Section R9-10-1020. Opioid Treatment Services

A.      A governing authority of an outpatient treatment center that is authorized to provide opioid treatment services shall:

1.        Ensure that the outpatient treatment center obtains certifi- cation by the Substance Abuse and Mental Health Ser- vices Administration before providing opioid treatment,

2.        Maintain a current Substance Abuse and Mental Health Services Administration certificate for the outpatient treatment center on the premises, and

3.        Ensure that the administrator appointed as required in R9- 10-1003(B)(3) is  named on  the Substance Abuse  and Mental Health Services Administration certificate as the individual responsible for the opioid treatment services provided by or at the outpatient treatment center.

B.       An administrator of an outpatient treatment center that is authorized to provide opioid treatment services shall ensure that:

1.        In addition to the policies and procedures required in R9- 10-1003(D), policies and procedures are established, doc- umented, and implemented to protect the health and safety of a patient that:

a.         Include the criteria for receiving opioid treatment services and address:

i.         Comprehensive maintenance treatment consist- ing of dispensing or administering an opioid agonist treatment medication at stable dosage levels to a patient for a period in excess of 21 calendar days and providing  medical and health-related services to the patient, and

ii.        Detoxification treatment that occurs over a con- tinuous period of more than 30 calendar days;

b.        Include the criteria and procedures for discontinuing opioid treatment services;

c.         Address the needs of specific groups of patients, such as patients who:

i.         Are pregnant;

ii.        Are children;

iii.      Have chronic or acute medical conditions such as HIV infection, hepatitis, diabetes, tuberculo- sis, or cardiovascular disease;

iv.       Have a mental disorder;

v.        Abuse alcohol or other drugs; or

vi.       Are incarcerated or detained;

d.        Contain a method of patient identification to ensure the patient receives the opioid treatment services ordered;

e.         Contain methods to assess whether a patient is receiving concurrent opioid treatment services from more than one health care institution;

f.         Contain methods to ensure that the opioid treatment services provided to a patient by or at the outpatient treatment center meet the patient’s needs;

g.        Include relapse prevention procedures;

h.        Include for laboratory testing:

i.         Criteria for the assessment of a patient’s opioid agonist blood levels,

ii.        Procedures for specimen collection and pro- cessing to reduce the risk of fraudulent results, and

iii.      Procedures for conducting random drug testing of patients receiving an opioid agonist treat- ment medication;

i.         Include procedures for the response of personnel members to a patient’s adverse reaction during opi- oid treatment; and

j.         Include criteria for dispensing one or more doses of an opioid agonist treatment medication to a patient for use off the premises and address:

i.         Who may authorize dispensing,

ii.        Restrictions on dispensing, and

iii.      Information to be provided to a patient or the patient’s representative before dispensing;

2.        A physician provides direction for the opioid treatment services provided at the outpatient treatment center;

3.        If a patient requires administration of an opioid agonist treatment medication as a result of chronic pain, the patient:

a.         Receives consultation with or a referral for consulta- tion with a physician or registered nurse practitioner who specializes in chronic pain management, and

b.        Is not admitted for opioid treatment services:

i.         Unless the patient is physically addicted to an opioid drug, as manifested by the symptoms of withdrawal in the absence of the opioid drug; and

ii.        A medical practitioner at the outpatient treat- ment center coordinates with the physician or registered nurse practitioner who is providing chronic pain management to the patient; and

4.        In addition to the requirements in R9-10-1009(C), a med- ical record for each patient contains:

a.         If applicable, documentation of the dispensing of doses of an opioid agonist treatment medication to the patient for use off the premises; and

b.        If applicable, documentation of the patient's dis- charge from receiving opioid treatment services.

