2024 Edition

Opioid Treatment Definition

Purpose

Individuals who participate in Opioid Treatment Programs improve social, emotional, and vocational functioning, achieve optimal productivity, and attain the recovery they seek.

Definition

Opioid Treatment Programs (OTPs) provide opioid treatment and comprehensive medical, psychosocial, and addiction treatment for narcotic-dependent individuals in a therapeutic environment.

Note:Please see PA-OTP Reference List for the research that informed the development of these standards.


Note:For information about changes made in the 2020 Edition, please see the OTP Crosswalk.

2024 Edition

Opioid Treatment (PA-OTP) 1: Person-Centered Logic Model

The agency implements a program logic model that describes how resources and program activities will support the achievement of positive outcomes.

Note: Please see the Logic Model Template for additional guidance on this standard.  

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 1.01

A program logic model, or equivalent framework, identifies:
  1. needs the program will address;
  2. available human, financial, agency, and community resources (i.e. inputs);
  3. program activities intended to bring about desired results;
  4. program outputs (i.e. the size and scope of services delivered); 
  5. desired outcomes (i.e. the changes you expect to see in persons served); and
  6. expected long-term impact on the agency, community, and/or system.

Examples: Please see the W.K. Kellogg Foundation Logic Model Development Guide and COA's PQI Tool Kit for more information on developing and using program logic models.  

Examples: Information that may be used to inform the development of the program logic model includes, but is not limited to: 
  1. needs assessments and periodic reassessments; and
  2. the best available evidence of service effectiveness.
 

PA-OTP 1.02

The logic model identifies client outcomes in at least two of the following areas:
  1. change in clinical status;
  2. change in functional status;
  3. health, welfare, and safety;
  4. permanency of life situation; 
  5. quality of life; 
  6. achievement of individual service goals; and 
  7. other outcomes as appropriate to the program or service population.

Interpretation: Outcomes data should be disaggregated to identify patterns of disparity or inequity that can be masked by aggregate data reporting. See PA-PQI 5.02 for more information on disaggregating data to track and monitor identified outcomes. 

2024 Edition

Opioid Treatment (PA-OTP) 2: Personnel

Program personnel have the competency and support needed to provide services and meet the needs of persons served.
Interpretation: Competency can be demonstrated through education, training, or experience. Support can be provided through supervision or other learning activities to improve understanding or skill development in specific areas.

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VIEW THE STANDARDS

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 2.01

Direct service personnel are qualified by one of the following:
  1. an advanced degree in social work, medicine, psychology, pastoral counseling, marriage and family counseling, mental health or substance use counseling, or psychiatric nursing, and in-service or other training in the treatment of substance use conditions;
  2. a bachelor’s degree in social work or a related human service field with specialized training and experience in the area of substance use treatment;
  3. certification by the designated authority when the state has a mechanism for certifying addiction counselors;
  4. personal experience with drug use recovery and specialized training and demonstrated skills in the area of substance use treatment; or
  5. specific and relevant training in the treatment of substance use and a minimum of two years’ work experience in a substance use treatment service.
 

PA-OTP 2.02

Personnel who administer and dispense opioid treatment medication are:
  1. practitioners licensed and registered under the appropriate federal and state laws; or
  2. supervised by a licensed practitioner.
Interpretation: In some states, practitioners other than licensed physicians are permitted to administer and dispense opioid treatment medications. An “agent” must be a pharmacist, registered nurse, licensed practical nurse, physician assistant, or a healthcare professional authorized by federal and/or state law to administer and dispense opioid treatment medication.
 

PA-OTP 2.03

Supervisors are qualified by:
  1. an advanced degree in a human service field and a minimum of two years’ post-graduate professional experience; 
  2. specialized training and experience in substance use diagnosis and treatment and additional training in supervision; and/or
  3. certification by the designated authority in their state as an approved addiction counseling supervisor.
 

PA-OTP 2.04

A licensed physician with at least one year of experience in addiction medicine or addiction psychiatry, acts as the  medical director responsible for supervising and administering medical services.
 

