16 Del. Admin. Code § 6001-III-11.0

Current through Register Vol. 28, No. 7, January 1, 2025

Section 6001-III-11.0 - Standards Applicable to Ambulatory Detoxification (Amdetox)

In addition to these standards, all programs providing Amdetox services shall be in full compliance with Federal Regulations regarding the dispensing and handling of all medications used in the detoxification of substance use disorders.

11.1 Services Required

11.1.1 In addition to the requirements applicable to all programs, an Amdetox program shall provide:

11.1.1.1 An initial screening, documentation of which shall include:

11.1.1.1.1 Verification of an applicant's identity, including:

11.1.1.1.1.1 Name;

11.1.1.1.1.2 Address;

11.1.1.1.1.3 Date of birth; and

11.1.1.1.1.4 Photographic identification.

11.1.1.1.2 Determination of current physiologic dependence and/or history of dependence upon opium, morphine, heroin or any derivative or synthetic drug of that group, in accordance with DSM criteria, by medical examination performed by qualified medical personnel.

11.1.1.1.3 Determination of current physiologic dependence and/or history of dependence on alcohol or other substances known to result in physical dependence in accordance with DSM criteria.

11.1.1.1.3.1 Documentation to support that determination shall include:

11.1.1.1.3.1.1 Qualified medical personnel statement that treatment is medically necessary;

11.1.1.1.3.1.2 The five-axis DSM diagnosis (most current DSM edition);

11.1.1.1.3.1.3 A description of behavior(s) supportive of a diagnosis of dependence;

11.1.1.1.3.1.4 Determination of the duration of substance dependence.

11.1.1.1.3.2 A physical examination by qualified medical personnel that shall:

11.1.1.1.3.2.1 Include documentation of the client's general appearance with a focus on the clinical signs and symptoms of addiction;

11.1.1.1.3.2.2 Document vital signs;

11.1.1.1.3.2.3 Include a complete medical history;

11.1.1.1.3.2.4 Include the client's family medical history;

11.1.1.1.3.2.5 Include medications currently being taken; and

11.1.1.1.3.2.6 Completed at admission.

11.1.1.1.3.3 Determination by qualified medical personnel that the person's history and current symptomatology support Amdetox as the most appropriate level of care.

11.1.1.1.4 Laboratory tests including serology and other tests deemed necessary by the program physician.

11.1.1.1.5 A biological test for pregnancy for all women of child-bearing age.

11.1.1.1.6 HIV testing should be encouraged, with the client's signed consent.

11.1.1.2 A client enrolled in an Opioid Treatment program or another Amdetox program shall not be permitted to enroll in treatment in any other Amdetox program except in exceptional circumstances as determined by the medical director. Exceptions shall be:

11.1.1.2.1 Noted in the client's record.

11.2 Admission procedures

11.2.1 In addition to the procedures described in § 8.1.2. Amdetox programs shall provide:

11.2.1.1 A medical care plan within twenty-four (24) hours of admission based on the findings of the physical examination in § 11.1.1.1.3.2.

11.2.1.2 Diagnostic assessment in accordance with § 8.1.2.1.7 within twenty-four (24) hours of admission.

11.2.1.2.1 An Initial Recovery Plan as derived by the diagnostic assessment in § 11.2.1.7 of these standards and the medical care plan in § 11.2.1.1 of these standards within twenty-four (24) hours of admission.

11.2.1.2.2 Recovery plan updates/revisions shall occur:

11.2.1.2.2.1 As needed based on the changes of intensity level of treatment for each client and:

11.2.1.2.2.1.1 No later than the seventh (7h) day; AND

11.2.1.2.2.1.2 Every seven (7) days thereafter.

11.2.1.3 Procedures for referral to a licensed hospital or residential detoxification program when a more or less intensive level of care is indicated.

11.3 Client Orientation

11.3.1 In addition to the requirements of § 8.1.2.1.4 the Amdetox program shall inform clients of:

11.3.1.1 The facts concerning the use of buprenorphine, naltrexone, chlordiazepoxide or other detoxification medications dispensed by the program, including, but not limited to:

11.3.1.1.1 An explanation of the interaction between the detoxification medication(s) dispensed by the program and other medications, and medical procedures;

11.3.1.1.2 Any potential adverse reactions, including those resulting from interactions with other prescribed or over-the-counter pharmacological agents, other medical procedures; and

11.3.1.1.3 The importance of notifying the client's primary care physician of their admission to and discharge from the program.

