	Opioid Treatment

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

PA-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.

Interpretation:

PA-OTP 9.01

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

PA-OTP 9.02

Toxicology specimens are obtained:

with respect for individual privacy;
in a safe treatment atmosphere;
randomly; and
in a manner that minimizes the possibility of falsification.

Interpretation: Toxicology specimens are obtained randomly based on protocols established in PA-OTP 9.03.

Interpretation: Drug testing regimes are 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.

PA-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:

at least eight random drug tests per service recipient, per year;
at least one initial and two subsequent tests for individuals in interim maintenance treatment; and
tests, as appropriate, during medically superivsed and other types of withdrawal.

PA-OTP 9.04

Toxicology testing practices include, and are not limited to:

informing individuals about how specimens are collected and of their responsibility to provide a specimen when asked;
discussing positive toxicology results with the individual;
providing counseling, medical review, and other interventions if the person continues to test positive for illegal substance use;
methods to minimize falsification during the drug testing sample collection;
a process for reviewing false-positive and false-negative results; and
documenting results in the case record along with the person’s response.

Interpretation: Immediate action is taken to investigate possible diversion of opioid medication when toxicology tests indicate lack of opioids or related metabolites.

PA-OTP 9.05

Following the receipt of toxicology test results, the agency:

evaluates negative reports for opioid treatment medication and related metabolites;
reviews dosage when positive toxicology reports for drugs are received;
investigates the possibility of false positive results when individuals deny drug use;
rapidly responds if the individual is found to be in danger of relapse; and
uses the results to determine the need for additional interventions.

Interpretation: Immediate action is taken to investigate possible diversion of opioid medication when toxicology tests indicate lack of opioids or related metabolites.

PA-OTP 9.06

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

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

RELATED FILES


	PROGRAM A system of services offered by an organization. For example, an organization providing a mental health service may offer several mental health programs to different populations, e.g., a mental health program for adolescent teens. The word "program" can be used interchangeably with the word "service" or to describe specific programs.


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	PLANNING The process of specifying objectives, evaluating the means for their achievement, and exercising deliberate decision making about appropriate courses of action.


	CLINICAL The study, assessment, and diagnosis of the client situation followed by direct treatment to help the client achieve prescribed goals.


	PRACTICE Established actions or ways of proceeding in the regular performance of organizational duties. Policies and procedures often guide practice.


	CONTRACT A formal written agreement between two or more parties that specifies the services, space, or products to be provided in exchange for some form of compensation. Also known as "purchase of service arrangement."


	QUALITY In this context, the extent to which contemporary and generally recognized standards for professional practice are met and exceeded, and desirable service outcomes achieved.


	SCREEN A preliminary test administered to a client to determine whether he/she meets eligibility criteria for the services offered by an organization.


	PROTOCOLS Instruments and procedures used to accomplish a particular goal, activity, or purpose.


	ASSESSMENT An evaluation, which utilizes professional expertise and skills in the collection and analysis of data to understand and describe the nature of service needs of an individual, family, or group. Assessment, as in needs assessment, is also used to determine priorities of program planning and service development for the organization as a whole. See also DIAGNOSIS.


	COMMUNITY A specific group of people living in the same locality and who may share a common culture, values, and norms. Communities can also be defined by race, religion, ethnicity, age, occupation, political status, tribal affiliation, interest in particular problems or outcomes, or other common bonds. The term "community" encompasses worksites, schools, tribes, residential neighborhoods, business districts, recreational areas, and health and human service sites.


	SERVICE RECIPIENT The individuals, groups, organizations, or communities that use, receive, or benefit from programs and services. Service recipients can include consumers, patients, family members, legal guardians, advocates, public/private organizations, employers, and purchasers. All are regarded as significant stakeholders served in a variety of agencies and practice settings.


	SAMPLE A portion or representative percentage of a greater whole.


	CASE RECORD A written compilation that describes the client and the services delivered. Records can be in hard copy and/or electronic format. The case record can be used as a source of information for quality improvement or other evaluation activities, for research purposes, or to demonstrate accountability to funding bodies.


	MEDICATION A prescribed or over-the-counter drug that is injected, taken orally, applied topically, or otherwise administered.