Individuals participate in the development of an appropriate withdrawal schedule and receive the necessary support to prevent relapse.
Medical withdrawal from opioid treatment medication is
- a voluntary and therapeutic process planned for by the individual and a physician; or
- conducted in response to an individual's request, but against medical advice (AMA).
Medical withdrawal practices include:
- dose reduction at a rate well tolerated by the person and in accordance with accepted medical practices;
- periodic assessments of mental status;
- an assessment for pregnancy for women of childbearing age;
- availability of counseling and other support services; and
- discontinuation of withdrawal and resumed maintenance therapy, in the event of impending relapse.
Interpretation: Individuals that undergo medically supervised withdrawal AMA:
- are provided with information about the risks of discontinuing treatment and information about and referral to alternative treatment programs;
- can be readmitted to the program within 30 days without repeating the initial assessment noted in OTP 3; and
- are considered for maintenance treatment when withdrawal fails.
In the case of a pregnant individual the organization should keep the agency providing prenatal care informed of the individual’s status consistent with privacy standards.
Reason for seeking discharge and steps taken to avoid discharge are noted in the case record.
When individuals are administratively discharged, the agency provides a humane withdrawal schedule and refers or transfers the person to a suitable, alternative treatment program, whenever possible.
Administrative discharges are usually involuntary and may occur for reasons such as nonpayment of fees, incarceration, or disruptive conduct or behavior resulting from violence, dealing drugs, repeated loitering, and flagrant noncompliance.
A suggested schedule for medically supervised withdrawal for administrative withdrawal is a minimum of 30 days with adjustments made depending on clinical
factors. Referral or transfer to an alternative treatment program is the preferred approach due to the short timeframe and poor prognosis for administrative withdrawal.