1. (a) Programs seeking licensure as an opioid treatment program shall in addition to the General Standards meet the requirements of the standards listed in this section.
2. (b) The Division of Aging, Adult, and Behavioral Health Services of the Department of Human Services, Office of Alcohol and Drug Abuse Prevention has developed these standards specifically for the administration of opioid treatment programs in Arkansas.

3. (c)

   1. (1) The goal of opioid treatment is total rehabilitation of the client.

   2. (2)

      1. (A) While eventual withdrawal from the use of drugs, including methadone/buprenorphine, may be an appropriate treatment goal, some clients may remain on opioid maintenance for relatively long periods of time.
      2. (B)

4. (i) Periodic consideration of withdrawing from methadone/buprenorphine maintenance is appropriate only if it is in the individual client’s interest.

   1. (ii) Such considerations are between the client and the treatment program.

      1. (C) The program shall be progressive in nature, addressing the client’s individual need with methadone/buprenorphine as only one component of comprehensive treatment services.

         1. (d)
   2. (1) The program shall make records available to the office upon request.
   3. (2) In addition, access by the Center for Substance Abuse Treatment and the United States Drug Enforcement Administration is also allowed for determination of compliance with Center for Substance Abuse Treatment and United States Drug Enforcement Agency regulations.

5. (e) Applicant screening.

   1. (1) Applicant screening shall be extensive and thorough and shall form the basis for effective, long-term treatment planning.

   2. (2) It shall include a staff assessment as to:

      1. (A) Appropriateness of treatment;
      2. (B) That admission is voluntary; and

      3. (C) The client understands the:

         1. (i) Risks;
         2. (ii) Benefits; and
         3. (iii) Options.

   3. (3)

      1. (A) Prescription methadone is a highly addictive substance and entry into a program is a critical decision for both the client and the program.
      2. (B) Before admitting an applicant to methadone treatment, the program shall satisfy itself that the applicant fully understands the reasons for and ramifications of administrative detoxification and that the applicant voluntarily enters the program with that knowledge.

6. (f) Admission criteria.

   1. (1) The program shall verify the applicant’s:

      1. (A) Name;
      2. (B) Address;
      3. (C) Date of birth; and
      4. (D) Other critical identifying data.

   2. (2)

      1. (A) The program shall document a one-year history of addiction and current physiological dependence.
      2. (B) A one-year history of addiction means a period of continuous or episodic addiction for the one-year period immediately prior to application for admission to the program.

      3. (C) Documentation may consist of the applicant’s past treatment history, with presence of clinical signs of addiction, such as:

         1. (i) Old and fresh needle marks;
         2. (ii) Constricted or dilated pupils; or
         3. (iii) An eroded or perforated nasal septum.

   3. (3)

      1. (A) For applicants who are under the age of eighteen (18), the program shall document two (2) unsuccessful attempts at drug-free treatment prior to being considered for admission to a program.
      2. (B) Note. No person under the age of eighteen (18) years of age shall be admitted to maintenance treatment unless a parent, legal guardian, or responsible adult designated by the relevant state authority consents in writing to such treatment.
   4. (4) The program shall give admission priority to pregnant women.

   5. (5)

      1. (A) The Medical Director may refuse treatment with a narcotic drug to a particular client if, in the reasonable clinical judgment of the Medical Director, the client would not benefit from such treatment.
      2. (B) Prior to such a decision, appropriate staff may be consulted, as determined by the Medical Director.

   6. (6) Upon admission, the program shall:

      1. (A) Obtain the applicant’s signature on a voluntary agreement admitting the applicant to the program;

      2. (B)

         1. (i) Verify the applicant’s identification, including name, address, date of birth, and other critical identifying data from a social security card, birth certificate, driver’s license, etc.
         2. (ii) Copies of this identifying information shall include social security card and official photo identification and will become a part of the client’s record;

      3. (C)

         1. (i) Obtain a complete medical history from each client being admitted to treatment.
         2. (ii) The medical and laboratory examination of each client shall include:
7. (a) (a) Investigation of the possibility of infectious disease and possible concurrent surgery problems;

8. (b) (b) The complete blood count and differential;

   1. (c) (c) Serological tests for syphilis;

      1. (d) (d) Routine and microscopic urinalysis toxicology screening for drugs;
9. (e) (e) Multiphase chemistry profile;
10. (f) (f) Intradermal tuberculin purified protein derivative (PPD) administered and interpreted; and

11. (g) (g) A chest x-ray, pap smear, biological test for pregnancy, or screening for sickle cell disease if the examining medical personnel request these tests.