PA-OTP 2.05

The clinical team, including social work, medical, psychological, and psychiatric professionals with specialized training in the treatment of substance use:
  1. are on staff or available through formal agreement to provide services and support needed to meet the needs of individuals; and 
  2. make level of care, treatment, and termination-of-service decisions with service recipients.
 

PA-OTP 2.06

The medical director and program administrator or sponsor stay current with all applicable federal, state, and local laws and regulations applicable to opioid treatment programs, including those that address technology-based service delivery.
 
Fundamental Practice

PA-OTP 2.07

All personnel and consulting providers are annually screened for tuberculosis and receive a hepatitis B vaccination if they are considered to be at risk for exposure to hepatitis.
 

PA-OTP 2.08

Personnel are trained on, or demonstrate competency in:
  1. the concept of addiction as a disease;
  2. the goals of opioid treatment in regard to other drug use;
  3. the latest information, theories, and techniques in identification, diagnosis, and treatment of alcohol and other drug problems, including the harm reduction model;
  4. relapse prevention;
  5. recognition of co-occurring health and mental health conditions and integrated services available to meet them;
  6. management of drug overdose;
  7. special treatment needs of women;
  8. criminal justice issues, as appropriate;
  9. the benefits and limitations of tests that screen for drug use; and
  10. HIV/AIDS symptoms, risk-reduction and infection control guidelines, testing, and counseling.
 
Fundamental Practice

PA-OTP 2.09

There is at least one person on duty at each program site any time the program is in operation that has received first aid and age-appropriate CPR training in the previous two years that included an in-person, hands-on CPR skills assessment conducted by a certified CPR instructor.
 

PA-OTP 2.10

The agency minimizes the number of workers assigned to the individual over the course of their contact with the agency by:
  1. assigning a worker at intake or early in the contact; and
  2. avoiding the arbitrary or indiscriminate reassignment of direct service personnel.
 

PA-OTP 2.11

Employee workloads support the achievement of client outcomes and are regularly reviewed.

Examples: Factors that may be considered when determining employee workloads include, but are not limited to:
  1. the qualifications, competencies, and experience of the worker, including the level of supervision needed;
  2. the work and time required to accomplish assigned tasks and job responsibilities; and
  3. service volume, accounting for assessed level of needs of persons served.
2024 Edition

Opioid Treatment (PA-OTP) 3: Access to Service

The agency minimizes barriers to accessing services.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 3.01

The agency provides a welcoming environment that is conducive to rehabilitation, and services are available:
  1. during hours that are based on the needs of the service population; and
  2. 24 hours a day, seven days a week for emergencies.
 

PA-OTP 3.02

Individuals under 18 years of age are eligible for treatment only if they have experienced two documented, unsuccessful attempts at short-term detoxification or drug-free treatment.
NA The agency does not provide treatment to service recipient under 18 years of age.
 

PA-OTP 3.03

The agency does not serve individuals receiving services from other OTPs, except in extenuating circumstances, and the case record contains:
  1. results of a review to determine if the person is enrolled in another OTP; and
  2. justification of extenuating circumstances as determined by the medical director or physician, when they exist.
 

PA-OTP 3.04

At admission, a physician, or another qualified medical practitioner, documents that opioid treatment is medically necessary based on a determination that the individual:
  1. has been dependent on opiates for at least one year before admission, except in extenuating circumstances set forth in federal, state, and local law or regulation; and/or
  2. is physically dependent upon a narcotic drug, using accepted medical criteria, such as those listed in the Diagnostic and Statistical Manual for Mental Disorders.

Examples: Extenuating circumstances may include release from penal institutions, pregnancy, and prior treatment history.
 

PA-OTP 3.05

A physician assesses each service recipient to ensure that he or she has voluntarily chosen opioid treatment and understands all relevant facts concerning the use of opioid treatment medication.
2024 Edition

Opioid Treatment (PA-OTP) 4: Intake and Assessment

The agency's intake and assessment practices ensure that individuals receive prompt and responsive access to appropriate services.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 4.01

Individuals are screened and informed about:
  1. how well their request matches the agency's services; and
  2. what services will be available and when.
NA Another agency is responsible for screening, as defined in a contract.
 
