	Opioid Treatment

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

PA-OTP 15: Withdrawal

Individuals participate in the development of an appropriate withdrawal schedule and receive the necessary support to prevent relapse.

PA-OTP 15.01

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).

PA-OTP 15.02

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.

PA-OTP 15.03

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.

Interpretation: 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.

Interpretation: 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.

QUICK JUMP TO


	PURPOSE: Individuals who participate in Opioid Treatment Programs improve social, emotional, and vocational functioning, achieve optimal productivity, and attain the recovery they seek.

RELATED FILES


	PROGRAM A system of services offered by an organization. For example, an organization providing a mental health service may offer several mental health programs to different populations, e.g., a mental health program for adolescent teens. The word "program" can be used interchangeably with the word "service" or to describe specific programs.


	MEDICATION A prescribed or over-the-counter drug that is injected, taken orally, applied topically, or otherwise administered.


	PRACTICE Established actions or ways of proceeding in the regular performance of organizational duties. Policies and procedures often guide practice.


	ASSESSMENT An evaluation, which utilizes professional expertise and skills in the collection and analysis of data to understand and describe the nature of service needs of an individual, family, or group. Assessment, as in needs assessment, is also used to determine priorities of program planning and service development for the organization as a whole. See also DIAGNOSIS.


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	CASE A general term used to designate clients (including individuals, families, and groups) served by an organization for purposes of monitoring the provision of services. A foster care case is generally based on the placement of an individual child, although casework for the child may include services to the child's family. A child protective services case is based on an entire family household if a family assessment model is used; otherwise a case is defined as a child.


	CASE RECORD A written compilation that describes the client and the services delivered. Records can be in hard copy and/or electronic format. The case record can be used as a source of information for quality improvement or other evaluation activities, for research purposes, or to demonstrate accountability to funding bodies.


	CLINICAL The study, assessment, and diagnosis of the client situation followed by direct treatment to help the client achieve prescribed goals.


	DISCHARGE See CASE CLOSING