    1. (iii)

12. (a)

    1. (1) (a)(1) The program shall not require a medical examination for a client transferring to a new program who received a medical and laboratory examination within three (3) months prior to admission to the new program.
    2. (2) (2) The program physician may request a medical and laboratory examination for a transferring client.

13. (b)

    1. (1) (b)(1) However, the new program physician shall have, as part of the transfer summary, a medical summary and statement from the client’s previous program that indicates a significant medical problem.

    2. (2) (2) The transferred record shall include copies of the previous examination prior to admission;

       1. (D)

          1. (i) Conduct and complete a counseling intake interview and develop a narrative psychosocial history within twenty-one (21) days of the client’s admission date.
          2. (ii) This psychosocial narrative shall form the basis for preparing future treatment plans;
       2. (E) Develop a written statement, signed by the Medical Director, that the applicant is competent to sign the voluntary agreement admitting them to the program; and
       3. (F) Verify that the client is not currently enrolled in another opioid treatment program.

14. (g) Readmission criteria.

    1. (1) Readmission to a program depends on whether a client who is seeking readmission previously withdrew from methadone on a voluntary basis or as a result of an administrative decision due to the client’s violation of program policies.

    2. (2) A client, treated and later voluntarily detoxified from methadone maintenance treatment, may be readmitted to the program without evidence to support findings of current physiological dependence up to two (2) years after discharge, if the:

       1. (A) Program attended is able to document prior opioid maintenance treatment of six (6) months or more; and
       2. (B) Admitting physician, in his or her reasonable clinical judgment, finds readmission to opioid maintenance treatment medically justified.

    3. (3)

       1. (A) Clients seeking readmission to a program after an administrative detoxification shall at a minimum wait thirty (30) days prior to applying for readmission.
       2. (B) If a program administratively detoxifies a client twice in a year, then the client shall wait twelve (12) months to reapply for readmission.

15. (h) Exceptions to minimum admissions requirements.

    1. (1) An applicant who has been residing in a correctional institution for one (1) month or longer may enroll in a program within fourteen (14) days before release or discharge or within six (6) months after release from such an institution without evidence of current physiological dependence on narcotics provided that prior to his or her institutionalization the client would have met the one (1) year admission criteria.

    2. (2)

       1. (A) A program shall place a pregnant applicant on a maintenance regimen if the applicant has had a documented narcotic dependency in the past and may be in direct jeopardy of returning to narcotic dependency, with its attendant dangers during pregnancy.

       2. (B) The applicant need not show evidence of current physiological dependence on narcotic drugs if a program physician certifies the pregnancy and, in his or her reasonable clinical judgment, justifies medical treatment.

          1. (i) Services to women.
    3. (1) The program shall test women of childbearing age for pregnancy at the time of admission unless medical personnel determine that the test is unnecessary.
    4. (2) In addition to federal laws and regulations regarding pregnant clients, the program shall implement written policies and procedures to ensure the accessibility of services to pregnant women.

    5. (3) The program shall:

       1. (A) Give priority to pregnant women in its admission policy; and
       2. (B) Arrange for medical care during pregnancy by appropriate referral, and verify that the client receives medical care as planned.
    6. (4) The program shall inform pregnant clients of the Child Abuse Prevention and Treatment Act in accordance with state and federal laws.
    7. (5) The program will have specific policies and procedures developed to educate pregnant clients of the dangers and effects that alcohol and illicit drug use has on the fetus.

    8. (6)

       1. (A) Conduct a special staffing with the entire treatment team to provide intensive case management for pregnant clients who are noncompliant with phase requirements.
       2. (B) The Medical Director will develop specific protocols to ensure the safety of the fetus.

16. (j) Treatment structure.

    1. (1) The program shall provide the client a full range of treatment and rehabilitative services.
    2. (2) The absence of the use of controlled substances, except as medically prescribed, social, emotional, behavioral, and vocational status, and other individual client needs shall determine the frequency and extent of the services.

    3. (3)

       1. (A) The assessment and treatment team shall consist of a Medical Director, medical staff, and counselors who shall assess the client’s needs and, with the client’s input, develop a treatment plan.
       2. (B) As part of developing a treatment plan, the client shall have input in establishing or adjusting dosage levels.
    4. (4) The assessment and treatment team shall staff each case at least once each thirty (30) days during the first ninety (90) days of treatment and at least once each ninety (90) days thereafter.
    5. (5) The Medical Director shall sign off on the initial treatment plan, when developed, and the comprehensive treatment plan on an annual basis.