Fundamental Practice

PA-OTP 4.02

Prompt, responsive intake practices:
  1. gather information necessary to identify critical service needs and/or determine when a more intensive service is necessary;
  2. give priority to pregnant women, and individuals with urgent needs and emergency medical or psychiatric situations;
  3. facilitate the identification of individuals and families with co-occurring conditions and multiple needs;
  4. support timely initiation of services; and
  5. provide placement on a waiting list or referral to appropriate resources when individuals cannot be served or cannot be served promptly.
 

PA-OTP 4.03

Persons served participate in an individualized, culturally and linguistically responsive assessment that is:
  1. completed within established timeframes;  
  2. updated as needed based on the needs of persons served; and
  3. focused on information pertinent for meeting service requests and objectives.

Interpretation: The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA’s Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design.

 
Fundamental Practice

PA-OTP 4.04

Each person admitted to the program receives a medical evaluation by a physician, or a qualified medical practitioner under the supervision of the medical director, within 14 days of admission that includes, but is not limited to, the following baseline information:
  1. medical history, including history of narcotic dependence;
  2. evidence of current physical dependence;
  3. laboratory examinations, including a serological test for syphilis, a tuberculin skin test, and a toxicology test to analyze drug dependence;
  4. determination of the presence of infectious diseases or organ abnormalities; and
  5. determination of vital signs, general appearance.
 
Fundamental Practice

PA-OTP 4.05

Persons served are screened for:
  1. high-risk behaviors related to HIV/AIDS, sexually transmitted diseases, multi drug-resistant tuberculosis, and other infectious diseases;
  2. patterns of other drug use, including Benzodiazepines;
  3. presence of co-occurring health and mental health conditions; and
  4. issues related to criminal activities.
Interpretation: Individuals known to use Benzodiazepines, even when prescribed, should be counseled as to their risk and provided with overdose prevention education and medication to counter the effects in the event of opioid overdose.

Interpretation: Individuals identified as having mental health needs should receive integrated treatment directly or through referral to a cooperating service provider.
2024 Edition

Opioid Treatment (PA-OTP) 5: Service Planning and Monitoring

Each person participates in the development and ongoing review of a service plan that is the basis for delivery of appropriate services and support.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 5.01

An assessment-based service plan is developed in a timely manner with the full participation of persons served, and their family when appropriate, and includes:
  1. agreed upon goals, including education, vocational, and employment goals, desired outcomes, and timeframes for achieving them;
  2. recommendations for medical, psychosocial, economic, legal, or other support services and by whom they will be provided;
  3. possibilities for maintaining and strengthening family relationships and other informal social networks; 
  4. procedures for expedited service planning when crisis or urgent need is identified; and
  5. the individual’s signature.
 

PA-OTP 5.02

The agency works in active partnership with persons served to:
  1. assume a service coordination role, as appropriate, when the need has been identified and no other agency has assumed that responsibility;
  2. ensure that they receive appropriate advocacy support;
  3. assist with access to the full array of services to which they are eligible; and
  4. mediate barriers to services within the service delivery system.
 

PA-OTP 5.03

The worker and a supervisor, or a clinical, service, or peer team, review the case quarterly or more frequently depending on the needs of persons served, to assess:
  1. service plan implementation;
  2. progress toward achieving goals and desired outcomes; and
  3. the continuing appropriateness of the agreed upon service goals.
Interpretation: When experienced workers are conducting reviews of their own cases, the worker’s supervisor must review a sample of the worker’s evaluations as per the requirements of the standard.
 

PA-OTP 5.04

The worker and individual, and his or her family when appropriate:  
  1. review progress toward achievement of agreed upon goals; and 
  2. sign revisions to service goals and plans.
2024 Edition

Opioid Treatment (PA-OTP) 6: Community Services

The agency informs the community about its services, remains informed about community needs and resources, and identifies the mutual benefits of supporting individuals in their recovery.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 6.01

A public education and community relations service component:
  1. educates the public about the value of opioid treatment;
  2. builds community support; and
  3. provides information about the agency.
 

