of the service. The patient shall be expected to show responsibility for security and handling of take-home doses.

DHS 75.59(13)(a)4. 4. Service staff shall go over the requirements for take-home privileges with a patient before the take-home practice for self-dosing is implemented. Clinical staff shall require the patient to provide written acknowledgment that all the rules for self-dosing have been provided and understood at the time the review occurs.

DHS 75.59(13)(a)5. 5. Service staff may not use the level of the daily dose to determine whether a patient receives take-home medication.

DHS 75.59(13)(b) (b) Treatment team recommendation. A treatment team of appropriate staff in consultation with a patient shall collect and evaluate the necessary information regarding a decision about take-home medication for the patient and make the recommendation to grant take-home privileges to the service physician.

DHS 75.59(13)(c) (c) Service physician review. The rationale for approving, denying or rescinding take-home privileges shall be recorded in the patient’s case record and the documentation shall be reviewed, signed and dated by the service physician. Physician orders for take-home medication for substance use disorders shall expire every 90 days. The physician shall document how a patient meets all criteria in par. (d) 1. to 8. within the order for take-home medication and what phase level the patient is at for which medication.

DHS 75.59(13)(d) (d) Service physician determination. The service physician shall determine whether, in the service physician’s reasonable clinical judgment, the patient has made substantial progress in rehabilitation and can responsibly handle narcotic drugs. In order to make this determination in the affirmative and grant take home privileges, the service physician must consider and attest to all of the following:

DHS 75.59(13)(d)1. 1. The patient is not abusing substances, including alcohol.

DHS 75.59(13)(d)2. 2. The patient keeps scheduled service appointments.

DHS 75.59(13)(d)3. 3. The patient exhibits no serious behavioral problems at the service.

DHS 75.59(13)(d)4. 4. The patient is not involved in criminal activity, such as drug dealing and selling take-home doses.

DHS 75.59(13)(d)5. 5. The patient has a stable home environment and social relationships.

DHS 75.59(13)(d)6. 6. The patient has met the applicable criteria for length of time in treatment provided in pars. (e) and (h).

DHS 75.59(13)(d)7. 7. The patient provides assurance that take-home medication will be safely stored in a locked metal box within the home.

DHS 75.59(13)(d)8. 8. The rehabilitative benefit to the patient in decreasing the frequency of service attendance outweighs the potential risks of diversion.

DHS 75.59(13)(e) (e) Time in treatment criteria and exceptions. The time in treatment criteria under par. (h) shall be the minimum time before take-home medications will be considered unless there are exceptional circumstances and the service applies for and receives approval from the designated federal agency and the SOTA for a particular patient.

DHS 75.59(13)(f) (f) Individual consideration of request. A request for take-home privileges shall be considered on an individual basis. No request for take-home privileges may be granted automatically to any patient.

DHS 75.59(13)(g) (g) Additional criteria for 6-day take-home privilege. When a patient is considered for 6-day take-homes, the patient shall meet the following additional criteria:

DHS 75.59(13)(g)1. 1. The patient is employed, attends school, is a homemaker, or is disabled.

DHS 75.59(13)(g)2. 2. The patient is not known to have used or abused substances, including alcohol, in the previous year.

DHS 75.59(13)(g)3. 3. The patient is not known to have engaged in criminal activity in the previous year.

DHS 75.59(13)(h) (h) Phases.

DHS 75.59(13)(h)1. 1. Methadone shall be provided on a take-home basis as follows:

DHS 75.59(13)(h)1.a. a. For patient time in treatment starting day 31 through day 90, the patient shall be allowed no more than one take-home dose of medication per week.

DHS 75.59(13)(h)1.b. b. For patient time in treatment starting day 91 through 180, the patient shall be allowed no more than 2 take-home doses of medication per week.

DHS 75.59(13)(h)1.c. c. For patient time in treatment starting day 181 through day 270, the patient shall be allowed no more than 3 take-home doses of medication per week.