11.3.1.2 The facts concerning withdrawal from the use of, buprenorphine, naltrexone, chlordiazepoxide or other detoxification medications dispensed by the program, including, but not limited to:

11.3.1.2.1 Policies and procedures regarding voluntary, involuntary, and against medical advice withdrawal from detoxification medications;

11.3.1.2.2 An explanation of the potential interaction between withdrawal from the detoxification medication(s) dispensed by the program and other medications, medical procedures and;

11.3.1.2.3 Any potential adverse reactions as a result of withdrawal from detoxification medications, including those resulting from interactions with other prescribed or over-the-counter pharmacological agents, other medical procedures; and

11.3.1.2.4 The importance of notifying the client's primary care physician of withdrawal from the program.

11.4 Clinical Services

11.4.1 In addition to the requirements of § 8.0 the Amdetox program shall provide:

11.4.1.1 Individual counseling that shall include at least one (1) sixty (60) minute counseling session per week by a Counselor I or Counselor II.

11.4.1.2 Daily counseling contact by a Counselor I or Counselor II that shall include at a minimum:

11.4.1.2.1 One (1) fifteen (15) minute face-to-face or phone contact to:

11.4.1.2.1.1 Engage the client;

11.4.1.2.1.2 Help the client cope with withdrawal; and

11.4.1.2.1.3 Continue in ongoing treatment services.

11.4.1.2.2 Group Counseling that shall include at least two (2) ninety (90) minute counseling session per week.

11.4.1.2.3 The discharge plan outlined in § 8.1.2.1.13 and discharge summary outlined in § 8.1.2.1.14 of these standards.

11.4.1.2.4 Referral to a more or less intensive level of care as outlined in § 8.1.3 of these standards.

11.5 Administrative Procedures

11.5.1 In addition to the requirements of § 4.0 of these standards the Amdetox program shall develop policies and procedures that describe:

11.5.1.1 The program's medical/nursing monitoring schedule including:

11.5.1.1.1 Monitoring on the first day to determine the response to detoxification medication;

11.5.1.1.2 Monitoring of vital signs throughout the detoxification process;

11.5.1.1.3 Monitoring of symptom history within the most recent 24 hours.

11.5.1.2 The program's drug-screening procedure;

11.5.1.3 The program's Amdetox medication dispensing procedure;

11.5.1.4 The program's rules including non-compliance, and discharge procedures, to include:

11.5.1.4.1 Administrative detoxification medication withdrawal;

11.5.1.4.2 The signs and symptoms of overdose; and

11.5.1.4.3 When to seek emergency assistance.

11.5.1.5 The emergency procedures maintained by the program as required in § 5.1.4.4.1.21 shall be available whenever clients are present at the program.

11.5.1.6 The program shall have protocols developed and supported by a physician knowledgeable in addiction medicine setting forth:

11.5.1.6.1 The requirement for qualified staff to obtain waivers allowing qualified physicians to dispense or prescribe specifically approved Schedule III, IV, and V narcotic medications for the treatment of Opioid addiction in treatment settings other than the traditional Opioid Treatment Program (i.e., methadone clinic) in accordance with the Drug Addiction Treatment Act of 2000 (DATA 2000.)

11.5.1.6.2 A medication policy that complies with § 5.1.4.4.1.19 and includes:

11.5.1.6.2.1 Induction protocols and policies for:

11.5.1.6.2.1.1 Day one (1) and day two (2) of Opioid detoxification;

11.5.1.6.2.1.2 Day three (3) of Opioid detoxification and forward.

11.5.1.6.2.2 Induction protocols and policies for all other medications used in detoxification.

11.5.1.6.2.3 Stabilization that includes:

11.5.1.6.2.3.1 Documentation and rationale for changes in medication dosage;

11.5.1.6.2.3.2 Average length of stay criteria; and

11.5.1.6.2.3.3 Criteria for linkage to outpatient treatment.

11.5.1.6.2.4 Protocols for the decrease and/or discontinuance of detoxification medications to include:

11.5.1.6.2.4.1 Protocols for decreasing or discontinuing detoxification meds when the client requests;

11.5.1.6.2.4.2 Protocols for decreasing or discontinuing when the program determines that maximum benefit has been achieved; and

11.5.1.6.2.4.3 Protocols for decreasing or discontinuing when being administratively discharged or if the client chooses no further treatment.

11.5.1.6.2.5 The protocol staff should follow to respond to medical complications throughout the detoxification process.

16 Del. Admin. Code § 6001-III-11.0

14 DE Reg. 471 (11/01/10)