PA-OTP 6.02

A public education and community relations service component also:
  1. serves as a community resource for substance use and related health, mental health, and social issues;
  2. establishes mechanisms to hear community views and issues about opioid treatment and the agency's presence in the community; and
  3. aims to address and resolve community concerns.
2024 Edition

Opioid Treatment (PA-OTP) 7: Service Elements

Services are responsive to individual strengths, needs, and goals.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 7.01

The agency provides, directly or by formal arrangement:
  1. substance use counseling that is coordinated with other counseling and services;
  2. access to physicians with knowledge of appropriate prescribing practices for individuals with addiction;
  3. activities that address the importance of drug and alcohol-free lifestyles and de-emphasize the role of intoxicants; and
  4. activities that address issues of particular concern to women, including intimacy, intimate partner violence, physical trauma, sexual trauma, prevention of exposure to and transmission of HIV/AIDS and other STDs, child care, pregnancy, and family planning.

Examples: Formal arrangements can include service agreements and formal referral arrangements.
 

PA-OTP 7.02

Persons served, and adults with whom they live, are educated about:
  1. program guidelines, rules, and regulations;
  2. the nature of addictive disorders;
  3. signs and symptoms of overdose and when to seek emergency assistance;
  4. the dangers of cross-tolerance;
  5. dependency substitution and self-medication;
  6. therapeutic effects of opioid treatment medication;
  7. common myths about opioid treatment medication;
  8. the benefits of treatment and the recovery process;
  9. dispensing medication; and
  10. toxicology testing procedures.
 

PA-OTP 7.03

Persons served receive:
  1. infectious disease prevention and risk reduction information and education;
  2. counseling on the importance of treatment adherence and honest communication with the provider;
  3. counseling on HIV infection and other infectious diseases and referral for testing;
  4. intensive clinical support for continued active use of alcohol and other drugs, including tobacco;
  5. supplemental psychotherapy services or referrals for co-occurring mental health disorders;
  6. support, information, and referral when seeking alternative therapies;
  7. access to vocational rehabilitation, evaluation, education, and training services; 
  8. access to parenting workshops;
  9. access to support and specialized recovery groups if the person and his/her family is affected by HIV/AIDS; and
  10. noncompliance and discharge procedures.
 

PA-OTP 7.04

The agency uses multiple models of care in the treatment process to meet individual needs and embraces a recovery-oriented system of care framework that is: 
  1. person-centered;
  2. strengths-based;
  3. culturally-responsive;
  4. facilitative and self-directed;
  5. supported by formal and informal resources; and
  6. ongoing.

Examples: The agency may organize treatment in a group format based on the characteristics of a particular population, for example, by gender, age, sexual orientation, or racial, ethnic, and cultural background.
 

PA-OTP 7.05

The agency provides, either directly or by referral, peer support and self-help services.

Examples: Peer support refers to services provided by individuals who have shared, lived experience. Peer support workers may be part of the treatment team. Services promote resiliency and recovery and can include peer recovery groups, peer-to-peer counseling, peer mentoring or coaching, family and youth peer support, or other consumer-run services.
 

PA-OTP 7.06

Individuals diagnosed as having co-occurring health, mental health, and substance use conditions receive integrated treatment directly or through active involvement with a cooperating service provider.

Note: An agency that has a specialized outpatient co-occurring disorder treatment program must also complete Mental Health and/or Substance Use Services (PA-MHSU), recognizing that the mental health standards may need to be adapted for specialized core services provided within the context of services for substance use conditions.
 

PA-OTP 7.07

The agency coordinates with the criminal justice system to advocate for continuous treatment for individuals who are incarcerated, or on probation or parole.
NA The agency does not serve any individual involved in the criminal justice system.
 

PA-OTP 7.08

The agency provides, or makes referrals for, relapse prevention services including counseling, support, and education for individuals who want to discontinue opioid treatment.
2024 Edition

Opioid Treatment (PA-OTP) 8: Medical Services

Medical services are provided, directly or by referral, according to individual needs.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 8.01

The agency provides or makes referrals to medical and psychiatric services for necessary screening and follow-up.
 
