Section 0940-05-42-.17 - DRUG SCREENS(1) Random urine drug screening and other adequately tested toxicological procedures shall be used for the purposes of assessing the service recipient's abuse of drugs and evaluating a service recipient's progress in treatment.(2) Drug screening procedures shall be individualized and shall include at least weekly random drug screens for newly admitted service recipients during the first 30 days of treatment and at least monthly thereafter.(3) Service recipients on a monthly schedule whose drug screen reports indicate drug abuse shall be returned to a weekly schedule for at least two weeks, or longer, if clinically indicated.(4) More frequent collection and analysis of samples during medically-supervised or other types of withdrawal may occur.(5) Collection of observed specimens on an unannounced basis when using urine as a screening mechanism may occur if the staff believes that observation is necessary based on service recipient behavior or need.(6) Each sample collected shall be screened to include, but not be limited to: (a) Opioids including synthetics at common levels of dosing;(b) Methadone or any other medication used by the Facility's program as an intervention for that service recipient;(e) Meth-amphetamine/amphetamines;(f) Tetrahydrocannabinol (THC); and(g) Other drugs as indicated by individual service recipient use patterns, community standards, regional variation or clinical indication (e.g., carisoprodol, barbituates) or drugs that are heavily used in the locale of the service recipient or as directed by the SOTA.(7) Collection and testing shall be done in a manner that assures that urine collected from service recipients is unadulterated. Such collection and testing may include random direct observation conducted professionally, ethically and in a manner which respects service recipients' privacy.(8) Positive Test. Any refusal to participate in a random drug test shall be considered a positive test. A positive test is a test that results in the presence of any drug or substances listed in section (6) of this rule that is illegal or for which the service recipient cannot provide a valid prescription or any drug or substance prohibited by the opioid treatment program or SOTA; the presence of medication which is documented as part of the service recipient's treatment plan shall not be considered a positive test.(9) A positive drug test result after the first six months in an opioid treatment program shall result in the following: (a) Upon the first positive drug test result, the opioid treatment program shall:1. Provide mandatory and documented weekly counseling, which shall include weekly meetings with a counselor who is qualified by training, education and/or two years' experience in addiction treatment under appropriate clinical supervision; and2. Immediately revoke the take-home privilege for a minimum of 30 consecutive days;(b) Upon a second positive drug test result within six months of the first positive drug test result, the opioid treatment program shall:1. Provide mandatory and documented weekly counseling which shall include weekly meetings with a counselor who is qualified by training, education and/or two years' experience in addiction treatment under appropriate clinical supervision;2. Immediately revoke the take-home privilege for a minimum of 30 consecutive days; and3. Provide mandatory documented treatment team meetings with the service recipient;(c) Upon a third positive drug test result within six months of the second positive drug test result, the opioid treatment program shall:1. Provide mandatory and documented weekly counseling, which shall include weekly meetings with a counselor who is qualified by training, education and/or two years' experience in addiction treatment under appropriate clinical supervision;2. Immediately revoke the take-home privilege for a minimum of 30 consecutive days; and 3. Provide mandatory and documented treatment team meetings with the service recipient which shall include, at a minimum: the need for continuing treatment; a discussion of other treatment alternatives; and documentation that the service recipient has been advised that the service recipient may be discharged for continued positive drug tests; and(d) Upon a fourth positive drug test result within six months of the third positive drug test result, opioid treatment program shall:1. Through an assessment of the service recipient's IPP, address the on-going multi-drug use through increased group and individual counseling, intensive outpatient and residential clinical treatment. The treatment team shall consider each service recipient's condition and address the situation from an individualized clinical perspective;2. Immediately revoke the take-home privilege for a minimum of 30 consecutive days; and3. If the service recipient refuses recommended, more intensive levels of care, the service recipient shall be immediately enrolled in an individualized, medically supervised detoxification plan for up to two weeks, followed by immediate discharge from the opioid treatment program.(10) The Facility shall document both the results of toxicological tests and the follow-up therapeutic action taken in the service recipient record.(11) Treatment programs shall work carefully with toxicology laboratories to ensure valid, appropriate results of toxicological screens. Workplace testing standards are not appropriate for urine testing.(12) The Facility shall ensure that its physicians demonstrate competence in interpretation of "false negative" and "false positive" laboratory results as they relate to physiological issues, differences among laboratories, and factors that impact absorption, metabolism and elimination of opioids.(13) The program physician shall thoroughly evaluate a positive toxicological screen for any potentially licit substance such as benzodiazepines, carisoprodol, barbiturates and amphetamines. The Facility shall verify with appropriate releases of information that:(a) The service recipient has been prescribed these medications by a licensed prescriber for a legitimate medical purpose; and(b) The prescribing physician is aware that the service recipient is enrolled in an opioid treatment program.(14) If the service recipient refuses the release of information to contact his or her physician but can produce prescriptions and/or other evidence of legitimate prescription (such as current medication bottles, fully labeled), the team shall consider the service recipient's individual situation and the possibility that he or she may be dismissed from the care of his or her physician if the physician discovers that the service recipient is in medication-assisted treatment. The program physician shall make the ultimate decision as to the service recipient's continuing care in the clinic and the circumstances of that care.(15) Absence of methadone or other medications prescribed by the Facility for the service recipient shall be considered evidence of possible medication diversion and evaluated by the physician accordingly.(16) As appropriate and necessary, the SOTA shall develop guidelines for frequency of toxicological screening for alternative treatment modalities such as buprenorphine.(17) The Facility shall access the PMP:(a) Upon admission of a service recipient;(b) Before the initial administration of methadone or other treatment in an opioid treatment program;(c) After any positive drug test for prescription medication;(d) Every six months to determine if controlled substances other than methadone are being prescribed for the service recipient. The service recipient's record shall include documentation of the check of the PMP database and the date upon which it occurred; and(e) Each PMP access shall confirm that the service recipient is not seeking prescription medication from multiple sources.(18) Nothing contained in this rule shall preclude any opioid treatment program from administering any additional drug tests it determines necessary.Tenn. Comp. R. & Regs. 0940-05-42-.17
Original rule filed September 20, 2012; effective December 19, 2012.Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404.