    6. (6) Services to each client shall include individual, group, and family counseling at the following minimum levels:

       1. (A) Phase I.

          1. (i) Phase I consists of a minimum of a ninety-day period in which the client attends the program for observation daily or at least six (6) days a week.
          2. (ii) During the first ninety (90) days of treatment, the take-home supply is limited to a single dose each week.
          3. (iii)
17. (a) (a) Phase I requires at least four (4) hours of counseling per week.

18. (b) (b) The counseling sessions at a minimum shall consist of two (2) hours of group therapy sessions, one (1) hour of individual counseling, and one (1) hour of twelve-step/self-help meetings per week.

    1. (iv)
19. (a) (a) The assessment and treatment team and the client shall determine the client’s assignment of group therapy attendance.

20. (b) (b) The issues to be discussed in group therapy sessions shall, at minimum, consist of the following without limitation:

    1. (1) (1) Family or significant others;
    2. (2) (2) Living skills;
    3. (3) (3) Methadone maintenance;
    4. (4) (4) Peer confrontation;
    5. (5) (5) Positive drug screen;
    6. (6) (6) Educational training;
    7. (7) (7) Vocational training and/or employment; and

    8. (8) (8) Acquired immunodeficiency syndrome (AIDS) education as related to human immunodeficiency virus (HIV).

       1. (v)

21. (a) (a) Prior to a client moving to Phase II, the client shall demonstrate a level of stability as evidenced by the following:

    1. (1) (1) Absence of recent, i.e., past thirty (30) days, abuse of drugs, opioid or non-narcotic, including alcohol;
    2. (2) (2) Clinic attendance as required in Phase I;
    3. (3) (3) Absence of serious behavioral problems at the clinic;
    4. (4) (4) Absence of known criminal activity within the last thirty (30) days, e.g., drug dealing;
    5. (5) (5) Stability of the client’s home environment and social relationships;
    6. (6) (6) Length of time in comprehensive maintenance treatment;
    7. (7) (7) Assurance that take-home medication can be safely stored within the client’s home; and
    8. (8) (8) Whether the rehabilitative benefit the client derived from decreasing the frequency of attendance outweighs the potential risks of diversion.

22. (b) (b) In addition, the client shall provide assurance to the program regarding safe transportation and storage of take-home medication;

    1. (B) Phase II - Level 1.

       1. (i) A client admitted more than ninety (90) days and successfully completing Phase I shall attend the program no less than four (4) times weekly.

          1. (ii) The program may issue no more than two (2) take-home doses per week.
          2. (iii) A client must have continuous clean drug screens for the past thirty (30) days, while in Phase I, prior to advancement into Phase II - Level 1.
          3. (iv)
23. (a) (a) A client must spend a minimum of ninety (90) days in Phase II - Level 1.

24. (b) (b) Prior to a client moving to Phase II - Level 2, the client shall demonstrate a level of stability as evidenced by the following:

    1. (1) (1) Absence of recent, past sixty (60) days, abuse of drugs, opioid or non-narcotic, including alcohol;
    2. (2) (2) Clinic attendance as required in Phase II – Level 1;
    3. (3) (3) Absence of serious behavioral problems at the clinic;
    4. (4) (4) Absence of known criminal activity within the last sixty (60) days, e.g., drug dealing;
    5. (5) (5) Stability of the client’s home environment and social relationships;
    6. (6) (6) Length of time in comprehensive maintenance treatment;
    7. (7) (7) Assurance that take-home medication can be safely stored within the client’s home; and

    8. (8) (8) Whether the rehabilitative benefit the client derived from decreasing the frequency of attendance outweighs the potential risks of diversion;

       1. (C) Phase II - Level 2.

          1. (i) A client, admitted more than one hundred and eighty (180) days and successfully completing Phase II – Level 1, shall attend the program no less than three (3) times per week.
          2. (ii) The program may issue no more than three (3) take-home doses per week.
          3. (iii)
25. (a) (a) A client must spend a minimum of ninety (90) days in Phase II – Level 2.

26. (b) (b) Prior to a client moving to Phase II – Level 3, the client shall demonstrate a level of stability as evidenced by the following:

    1. (1) (1) Absence of recent, past ninety (90) days, abuse of drugs, opioid or non-narcotic, including alcohol;
    2. (2) (2) Clinic attendance as required in Phase II – Level 2;
    3. (3) (3) Absence of serious behavioral problems at the clinic;
    4. (4) (4) Absence of known criminal activity within the last ninety (90) days, e.g., drug dealing;
    5. (5) (5) Stability of the client’s home environment and social relationships;
    6. (6) (6) Length of time in comprehensive maintenance treatment;
    7. (7) (7) Assurance that take-home medication can be safely stored within the client’s home; and

    8. (8) (8) Whether the rehabilitative benefit the client derived from decreasing the frequency of attendance outweighs the potential risks of diversion;

       1. (D) Phase II - Level 3.