Fundamental Practice

PA-OTP 8.02

The agency obtains medication blood levels and conducts other medical and diagnostic procedures when clinically indicated.
 

PA-OTP 8.03

The agency uses opioid agonist treatment medications approved by the U.S. Food and Drug Administration in the treatment of opioid addiction.

Examples: Opioid addiction treatment medications include: buprenorphine, methadone and naltrexone.
 

PA-OTP 8.04

Individuals are maintained on opioid treatment medication as long as they desire, and derive benefit from treatment.
 
Fundamental Practice

PA-OTP 8.05

The agency makes referrals for consultation with a specialist in pain medicine for individuals with chronic pain disorder.
Interpretation: Generally, individuals with chronic pain disorder should not be admitted to receive opioids only for pain, but there are exceptions if the program is the only available resource in the community. Individuals with both chronic pain and addiction should receive integrated treatment from appropriate medical specialists.
 

PA-OTP 8.06

The agency queries the state prescription drug monitoring program (PDMP):  
  1. prior to initiating dosing for new patients;
  2. at clinical decision points, such as ordering take home medication; and
  3. routinely for all patients.
NA There is no PDMP available in the state.
2024 Edition

Opioid Treatment (PA-OTP) 9: Toxicology Testing for Continued Drug Use

Toxicology testing is an integral component of service planning and clinical practice to help monitor and evaluate the individual's progress in treatment.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 9.01

Prior to establishing a contract, the agency evaluates the quality of the laboratory to perform drug screens, including use of equipment, methodology, and quality control.
 

PA-OTP 9.02

Toxicology specimens are obtained:
  1. with respect for individual privacy; and
  2. in a safe treatment atmosphere.
 

PA-OTP 9.03

After the individual's initial admission test, the timing and frequency of toxicology testing is clinically appropriate for each individual, and the opioid treatment program conducts:
  1. at least eight random drug tests per service recipient, per year;
  2. at least one initial and two subsequent tests for individuals in interim maintenance treatment; and
  3. tests, as appropriate, during medically supervised and other types of withdrawal.
Interpretation: Drug testing regimes should be determined based on individual assessment results and by analyzing community drug-use patterns. Testing may include, but not be limited to, opiates, benzodiazepines, barbiturates, cocaine, marijuana, methadone (and its metabolites), amphetamines, and alcohol.
 

PA-OTP 9.04

Toxicology testing procedures include, and are not limited to:
  1. informing persons served about how specimens are collected and of their responsibility to provide a specimen when asked;
  2. discussing positive toxicology results with the individual;
  3. providing counseling, medical review, and other interventions if the person continues to test positive for illegal substance use;
  4. methods to minimize falsification during the drug testing sample collection;
  5. a process for reviewing false-positive and false-negative results; and
  6. documenting results in the case record along with the person’s response.
 

PA-OTP 9.05

Following the receipt of toxicology test results, the agency:
  1. evaluates negative reports for opioid treatment medication and related metabolites;
  2. reviews dosage when positive toxicology reports for drugs are received;
  3. investigates the possibility of false positive results when persons served deny drug use;
  4. rapidly responds if the individual is found to be in danger of relapse; and
  5. uses the results to determine the need for additional interventions.
Interpretation: Immediate action should be taken to investigate possible diversion of opioid medication when toxicology tests indicate lack of opioids or related metabolites.
 
Fundamental Practice

PA-OTP 9.06

Evidence of ongoing drug use is not considered grounds for discharge, unless the individual refuses to cooperate with treatment recommendations.
2024 Edition

Opioid Treatment (PA-OTP) 10: Take-Home Privileges for Unsupervised Use of Medication

The agency establishes criteria to determine when take-home privileges can become part of an individual’s service plan and how medications are provided in accordance with applicable federal regulations concerning the prescription and distribution of controlled substances.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 10.01

Direct service personnel, medical and other appropriate personnel, persons served, and, whenever possible, family members, participate in determining if the individual meets criteria for take-home medication.
 

