Section 325.14409. Methadone maintenance program; minimum standards for admission.

(1) Each person who is selected as a client for a methadone maintenance program, regardless of age, shall be  determined  by   a  staff physician to be currently physiologically dependent upon narcotics and shall have first become physiologically dependent at least 1 year before admission to methadone maintenance treatment. A 1-year history of  drug dependence   means  that   an  applicant   for admission to a methadone maintenance program has been continuously physiologically addicted  to   a narcotic for at least 1 year before admission to a program.

(2)   In determining current physiologic dependence, the physician shall consider signs and symptoms of intoxication, a positive urine specimen for a narcotic drug, and old or fresh needle marks. Other evidence of current physiologic dependence can be obtained by noting early signs  of withdrawal, such as  lacrimation,   rhinorrhea, pupilary dilatation, and piloerection, during the  initial   period  of  abstinence. Withdrawal signs may be observed during the initial period of hospitalization or while the person is an outpatient undergoing diagnostic evaluation, such as medical and personal history, physical examinations, and laboratory studies. Increased body temperature, pulse rate, blood pressure, and respiratory rate are also signs of withdrawal, but their detection may require inpatient observation. It is unlikely, but possible, that a person could be currently dependent on narcotic drugs without having a positive  urine  test for narcotics. Thus, a urine sample that is positive for narcotics is not a  requirement  for  admission  to  detoxification   or  maintenance treatment.

(3)     A  patient  who  has  been  treated  and  subsequently   detoxified  from methadone maintenance treatment may be readmitted to methadone   maintenance treatment without evidence to support findings of  current  physiologic dependence up to 6 months after discharge provided that prior methadone maintenance treatment of 6 months or more is documented from the program attended and that the admitting program physician, in his or her reasonable clinical judgment, finds readmission to methadone maintenance treatment to be medically justified. For patients meeting these criteria, the quantity of take-home medication shall be determined in the reasonable clinical judgment of the program physician, but in no case shall the quantity of take- home medication be greater than would have been allowed at the time that person terminated previous treatment. Documented evidence  of prior treatment and evidence of all other findings and criteria  used  to determine such findings shall be recorded in the patient's chart by the admitting program physician or program personnel under supervision of  the

admitting program physician. The admitting program  physician  shall   date and sign the recordings or date, review, and countersign such recordings in the patient's chart prior  to  the  administration  of the  initial methadone dose to the patient.

(4)   Documented evidence of prior treatment and evidence  of  all  other findings and criteria used to determine such findings shall be recorded in the client's chart by the admitting program physician or program personnel under supervision of the admitting program physician. The admitting program physician shall   date,  review,   and countersign such recordings in the client's chart before the administration of the initial methadone dose to the client.

(5)    A person who is between the ages of 16 and 18 years shall have had 2 documented attempts at detoxification and at least a 1-year  history   of addiction before admission to maintenance. A 1-year history of dependence means that an applicant for admission to a maintenance program shall have been continuously physiologically dependent to a narcotic for at least 1 year before admission to a program. A person under 16 years of age is not eligible for methadone maintenance treatment without the prior approval of the state methadone authority and the food and drug administration. This subrule does not preclude a person who is under 16 years of age and who is currently physiologically dependent on a narcotic from being detoxified with methadone if it is deemed medically appropriate by the program physician and is in accordance with the requirements  for  detoxification.

History: 1981 AACS.