          1. (i) A client admitted more than two hundred and seventy (270) days and successfully completing Phase II – Level 2 shall attend the program no less than one (1) time per week.
          2. (ii) The program may issue no more than six (6) take-home doses at a time.
          3. (iii) A client must spend a minimum of ninety (90) days in Phase II - Level 3.
          4. (iv)
27. (a) (a) During Phase II - Level 1, a client shall attend at least two (2) hours of counseling, one (1) of which shall be individual, and two (2) self-help group meetings per week.

28. (b) (b) For the remainder of Phase II - Levels 2 and 3, the client, primary counselor, Medical Director, and other appropriate members of the treatment team shall determine a client’s counseling and self-help activities provided that the minimum level of service delivery shall be one (1) hour of counseling per month and one (1) self-help group meeting per week;

    1. (E) Phase III.

       1. (i) A client admitted more than one (1) year and successfully completing Phase II shall attend the program no less than one (1) time biweekly, not to exceed fifteen (15) calendar days.

          1. (ii) The program may issue no more than fourteen (14) take-home doses in fifteen (15) calendar days at a time.
          2. (iii) A client must have at least six (6) months of continuous clean screens while in Phase II, prior to advancement into Phase III.
          3. (iv)
29. (a) (a) The client, primary counselor, and Medical Director shall determine a client’s counseling and self-help activities provided that the minimum level of service delivery shall be one (1) hour of counseling per month and two (2) self-help group meetings per month.

30. (b) (b) The one (1) hour counseling may be either individual counseling or group therapy, as determined by staff and client;

    1. (F) Phase IV.

       1. (i) The program may provide a twenty-eight (28) day supply of methadone if a client admitted for two (2) years has successfully completed Phase III.

          1. (ii) A client must have at least twelve (12) months of continuous clean screens while in Phase III prior to advancement into Phase IV.
          2. (iii) Phase IV requires at least one (1) hour of counseling per month in addition to attendance at one (1) self-help group meeting per month as long as the client maintains a twenty-eight-day take-home medication status; and

       2. (G) Phase V.

          1. (i) During the above four (4) phases a client, in consultation with the assessment and treatment team, may elect to enter Phase V.
          2. (ii)
31. (a) (a) This phase implements the methadone detoxification plan.

32. (b) (b) The program physician determines the take-home dosage schedule for the client.

    1. (c) (c) The primary counselor determines the number of counseling sessions provided during this phase based on the clinical judgment of the primary counselor with input from the client.

       1. (iii) At the onset of Phase V, the client may require an increased level of support services, i.e., increased levels of individual, group counseling, etc.

          1. (iv) Prior to successful completion of Phase V, the primary counselor and client shall develop a plan that shall integrate the client into a drug-free treatment regimen for ongoing support.
          2. (v) The client’s use of controlled substances except as medically prescribed, deterioration of social, emotional, vocational, or behavioral status, and or other individual needs shall result in increased frequency and extent of treatment and rehabilitation services.
          3. (vi)

33. (a) (a)The program shall assess each client for referral, if appropriate, to:

    1. (1) (1) The Division of Workforce Services;
    2. (2) (2) Vocational training; and or
    3. (3) (3) Enrollment in school.

34. (b) (b) The program shall conduct a follow-up at least every thirty (30) days.

    1. (vii)
35. (a) (a) The assessment and treatment team and the client shall negotiate a methadone detoxification plan with potential target dates for implementation in Phase V.
36. (b) (b) Such a plan may be short-term or long-term in nature based on the client’s need and may include intermittent periods of methadone/buprenorphine maintenance between detoxification attempts.

37. (k) Special staffing.

    1. (1) The program shall conduct a special staffing to determine an appropriate response whenever a client has two (2) or more drug screenings in a one-year period that are positive for illicit drugs other than methadone/buprenorphine.

    2. (2)

       1. (A) The Medical Director shall use test results as a guide to change treatment approaches and not as the sole criteria to force a client out of treatment.
       2. (B) When using test results, the Medical Director shall distinguish presumptive laboratory results from definitive laboratory results.
    3. (3) Clients in Phase II – Level 3 having a positive drug screen for illicit drugs and alcohol will be placed in Phase II – Level 2 to be completed in its entirety prior to moving back to Phase II – Level 3.
    4. (4) Clients in Phase III or IV having a positive drug screen for illicit drugs and alcohol will be placed in Phase II - Level 3 to be completed in its entirety prior to moving back to Phase III.

