Rule 111-8-53-.15 - Narcotic DrugsPrograms shall develop and implement written policies and procedures for prescription and administration of narcotic drugs and their security. These policies and procedures must include the following:
(a) Administration. 1. The program physician shall determine the patient's initial and subsequent dose and schedule. If the program physician did not perform the medical assessment required in Rule 111-8-53-.12, the program physician must consult with the person who performed the assessment before determining the patient's initial dose and schedule. The program physician shall communicate the initial and subsequent doses and schedule to the pharmacy or the person supervising medication. The program physician may assign such dose and schedule by verbal order; however, the program physician must confirm all such orders in writing within 72 hours.2. Individual doses shall be based on the clinical judgment of the program physician who has personally reviewed the patient's record and who has considered all available relevant information, including, but not limited to, drug screens, quantitative levels of methadone and related drugs, patient interview, and specific circumstances pertaining to the individual patient.3. A program shall maintain current procedures that are adequate to ensure that the following dosage form and initial dosage requirements are met: (i) Methadone shall be administered or dispensed only in oral form and shall be formulated in such a way as to reduce its potential for parenteral abuse;(ii) For each new patient enrolled in a program, the initial dose of methadone shall not exceed 30 milligrams and the total dose for the first day shall not exceed 40 milligrams, unless the program physician documents in the patient's record that 40 milligrams did not suppress opiate abstinence symptoms; and(iii) For the use of any other approved opioid agonist treatment medication, the program shall ensure that the dosage form and initial dosage requirements are in accordance with currently accepted standards of treatment.4. Patients are stabilized on methadone or a related drug when they are receiving a therapeutic dose that is sufficient to stop opioid use and sufficient to keep the patient comfortable for at least 24 hours with no need to resort to illicit opiates to satisfy opiate cravings.5. The dose must either be administered by a licensed medical professional authorized by law to do so or be self-administered by the patient while under the supervision of a licensed medical professional. No methadone or any other drug may be administered unless the applicant has undergone all of the screening and admission procedures required, unless there is an emergency situation that is fully documented in the records. In that case, intake procedures must be completed on the next working day. No take-home medication may be given in such an emergency.6. The program shall be responsible for ensuring that all dosages are within therapeutically acceptable limits;(b) Any narcotic drug prescribed and administered shall be documented on an individual medication administration record that is maintained on site and stored when complete in the patient's clinical record. The record must include: 5. Route of administration;6. Date and time administered; and7. Signed documentation of staff administering medication or supervising self-administration;(c) Take-home doses of methadone shall be handled in accordance with applicable rules of SAMHSA or other applicable federal agency. A narcotic treatment program shall permit take-home doses of methadone according to these rules and the following restrictions: 1. During the first 90 days of treatment for a patient, the take-home supply shall be limited to a single dose per week, not to include any single take-home supply given to the patient for a day that the clinic is legitimately closed for business, including Sundays and state and federal holidays;2. During the second 90 days of treatment for a patient, the take-home supply shall be limited to two doses per week, not to include any single take-home supply given to the patient for a day that the clinic is legitimately closed for business, including Sundays and state and federal holidays;3. During the third 90 days of treatment for a patient, the take-home supply shall be limited to three doses per week, not to include any single take-home supply given to the patient for a day that the clinic is legitimately closed for business, including Sundays and state and federal holidays;4. During the remaining months of the first year of treatment for a patient, the take-home supply shall be limited to no more than a six-day supply;5. After one year of continuous treatment for a patient, the take-home supply shall be limited to no more than a two-week supply; and6. After two years of continuous treatment for a patient, the take-home supply shall be limited to no more than a one-month supply, provided that the patient makes at least one visit per month;(d) Adverse drug reaction and medication administration errors must be documented and reported to a program physician immediately and corrective action initiated. The adverse reaction or error also must be recorded in the drug administration record and the nurse progress notes and the Medical Director must be alerted;(e) No drug shall be dispensed or administered except upon receipt of a medication drug order written by a licensed medical practitioner granted rights to prescribe such medication under the Rules and Regulations of the Georgia State Board of Pharmacy, Chapter 480-18-.07;(f) All medications must be appropriately stored in a locked safe when not being administered or self-administered; and(g) Emergency medications, such as NARCAN or other medically appropriate emergency narcotic antagonists, must be kept available for appropriate use.Ga. Comp. R. & Regs. R. 111-8-53-.15
O.C.G.A. §§ 26-5-2et seq., 31-2-5, 31-2-7.
Original Rule entitled "Narcotic Drugs" adopted. F. Sep. 9, 2013; eff. Sept. 29, 2013.Amended: F. Feb. 15, 2018; eff. Mar. 7, 2018.