C.      An administrator of an outpatient treatment center that is authorized to provide opioid treatment services shall ensure that for a patient receiving opioid treatment services:

1.        The opioid treatment services provided to the patient meet the needs of the patient;

2.        A physician or a medical practitioner under the direction of a physician:

a.         Performs a medical history and physical examina- tion on the patient within 30 calendar days before admission or within 48 hours after admission, and

b.        Documents the medical history and physical exam- ination in the patient’s medical record within 48 hours after admission;

3.        Before receiving opioid treatment, the patient is informed of the following:

a.         The progression of opioid addiction and the patient’s apparent stage of opioid addiction;

b.        The goal and benefits of opioid treatment;

c.         The signs and symptoms of overdose and when to seek emergency assistance;

d.        The characteristics of opioid agonist treatment medi- cation, including common side-effects and potential interaction effects with other drugs;

e.         The requirement for a staff member to report sus- pected or alleged abuse or neglect of a child or an incapacitated or vulnerable adult according to state law;

f.         Confidentiality requirements;

g.        Drug screening and urinalysis procedures;

h.        Requirements for dispensing to a patient one or more doses of an opioid agonist treatment medica- tion for use by the patient off the premises;

i.         Testing and treatment available for HIV and other communicable diseases; and

j.         The patient complaint process;

4.        Documentation of the provision of the information speci- fied in subsection (C)(3) is included in the patient’s medi- cal record;

5.        The patient receives a dose of an opioid agonist treatment medication only on the order of a medical practitioner;

6.        The patient begins detoxification treatment only at the request of the patient or according to the outpatient treat- ment center’s policy and procedure for discontinuing opi- oid treatment services required in subsection (B)(1)(b);

7.        If the patient has an adverse reaction during opioid treat- ment, a personnel member and, if appropriate, a medical practitioner responds by implementing the policy and procedure required in subsection (B)(1)(i);

8.        Before the patient’s discharge from opioid treatment ser- vices, the patient is provided with patient follow-up instructions that:

a.         Include information that may reduce the risk of relapse; and

b.        May include a referral for counseling, support groups, or medication for depression or sleep disor- ders; and

9.        After the patient's discharge from opioid treatment ser- vices provided by or at the outpatient treatment center, the medical practitioner responsible for the opioid treat- ment services provided to the patient documents the patient’s discharge in the patient’s medical record within

30  calendar   days  after   the  patient’s  discharge  and includes:

a.         A description of the patient’s medical condition and the opioid treatment services provided to the patient, and

b.        The signature of the medical practitioner.

D.      An administrator of an outpatient treatment center that is authorized to provide opioid treatment services shall ensure that an assessment for each patient receiving opioid treatment services:

1.        Includes, in addition to the information in R9-10- 1010(B):

a.         An assessment of the patient’s need for opioid treat- ment services,

b.        An assessment of the patient’s medical conditions that may be affected by opioid treatment,

c.         An assessment of other medications being taken by the patient and conditions that may be affected by opioid treatment, and

d.        A plan to prevent relapse;

2.        Identifies the treatment to be provided to the patient and treatment goals; and

3.        Specifies whether the patient may receive an opioid ago- nist treatment medication for use off the premises and, if so, the number of doses that may be dispensed.

Historical Note

Adopted as an emergency effective November 17, 1983, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 83-6). Former Section R9-10-1020 adopted as an emergency now adopted and amended as a permanent rule effective February 15, 1984 (Supp. 84-1). Repealed by summary action, interim effective date July 21, 1995 (Supp. 95-3). The proposed summary action repealing R9-10-1020 was remanded by the Governor’s Regulatory Review Council which revoked the interim effectiveness of the summary rule. The Section in effect before the pro- posed summary action has been restored (Supp. 97-1).

Section repealed by final rulemaking at 5 A.A.R. 1222, effective April 5, 1999 (Supp. 99-2). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective Octo- ber 1, 2013 (Supp. 13-2). Amended by exempt rulemak-

ing at 20 A.A.R. 1409, pursuant to Laws 2013, Ch. 10, §

13; effective July 1, 2014 (Supp. 14-2).