    5. (5)

       1. (A) Patients who are noncompliant with all requirements of their current phase level(i.e. positive toxicology screens and unexcused dosing and counseling absences) shall result in a decrease in phase level and take-home dose privileges.

       2. (B) In addition, program staff must conduct a special staffing with the client present to determine corrective action protocol.

          1. (l) Program policies.

    6. (1) The program shall implement a written policy that states the program shall not deny treatment to a person based on:

       1. (A) His or her actual or perceived serostatus;
       2. (B) Human immunodeficiency virus (HIV)-related condition; or
       3. (C) Acquired immunodeficiency syndrome (AIDS).
    7. (2) Program staff shall receive yearly training on the subject of HIV and hepatitis C infection and treatment of HIV and hepatitis C infected clients.
    8. (3) The program shall have written policies for infection control, which are in compliance with the Centers for Disease Control and Prevention guidelines.

    9. (4)

       1. (A) The program shall provide AIDS education to clients and shall provide or refer clients for HIV pretest counseling and voluntary HIV testing.

       2. (B)

          1. (i) If the program does test for AIDS, it shall be with the informed consent of the client.
          2. (ii) The program shall ensure the provision of pre- and post-test counseling for the clients.
    10. (5) The program shall provide annual medical evaluations to clients as appropriate for dose-level serostatus and identified medical concerns.

    11. (6)

        1. (A) The program shall provide or refer clients for tuberculosis and sexually transmitted disease testing upon admission and at least annually thereafter.
        2. (B) However, programs shall not require clients to receive HIV/AIDS testing.

    12. (7) The program shall:

        1. (A) Develop written policies and procedures for continued treatment with methadone or buprenorphine in the event of an emergency or natural disaster;
        2. (B) Have hours which provide for early-morning or late-evening services to meet the needs of its client population;
        3. (C) Implement written policies and procedures to ensure positive identification of the client before methadone or buprenorphine is administered;

        4. (D)

           1. (i) Develop written policies regarding the recording of client medication intake and a daily methadone/buprenorphine inventory.
           2. (ii) These policies shall comply with the United States Drug Enforcement Agency, Arkansas State Board of Pharmacy, and Arkansas State Medical Board, as appropriate;

        5. (E)

           1. (i) Develop and implement written policies and procedures to contact other opioid treatment programs within a two hundred-mile radius to prevent duplication of services to an individual.
           2. (ii) The policy shall be in accordance with federal confidentiality regulations, 42 C.F.R. pt. 2;
        6. (F) Monitor a client’s progress and shall satisfy itself that the client is continuing to benefit from treatment; and

        7. (G)

           1. (i) Not use incentives or rewards or unethical advertising practices to attract new clients.
           2. (ii) This shall not forbid the program from rewarding clients that maintain exemplary compliance with program rules and their individualized treatment plans.

    13. (8)

        1. (A) The program has the right to randomly schedule telephone requests to clients who have take-home privileges requiring them to report to the treatment facility and to bring their remaining take-home medication with them.
        2. (B) At least twice annually, the program shall randomly select at least five percent (5%) of these clients who have take-home privileges for this purpose.
    14. (9) Programs shall be responsible for contacting the previous programs of transferring clients regarding such issues as their stability in treatment and take-home status before initiating take-home privileges for these clients.
    15. (10) To prevent relapse, programs shall place transferring clients with take-home privileges on an increased drug screening surveillance schedule for the first thirty (30) days after admission.
    16. (11) Client-to-counselor ratios shall not exceed forty to one (40:1).
    17. (12) Programs shall employ at least one (1) full-time medical doctor, as licensed to practice medicine in the State of Arkansas, for every three hundred (300) clients.
    18. (13) The Medical Director of an opioid treatment program will be ASAM certified, have documented references of working experience in an opioid treatment program, or have documented continuing education in addiction treatment.
    19. (14) The Medical Director will be available to the program on a continual basis, seven (7) days per week, twenty-four (24) hours per day.

    20. (15)

        1. (A) Direct observation shall be used in collecting urine specimens.
        2. (B) Observation shall be conducted professionally, ethically, and in a manner which respects clients’ privacy and does not damage the client-clinic relationship.
    21. (16) Random, periodic testing, including breathalyzer tests for alcohol, shall be done to ascertain use of other substances for clients with a history of abusing these substances.

