$7.00 per dosing unless covered by your medical provider.
The primary target group for this program is the consumer who has a long-term pattern of opioid dependence. We understand that many of these individuals are also “addicted” to a variety of other substances. Our primary area of concern is to provide treatment to eligible individuals residing in the Eastern Region of North Carolina, particularly those who are being treated with Methadone. To this end, special policies are developed for coordination of care with substance abuse programs in the Eastern Region. The program adopts as its policy concerning eligibility, the recommendations in 21-CFR-291.505, and the “Guidance of the Use of Methadone In Maintenance and Detoxification Treatment of Narcotic Addicts” of March 1989. The program has available its eligibility requirements to interested clients, family, and other parties. The program eligibility requirements include those consumers who meet the accepted medical criteria of the DSM-IV diagnosis of Opioid dependence and the consumer became addicted at least 1 year before their treatment admission. This condition can be waived for the following consumers if clinically appropriate: 1. Pregnant women 2. Those released from incarceration in the last 6 months and 3. If the consumer was previously treated for Opioid dependence.
Screening, Evaluation, Admission, Treatment Planning, and Rejection
After authorization is received from the LME, the program’s Qualified and Independent Practitioners carry out Initial screening of all referrals to the I.V. Drug and Opioid Treatment Program. At this time an immediate needs assessment will be done. If the client is deemed to be in crisis and/or an emergency situation, s/he will be immediately triaged and attempts will be made to address their needs through program services. If necessary, other emergency services within the community will be accessed. Those individuals who do no state the use of opiate drugs will be referred to other appropriate treatment program, such as detox. The I.V. Drug and Opioid Treatment Program will schedule individuals who admit to a history of opiate abuse or dependence for an evaluation within 48 hours or less.
We believe that prospective clients should be given a complete assessment evaluation as expediently as possible. We realize, however, due to high demands for treatment, a waiting list for assessment evaluation is maintained when necessary.
We have developed a plan to provide services to those individuals on our waiting list for the I.V. Drug and Opioid Treatment Program. Upon client’s initial request for services s/he will be offered an individual session with one of our clinical counselors. This session will be offered within 48 hours of request. At this session pertinent data will be gathered from the client, treatment services explained, and early addictions treatment counseling conducted. If the client requests immediate and intensive intervention, a referral will be made to the Detox Unit and/or inpatient treatment unit. Additionally, a preliminary “needs” assessment will be done and referral to individual counseling every two weeks until admission to treatment. NA, AA lists will be given and attendance at these meetings recommended. Following the session with the clinical counselor, HIV/AIDS/HCV, TB and other blood-borne pathogen the program nurse will conduct education and counseling. TB treatment referral will be done, if necessary. Pregnant females will receive prenatal drug and alcohol education and a prenatal case referral will be made when needed.
REFERRAL TO OTHER TREATMENT OPTIONS:
Those clients who state a desire for more immediate intervention will be referred to other treatment modalities that may provide more rapid access to services as well as supportive care i.e. inpatient non-methadone treatment such as Walter B. Jones ADATC, our detoxification unit, and outpatient services such as ECU’s pain clinic, Narcotics Anonymous, Community Shelter, and when necessary to a private physician, therapist or counseling service.
Each client being considered for Methadone treatment will have an evaluation conducted by a program counselor. This assessment will entail a psychosocial summary, including family/social history, chemical use history, presenting problem/precipitant to treatment, treatment history, medical history, mental status exam, formulation of current status/problem, and initial diagnosis and/or diagnostic impression consistent with DSM-IV-criteria. It is essential that the client voluntarily agrees to participate in the treatment process.
Counselor will present summary of assessment to the Case Staffing Team within five working days of the assessment. The multi-disciplinary team present at the Case Staffing Meeting will consist of a physician, supervisor, practitioners, registered nurse, case manager and representation by outreach staff. This team will formulate appropriate treatment recommendations from intake, including appropriateness of Methadone maintenance treatment versus other treatment options for client, and recommendations for addressing other pertinent holistic client needs. Diagnosis shall be made following DSM-IV criteria.
Each client is expected to meet, at a minimum, the following requirements for maintenance treatment. These include:
- History of at least one year of continuous addiction.
- Evidence of current physiological dependence such as signs and symptoms of intoxication or withdrawal, a positive urine specimen (taken on assessment), and old or fresh needle tracks.
- History of failure of previous attempts to establish a drug free lifestyle.
- Individuals under the age of 18-years will be eligible for admission only if they have experienced at least two documented unsuccessful attempts at short-term detoxification, or drug-free treatment
**Any exceptions will be in accordance to State and Federal guidelines.
Minimum Standards for Detoxification/Tapering Treatment:
- Client will have been determined by physician to be currently physiologically dependent on narcotic drugs.
- If detoxification is to last longer than 21 days, the physician shall document in record that short-term detoxification is not sufficiently long enough to provide client with program services s/he requires per rehabilitation. The physician shall document this information in client’s record prior to start of long-term detox.
