Section 0940-05-42-.18 - DETOXIFICATION AND MEDICALLY SUPERVISED WITHDRAWAL(1) The Facility shall offer detoxification services as an admission alternative. All potential service recipients shall be offered long-term detoxification as an admission alternative; however, a Facility may choose to offer short-term detoxification for those service recipients who desire such a service.(2) No standardized routines or schedules of increases or decreases of medications may be established or used.(3) The program physician shall ensure onsite medical supervision and oversight of the detoxification program.(4) For persons projected to be involved in detoxification for six months or less, except as described in 0940-05-42-.17(9)(d), the Facility must offer the service recipient counseling as described in 0940-05-42-.14(3).(5) Exceptions or refusal to participate in the detoxification program shall be documented and tracked by the Facility.(6) The program physician shall determine on an individualized basis the appropriate dosage of opioid agonist medication to ensure stabilization during detoxification.(7) Urine and/or other toxicological screening instruments shall be used by Facility staff during detoxification in order to demonstrate the absence of use of alternative licit and/or illicit drugs.(8) In detoxification programs of 30 days or less duration, the Facility shall have a policy that does not allow more than one unsupervised or take-home medication per week for persons served. A Facility operating on a seven day per week basis (pursuant to 0940-05-42-.26) shall not allow take-home unsupervised-medications. This section shall not apply to detoxification programs conducted pursuant to Rule 0940-05-42-.17(9)(d) or administrative detoxification as defined in 0940-05-42-.18(12).(9) In detoxification programs of more than 30 days duration, the Facility shall have a policy that allows the persons served to have the opportunity for take-home medications.(10) The Facility shall have a policy regarding detoxification from opioid agonist medication that shall include: (a) Individualized determination of a schedule of detoxification that is: 1. Well tolerated by the service recipient; and2. Consistent with sound medical practices;(b) Implementation of a higher stabilizing dose if deemed medically necessary;(c) Assurances that voluntary detoxification shall be discontinued in the event of relapse and that provisions for maintenance treatment shall be made;(d) Evaluation and/or testing for pregnancy prior to detoxification; and(e) Provision for continuing care after the last dose of methadone or other treatment medication.(11) Counseling services provided in conjunction with detoxification services shall be designed to: (a) Explore other modalities of care including drug and alcohol treatment following detoxification or discharge;(b) Motivate the service recipient to continue to receive services or to develop a plan for recovery following discharge; and(c) Identify triggers for relapse and a coping plan for dealing with each, detailed and in writing and given to the service recipient prior to discharge. The plan shall be developed in conjunction with the service recipient.(12) In the event the service recipient becomes unable to pay for treatment, the Facility shall develop procedures for administrative detoxification or medically supervised withdrawal, including an appropriate time frame over which the procedure would take place. The schedule of withdrawal may be brief, less than 30 days if necessary. Such procedures shall include documentation of referral of the service recipient to alternative treatment resources. For persons involved in detoxification for 14 days or less, the Facility must offer a minimum of four counseling sessions per week.(a) The Facility shall develop policies and procedures clearly describing under what circumstances a service recipient may be subject to administrative withdrawal. Administrative withdrawal may result from:1. Non-payment of fees. The Facility shall make every effort to consider all clinical data including service recipient participation and compliance with treatment prior to initiating administrative withdrawal for non-payment. If the service recipient has a history of compliance and cooperation with treatment, the Facility shall document every effort to explore alternatives to administrative withdrawal with the service recipient prior to onset of withdrawal. If a service recipient has been in maintenance treatment for two years or more and subsequently cannot pay, the service recipient shall begin participation in a medically-supervised detoxification program for up to two weeks or as deemed medically necessary;2. Disruptive conduct or behavior considered to have an adverse effect on the Facility, staff or service recipient population of such gravity as to justify the involuntary withdrawal and discharge of a service recipient. Such behaviors may include violence, threat of violence, dealing drugs, diversion of pharmacological agents, repeated loitering, and/or flagrant noncompliance resulting in an observable, negative impact on the Facility, staff and other service recipients; or3. Other reasons as determined by the Facility and approved by the SOTA.(b) Medically supervised withdrawal occurs as a voluntary and therapeutic withdrawal agreed upon by staff and service recipient. In some cases the withdrawal may be against the advice of clinical staff (against medical advice).1. The Facility shall supply a schedule of dose reduction well tolerated by the service recipient.2. The Facility shall offer supportive treatment including increased counseling sessions and referral to a self-help group or other counseling provider as appropriate.3. If the service recipient leaves the Facility's program abruptly against medical advice, the Facility may readmit the service recipient within 30 days without a formal reassessment procedure. The Facility shall document attempting to assist the service recipient in any issues which may have triggered his or her abrupt departure.4. The Facility shall make provisions for continuing care for each service recipient following the last dose of medication and for re-entry to maintenance treatment if relapse occurs or if the service recipient should reconsider withdrawal.5. Female service recipients shall have a negative pregnancy screen prior to the onset of either administrative or medically-supervised withdrawal.(13) For detoxification or withdrawal, the Facility shall have in place a detailed relapse prevention plan developed by the counselor in conjunction with the service recipient and a copy of which shall be given to the service recipient prior to the administration of the final dose.Tenn. Comp. R. & Regs. 0940-05-42-.18
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.