    22. (17)

        1. (A) The program has policies and procedures that address the dangers associated with the use of benzodiazepines when taking methadone.

        2. (B)

           1. (i) This will include provisions for admission/discharge protocol for illicit use and obtaining a release of information with the prescribing physician's acknowledgement that the patient is also being prescribed methadone.
           2. (ii) The patient must sign and date an informed consent of the program's policy.
    23. (18) When appropriate, family involvement shall be requested through a consent form to release information to family members.
    24. (19) Each client whose daily dose is above one hundred milligrams (100 mg) is required to be under observation while ingesting the drug at least six (6) days per week irrespective of the length of time in treatment, unless the program has received prior approval from the State Authority.
    25. (20) In addition to federal reporting requirements, the program will have specific policies and procedures to report lost or stolen doses, theft and diversion, and fatalities of overdose to the Office of Alcohol and Drug Abuse Prevention per the incident reporting policy.

    26. (21) The program will have specific policies and procedures delineating staff access into the medication storage area or areas.

        1. (m) Exceptional take-home.

    27. (1)

        1. (A) Take-home medication exceptions must be approved in writing by the State Authority prior to dispensing.

        2. (B)

           1. (i) Exceptional take-homes will not normally be granted to Phase I, Phase II, Phase III, and Phase IV clients.
           2. (ii) Reasons for exceptional requests may include, but are not limited to the following:

38. (a)

    1. (1) (a)(1) A client is found to have a physical disability which interferes with his or her ability to conform to the applicable mandatory schedule.
    2. (2) (2) The client may be permitted a temporary or reduced schedule, provided the client is also responsible in handling narcotic drugs;

39. (b)

    1. (1) (b)(1) A client, because of exceptional circumstances such as illness, personal or family crisis, travel, or other hardship, is unable to conform to the applicable mandatory schedule, provided the client is also responsible in handling narcotic drugs.

    2. (2)

       1. (A) (2)(A) The rationale for the exception shall be based on the reasonable clinical judgment of the program’s physician.

       2. (B)

          1. (i) (B)(i) The client’s record shall document the rationale.
          2. (ii) (ii) The rationale is endorsed via the physician’s signature;
          3. (c)
    3. (1) (c)(1) If the program is not in operation due to the observance of an official state holiday, clients may be permitted one (1) extra take-home dose and one (1) fewer program visit per week on the day in which the holiday occurs.

    4. (2) (2) An official state holiday is the day on which state agencies are closed and routine state government business is not conducted; and

       1. (d)
    5. (1) (d)(1) In the event that a winter storm watch is issued by the National Weather Service, a three-day take-home dose may be dispensed.
    6. (2) (2) Additional days shall require State Authority approval.
    7. (3) (3) The State Authority retains the right to reduce or revoke the take-home dosing.
    8. (2) The dosing area or areas used will be a separate area that provides sufficient privacy to maintain confidentiality of the client’s identity and communication between staff and the client.
    9. (3) Any client receiving a one hundred milligram (100 mg) or larger methadone dose shall not be allowed exceptional take-home privileges unless approved via the State Methadone Authority.

    10. (4)

        1. (A) All requests for methadone take-home medication exceptions must be submitted to the State Methadone Authority in writing or through Substance Abuse Mental Health Services Administration/Center for Substance Abuse Treatment extranet.

        2. (B) Each request must document the following:

           1. (i) The name of the client for whom the request is made;
           2. (ii) The address, phone number, and social security number of the client;
           3. (iii) Date of admission;
           4. (iv) Date of last request;
           5. (v) Program number;
           6. (vi) The dates for the requested take home;
           7. (vii) The rationale for the exceptions;
           8. (viii) The current dosing amount;
           9. (ix) Date of last positive drug screen;
           10. (x) Current phase; and
           11. (xi) Medical Director’s signature.
        3. (C) These requests submitted in writing can be mailed, hand-delivered, or faxed to: Division of Aging, Adult, and Behavioral Health Services of the Department of Human Services Alcohol and Drug Abuse Prevention Director of Program Compliance and Outcome Monitoring 305 South Palm Street, Administration Little Rock, Arkansas 72205 FAX: (501) 686-9035
        4. (D) Patient exception requests must be submitted online via the Substance Abuse Mental Health Services Administration’s Opioid Treatment Program extranet site.

40. (n) Program security.