- Client is required to wait at least 7 days between concluding a longer-term detox treatment episode and beginning another.
When the case review team recommends Methadone Treatment for the evaluated client, s/he will then be admitted to the I.V. Drug Methadone Program. At this time the client’s chart will be opened and Form B activated. Priority will be given to clients who are Pregnant, HIV positive, and who have other serious medical/psychiatric condition(s).
History and Physical Examination:
Prior to being admitted to the Methadone Program the physician will assess the client to ensure that s/he has voluntarily chosen opioid treatment and understands the facts concerning the use of opioid treatment medication. When this information is verified, the client being admitted will have a thorough history and physical exam including a history of narcotic dependence as well as evidence of current physical dependence completed by the staff physician. This documentation will include a mental status exam, diagnosis, and the presence of infectious diseases, and organ abnormalities, vital signs; immediate care plan, and pertinent medical and health findings. If other medical/treatment personnel treat the client, care will be coordinated with these individuals provided the client consents to such referral(s). The above documentation will be completed prior to medication being administered.
Methadone Evaluation, Blood Work, TB Testing
- Methadone evaluation: The program nurse will evaluate clients being admitted to the Methadone Treatment Program. This assessment will include vital signs, history of allergies, information on medications currently prescribed to the client, infectious disease screening that are related to HIV/AIDS, STD’s, TB, and other blood-borne pathogens, and an evaluation for signs and symptoms of opiate withdrawal. History of present illness will be gathered during this evaluation. Please refer to Appendix B for a copy of form CMHC 1 – 50 – 80 (Methadone Evaluation), and for form entitled Infectious Disease Screening. . If other medical/treatment personnel are treating the client, care will be coordinated with these individuals provided the client consents to such referral(s).
- Blood Work: Upon admission the physician will order routine blood work and the client will be sent to the Spectrum Lab in Greenville, NC. This includes standing chemistry panel, CBC, RPR, Thyroid panel, urinalysis, and Hepatitis C.
- TB Testing: Clients admitted to the program will be tested for TB on the day of admission. If client tests positive for TB, s/he will be referred to the Health Department for appropriate follow-up. If client has a history of having a positive reaction s/he will be screened as to treatment history and a form will be signed and witnessed by the client and nurse doing the screening. Testing and screenings are done annually.
- Initial Methadone Dose: The initial dose of Methadone administered to a client will be determined by the staff physician in accordance with Federal Guidelines (30mg – 40mg on the day of admission)
- Initial Urine Screen: All admissions will be given a urine drug screen prior to receiving initial dose. The cost will be $10.00 for initial and all subsequent UDS taken while in treatment at this center
- Consent for Methadone Treatment, Medication Education, Information regarding Program: Consent for Methadone: Upon admission the program nurse will review and have client sign the Methadone consent form AP 4 – 02A – 90
- Information on Methadone: Upon admission program nurse will give client medication education concerning the effects and side effects of Methadone. S/he will be given the Methadone Information sheet (see Appendix G).
- Information regarding Program: Upon admission client will be given program information, including rules and behavioral expectations, medication hours, group schedule, and clients rights and responsibilities booklet.
- PORT Human Services policies require that a treatment plan be developed for every client upon admission. This plan will address short and long-term goals, specific behavioral tasks, educational, vocational, and employment requirements, recommendations for medial, psychosocial, economic, legal, and other support services, level, duration, and frequency of services needed, and outcome indicators. This plan will be reviewed by staffing team every ninety days for the first year, and thereafter every six months. The initial recommendations for the treatment plan will be done at a multi-disciplinary staffing within seven days of the admission following the review of the admission assessment. The client will be involved in the development of his/her treatment plan.
- When necessary BNI (brief network interventions) will be implemented with his/her consent to address the client’s needs via contact with family members and significant others in order to enhance treatment-planning goals.
- The Methadone-Advocacy group meets on the third Thursday of each month to provide peer support and self-help services to the client. This group comprise of the clients themselves and one Methadone staff member chosen by the group. This staff acts as a liaison between the clients and administration.
- The I.V. Drug Program Counselors will normally be the primary therapists for all clients enrolled in the program. Exceptions may be made for individuals who have another individual as their primary therapist for a particular reason. The primary therapist has the main responsibility for maintenance of the record and completion of the treatment plan and termination summary.
Rejection of Admission:
The case review team may decide not to admit a client to the I.V. Drug Program when s/he is determined as not being appropriate for Methadone Treatment. Such cases may include individuals who do not meet eligibility requirements, refuse to accept treatment recommendations, or whose primary and immediate needs are for some alternative treatment program. The I.V. Drug and Opioid Treatment Program will help facilitate a screening appointment with the recommended treatment program when indicated. When client is not admitted to the I.V. Drug and Opioid Treatment Program a chart will not be opened on the client. An I.V. Drug and Opioid Treatment Program screening note and progress note containing case staffing team decision and recommendations will be completed per inclusion into the client’s chart.