Overview

The Medical Director, with input from members of the clinical team, determines if a person is eligible for unsupervised take-home medications based on specified criteria and length of time in the program.

Accreditation Requirement(s)

To conform to these standards, the organization must show evidence of the following:

• The policy and procedure specifies how eligibility is determined for take-homes.
• Criteria should include the rehabilitation status of the client, program attendance, absence of abuse of drugs, absence of behavioral problems at the clinic, absence of recent criminal activity, stability of the home and social relationships, assurance that medication can be stored safely, length of time in treatment, daily life schedule, any risk of diversion, and how reduced attendance is a benefit to the person's progress in treatment.
• The client should demonstrate an understanding of the risks of accidental poisoning of children and family members.
• The Medical Director has the final determination as to a client's eligibility for take-home medication.
• The amount of take-home medication is determined with the treatment team and does not exceed:
  
  
  • A single dose during the first 90 days of treatment
  • Two doses per week after the second 90 days of treatment
  • Three doses per week in the third 90 days of treatment
  • A 6-day supply in the remaining months of the first year of treatment
  • Two weeks supply after 1 year of continuous treatment
  • One month supply after 2 years of continuous treatment, with monthly visits

Implementation Tips

Some Implementation Tips provided, in part, by Robert Johnson at: www.accreditationnow.com.

• The Federal guidelines have become more liberal than the field has been accustomed to over the past 30 years. The intent of the CARF standards is not to mandate more liberalized take-homes but to allow treatment/medical discretion for take-homes up to a maximum limit.
  
  
• The intent of the standards is to provide medication for unsupervised use dependent on criteria that indicate the client has improved in his or her rehabilitative status over time in treatment. The benefits of take-homes and less frequent program attendance should outweigh the potential risk for diversion of methadone.
  
  
• The CARF standards do not require that methadone be picked up or stored in a locked box. However, that is the practice of many programs in order to assure safety.
  
  
• Some clinics have multiple-tiered processes for determining take-home requests, from the counselor's approval, Clinical Director's approval, and nurse's approval, to the physician's approval. Some clinics choose to discuss all take-home requests during the weekly treatment team meeting, where the multidisciplinary staff members are present. Whatever internal processes are utilized, the physician ultimately determines eligibility for take-homes and signs off on the appropriate documentation.
  
  
• Policies for take-homes should include special circumstances that include one time or temporary (usually not exceeding 3 days) for family or medical emergencies and other travel-related absences, which are a common practice. Should these exceptions be required when a person served is not otherwise eligible for reduced attendance, an exemption is required from the Center for Substance Abuse Treatment's Division of Pharmacologic Therapies and may be required by the state methadone authority.
  
  
• Unsupervised take-home medication should always be labeled with the name of the program, the address, and telephone number and packaged in conformance with Federal regulations.
  
  
• See Frequently Asked Questions related to take-home privileges at http://dpt.samhsa.gov/OTP_FAQs_4home.htm