    1. (1)

       1. (A) Programs are subject to United States Drug Enforcement Administration regulations concerning the Registration of Manufacturers, Distributors, and Dispensers of Controlled Substances (Chapter II, 21 C.F.R. pts. 1301 – 1307).
       2. (B) Clients shall be physically separated from the narcotic storage and dispensing area.
    2. (2) The program shall not allow clients to congregate or loiter on the grounds or around the building or buildings wherein the program operates.
    3. (3) Entrances that have windows will be tinted or have coverings so the client's identity and confidentiality are protected from the view of the public.

41. (o) Client records. In addition to client record criteria, the opioid treatment program shall also contain:

    1. (1) Documents and test results as generated by activities on admission;
    2. (2) Client progress in treatment case notes;
    3. (3) Results of case staffing;
    4. (4) Results of drug screening tests; and
    5. (5) Such treatment plan reviews as required by 20 CAR § 433-311(b); and
    6. (6) Any other client-related material deemed appropriate by the program.

42. (p) Drug screening.

    1. (1) The program shall:

       1. (A) Complete an initial drug screening test or analysis for each client upon admission;

       2. (B)

          1. (i) Conduct new client drug screening weekly for the first three (3) months in treatment.
          2. (ii) The program may place a client who completes three (3) months of drug screening showing no indications of drug abuse on a monthly urine-testing schedule;
       3. (C) Implement procedures, including the random collection of samples, to effectively minimize the possibility of falsification of the sample; and

       4. (D)

          1. (i) Use drug screening as a clinical tool for the purposes of diagnosis and the development of treatment plans.
          2. (ii) After admission, the results of a single screening report shall not determine significant treatment decisions.
    2. (2) Clients on a monthly schedule for whom screening reports indicate positive results for drugs other than methadone shall return to a weekly schedule for a period of time clinically indicated by the physician.
    3. (3) The program shall analyze each sample for opiates, methadone, amphetamines, crack/cocaine, benzodiazepines, marijuana, and other drugs as may be indicated by clients’ use patterns.

    4. (4) Laboratories that perform the testing required under this rule shall be in compliance with applicable:

       1. (A) Federal proficiency testing and licensing standards; and
       2. (B) State standards.

43. (q) Dosage reporting requirements.

    1. (1)

       1. (A) The Medical Director may order methadone dosages in excess of one hundred milligrams (100 mg) but less than one hundred twenty milligrams (120 mg) only where medically indicated.
       2. (B) The Medical Director shall fully document the reasons for the dosage level and report such orders to the State Methadone Authority.
    2. (2) The Medical Director shall obtain prior written approval from the State Authority for methadone dosage orders in excess of one hundred twenty milligrams (120 mg).

44. (r) Take-home medication.

    1. (1)

       1. (A) The requirement of time in treatment is a minimum reference point after which a client may be eligible for take-home medication privileges.
       2. (B) The time reference does not mean that a client in treatment for a particular time has a specific right to take-home medication.

       3. (C)

          1. (i) Since the use of take-home privileges creates a danger of not only diversion, but also accidental poisoning, the Medical Director must make every attempt to ensure that take-home medication is given only to clients who will benefit from it and who have demonstrated responsibility in handling methadone.
          2. (ii) Thus, regardless of time in treatment, a Medical Director may, in his or her reasonable judgment, deny or rescind the take-home medication privileges of a client.
          3. (iii) Concurrently, the client shall provide assurance to the program that take-home medication can be safely transported and stored by the client for the client’s use only.
    2. (2) Warning labels identifying the dangers associated with the ingestion of methadone shall be placed on every take-home dose.

45. (s) 24-hour emergency services.

    1. (1) Clients shall have access to the program in case of an off-hour emergency.
    2. (2) The program shall maintain a twenty-four-hour emergency hotline with individuals designated as on-call to handle client emergencies.

46. (t) Transferring or visiting clients.

    1. (1) When a client transfers from one program to another, the transferring program shall send copies of the transferring client’s records to the licensed receiving program prior to admission.

    2. (2)

       1. (A) Transferring clients shall enter Phase I for a minimum of two (2) weeks.
       2. (B) With successful completion of Phase I, they enter the appropriate treatment phase.

    3. (3)

       1. (A) Individuals visiting the State of Arkansas who are part of a methadone treatment program, shall have their home program provide information to a licensed program prior to the individual’s arrival in the state.

       2. (B)

          1. (i) The Arkansas program shall provide qualified visiting clients up to twenty-eight (28) days of methadone medication.
          2. (ii) However, take-home privileges shall not be greater than the privileges accorded by the home program, and in no case for longer than six (6) days.

47. (u) Discharge procedures.

