More on methadone take‐home changes in SAMHSA final rule

Abstract

The American Association for the Treatment of Opioid Dependence (AATOD) hosted two webinars on the final rule for opioid treatment programs, both of which we covered (see tk and tk). One of the key provisions is changes in take‐homes. The changes incorporate flexibilities of the COVID‐19 era, in which more take‐homes were allowed to limit the exposure of patients and staff to the virus. The new rule allows for up to seven days of take home doses during the first 14 days of treatments, and up to 14 doses up from 15 days of treatment and 28 take home doses from 31 days in treatment.” This month AATOD president Mark Parrino commented on various aspects of the rule, which he supports in general, to clarify the role of the OTP. Always the undercurrent exists that the OTP has full liability for any mishaps. And this is codified in the rule, which states: “The requirement that OTPs maintain procedures to protect take home from theft and diversion is finalized as well as patient education on safe transport and storage of take home doses, including documentation of the provision of this education and the patient's clinical record.” Parrino says: “To be clear, the OTP clinician makes the final determinations of who is eligible to receive take home medication. While toxicology reports should not be used punitively, they should be employed in providing objective information to the clinician within the OTP as to best ascertain who is most capable of handling take home medication at such early stages of treatment. We have stated this throughout our commentary on regulatory oversight of take home medication. There must be a balance in providing flexibility to the patients in order to retain the patients in treatment against the safety of providing such take home medication to an unsupervised individual. While we have learned that there is increased safety in providing such take home to patients as a result of the COVID‐19 experience, it does not relieve the OTP using careful balancing standards in order to provide safety and flexibility.”