1. (1) Random urine drug screening or other adequately tested toxicological procedures shall be used for the purposes of assessing the service recipient’s progress in treatment.
2. (2) Drug screening procedures shall be individualized and shall include at least an initial observed drug screen for newly admitted service recipients, then a weekly drug screen during the first thirty (30) days of treatment, and at least eight (8) drug screens annually thereafter. In addition to the initial observed drug screen, the patient shall receive at least one
3. (1) random observed drug screen annually.
4. (3) Service recipients whose drug screen results are unfavorable, or otherwise indicate treatment instability, shall be notified of the drug screen result within seventy-two (72) hours and receive a randomized drug screen at least every two (2) weeks, for a minimum of twenty- eight (28) days from the date of receiving the result of most recent unfavorable drug screen.

5. (4) Each sample collected shall be screened to include, but not be limited to:

   1. (a) Opioids, including synthetic opioids;
   2. (b) Methadone, buprenorphine, or any other treatment medication used by the Facility’s program, as applicable;
   3. (c) Benzodiazepines;
   4. (d) Cocaine;
   5. (e) Methamphetamine/amphetamines; and
   6. (f) Other drugs as indicated by individual service recipient use patterns, community standards, regional variation, or clinical indication (e.g., THC, carisoprodol, barbiturates) or as directed by the SOTA.
6. (5) Collection and testing shall be done in a manner that assures that specimens collected from service recipients are unadulterated. In the case of urine collection, such collection and testing shall include random direct observation conducted professionally, ethically, and in a manner which respects the service recipients’ privacy.
7. (6) A drug screen is considered unfavorable when the results indicate the presence of any drug or substances listed in Paragraph (4) of this rule that is illegal or for which the service recipient cannot provide a valid prescription or any drug or substance prohibited by the Facility or SOTA; the presence of medication which is documented as part of the service recipient’s treatment plan shall not be considered an unfavorable screen. Any refusal to participate in a random drug screen shall be considered an unfavorable screen. OPIOD TREATMENT PROGRAM FACILITIES

8. (7) Unfavorable drug screen results after the first six (6) months in a Facility shall result in the following:

   1. (a) Upon the first unfavorable drug screen result, the Facility shall contact the service recipient within seventy-two (72) hours of receiving the drug screen result and provide mandatory and documented weekly counseling, which shall include weekly meetings with a qualified counseling provider, either in person or via telehealth platforms, for a minimum of twenty-eight (28) days.

   2. (b) Upon a second unfavorable drug screen result within six (6) months of the first unfavorable drug screen result, the Facility shall:

      1. 1. Contact the service recipient within seventy-two (72) hours of receiving the drug screen result, provide mandatory and documented weekly counseling which shall include weekly meetings with a qualified counseling provider, either in person or via telehealth platforms, for a minimum of twenty-eight (28) days; and
      2. 2. Provide mandatory, in-person, documented treatment team meetings with the service recipient and review the service recipient’s ITP to ensure it is addressing the service recipient’s needs;

   3. (c) Upon a third unfavorable drug screen result within six (6) months of the second unfavorable drug screen result, the Facility shall:

      1. 1. Contact the service recipient within seventy-two (72) hours of receiving the drug screen result and provide mandatory and documented weekly counseling, which shall include weekly meetings with a qualified counseling provider, in-person, for a minimum of twenty-eight (28) days; and
      2. 2. Provide mandatory, in-person, and documented treatment team meetings with the service recipient, which shall include, at a minimum: a review of the ITP, a discussion related to the need for continuing treatment; a discussion of other treatment alternatives; and documentation on whether a referral to a higher level of care is appropriate.
9. (8) The Facility shall document both the results of drug screens and the follow-up therapeutic action taken in the service recipient’s medical record.
10. (9) The Facility shall work carefully with toxicology laboratories to ensure valid, appropriate results of toxicological screens.
11. (10) The Facility shall ensure that program providers demonstrate competence in recognizing factors that may contribute to “false negative” and “false positive” laboratory results.
12. (11) Absence of methadone or other medications ordered by the Facility for the service recipient shall be considered evidence of possible medication diversion and evaluated by the program provider accordingly.
13. (12) Nothing contained in this rule shall preclude any Facility from administering any additional drug screens it determines necessary.

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. Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025. OPIOD TREATMENT PROGRAM FACILITIES