    1. (1) In order to remain in the program and to successfully move through treatment, clients shall be in compliance with program rules or risk administrative detoxification from methadone.

    2. (2) For the purpose of these standards, an infraction means:

       1. (A) Threats of violence or actual bodily harm to staff or another client;
       2. (B) Disruptive behavior;

       3. (C) Community incidents, such as:

          1. (i) Loitering;
          2. (ii) Diversion of methadone; and
          3. (iii) Sale or purchase of drugs;
       4. (D) Continued unexcused absences from counseling; and
       5. (E) Other serious rule violations.

    3. (3)

       1. (A) Clients may also be discharged for failure to benefit from the program.

       2. (B) When a program determines to discharge a client, the program shall provide a written statement containing:

          1. (i) The reason or reasons for discharge;
          2. (ii) Written notice of his or her right to request review of the decision by the program director or his or her designee; and
          3. (iii) A copy of the appeal procedures.
          4. (v) Community liaison and concerns.

    4. (1)

       1. (A) A program shall instruct clients not to cause unnecessary disruption to the community by loitering in the vicinity of the program or engaging in disorderly conduct or harassment.
       2. (B) The program may discharge clients who cause such disruption to the community pursuant to the standards.

    5. (2)

       1. (A) Each program shall provide the State Authority with a specific plan to avoid disrupting the community and the actions it shall take to ensure responsiveness to community needs.

       2. (B)

          1. (i) The plan will include forming a committee of representative members of the community.
          2. (ii) Such committee shall meet at least once annually.
       3. (C) Further actions include assigning a staff member to act as community liaison to establish an open dialogue between the community and the program administration.
       4. (D) Educational material shall be made available to the immediate community regarding the treatment of opioid addiction.

48. (w) Staff training.

    1. (1) In an effort to maintain quality care, the program shall develop a training plan for personnel that fosters consistency of care in accordance with rapidly evolving knowledge in the opioid treatment field.

    2. (2) The program shall develop a method of rapidly disseminating information about pharmacological issues and other advances in the field.

       1. (x) Record keeping and reporting requirements.
    3. (1) The program shall keep records and make such reports required by the United States Drug Enforcement Administration regulation on Records and Reports of Registrants, 21 C.F.R. pt. 1304.

    4. (2)

       1. (A) The program shall adhere to record keeping and reporting requirements of the Center for Substance Abuse Treatment, United States Department of Health and Human Services, 21 C.F.R. § 291.505(d)(13) [removed].

       2. (B) These records shall include but not be limited to:

          1. (i) Client care;
          2. (ii) Drug dispensing; and
          3. (iii) Client’s records.
    5. (3) The program shall provide other reports as required by the State Opioid Treatment Authority with records as required by the United States Drug Enforcement Administration and the Center for Substance Abuse Treatment regulations.
    6. (4) The program shall provide other reports as required by the State Opioid Treatment Authority.

49. (y) Client appeal rights.

    1. (1)

       1. (A) Decisions regarding a client’s treatment by staff are subject to appeal.

       2. (B)

          1. (i) The program shall develop appeal procedures that allow clients to directly appeal to the State Opioid Treatment Authority.
          2. (ii) The authority shall approve the procedures.
       3. (C) In addition, procedures shall include a provision that a central file of client appeals be maintained at the program site for review by the State Opioid Treatment Authority staff.
    2. (2) The program shall post a list of client’s rights in a conspicuous place for the public.

50. (z) Program appeal rights.

    1. (1) An entity may appeal the disapproval of an application or program closure by the State Opioid Treatment Authority.
    2. (2) Refer to Section 6.00 of Alcohol and Drug Abuse Prevention’s Rules of Practice and Procedure for the Appeal Process for Adverse Action.

51. (aa) Program closure.

    1. (1) Failure of the program to adhere to the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment/United States Drug Enforcement Administration regulations or standards of the State Authority may result in revocation of program approval and/or licensure.
    2. (2) The State Authority shall report programs recommended for closure to the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment/United States Drug Enforcement Administration for revocation of the right to receive shipments of narcotic drugs in accordance with 21 C.F.R. § 291.505(h) [removed].

Codification Notes: 291 of Title 21 of the Code of Federal Regulations and the provisions of that part cited in this section were removed by Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction, 66 Fed. Reg. 4,076 (Jan. 17, 2001). "ASAM" means the American Society of Addiction Medicine. "SMA" means State Methadone Authority. "SAMHSA/CSATEXTRANET" means Substance Abuse Mental Health Services Administration/Center for Substance Abuse Treatment extranet.