PA-OTP 10.02

To support the initiation of take-home privileges, the medical director considers:
  1. length of time in treatment;
  2. consistency of clinic attendance;
  3. clinical status;
  4. progress in rehabilitation;
  5. medical necessity;
  6. behavioral factors;
  7. geographic considerations;
  8. employment schedules that create hardship for an individual to meet limited clinic hours;
  9. results of toxicology tests; and
  10. other special needs.
Interpretation: All elements should be considered collectively in determining whether take home privileges are appropriate for an individual. Decisions should not be based solely on toxicology test reports.

Interpretation: Time in treatment should not be a factor for patients prescribed buprenorphine for take-home use.

Examples: "Other special needs" may include, and are not limited to, emergency circumstances, split dosing, and pain treatment.
 
Fundamental Practice

PA-OTP 10.03

For each person provided with take-home medication, the agency:
  1. schedules toxicology tests to ensure he or she consumes the opioid treatment medication provided and remains free of substance use;
  2. implements measures to help avoid diversion of controlled substances;
  3. has a physician review his or her status at least every 90 days, or more frequently if clinically indicated; and
  4. periodically reviews the benefits and drawbacks of continued take-home privileges.
 

PA-OTP 10.04

The medical director uses established criteria to decide when take-home medication is contraindicated, including:
  1. signs or symptoms of withdrawal;
  2. evidence of continued alcohol and drug use;
  3. the absence of laboratory evidence of the opioid treatment medication in toxicology samples;
  4. participation in short-term detoxification or interim maintenance treatment programs;
  5. potential complications from concurrent disorders;
  6. ongoing criminal behavior; and
  7. absence of stable social relationships or a stable home environment.
 
Fundamental Practice

PA-OTP 10.05

The agency labels take-home medication with the agency's name, address, and telephone number and provides individuals with guidance on how to safely secure medication.
Related Standards:
Interpretation: The medical director should consider whether the medication can be safely stored in the person’s place of residence when determining if the individual may be permitted unsupervised use of medication.

Note: See also Program Administration (PA-PRG) for standards regarding Medication Control and Administration.
2024 Edition

Opioid Treatment (PA-OTP) 11: Dosage Requirements

The agency follows procedures for administration of opioid treatment medication to ensure that an adequate, individually-determined dose is dispensed.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 
Fundamental Practice

PA-OTP 11.01

Opioid treatment medication is administered as follows:
  1. a physician makes all dosage decisions within the medically accepted dosage range for effective treatment;
  2. conditions for use are documented in the person’s case record;
  3. medications are administered and dispensed in accordance with approved product labeling;
  4. the initial dose of methadone does not exceed 30 milligrams, and 40 milligrams as a total dose for the first day; and
  5. methadone is dispensed in oral form.
Interpretation: The initial dose of methadone must be determined by an OTP physician familiar with the most up-to-date product labeling, who considers factors, such as body weight, size, other substance-use and abuse, diet, co-occurring disorders, medical diseases, genetic factors, and tolerance. Although the initial dose is indicated not to exceed 30 milligrams, this dose is not appropriate for everyone, and some individuals may require much lower doses. All individuals should be closely monitored during the induction phase and the increases in dosage should be under the close supervision of the physician. It must be documented in the case record when the 40 milligrams total dose is exceeded based on the physician's determination that the previous dosage did not suppress the person's withdrawal symptoms.
 
Fundamental Practice

PA-OTP 11.02

When a physician determines a person is eligible to receive take-home medication, the dose is limited to no more than:
  1. one dose per week in the first 90 days of treatment;
  2. two doses per week in the second 90 days of treatment;
  3. three doses per week in the third 90 days of treatment;
  4. a six-day supply in the remaining months of the year;
  5. a two-week supply after one year of continuous treatment; and
  6. a one-month supply after two years of continuous treatment.
 
Fundamental Practice

PA-OTP 11.03

Persons served receive the appropriate dosage of opioid treatment medication for days when the clinic is closed, for weekends, holidays, and travel.
Interpretation: The agency should inform persons served of its plan for administration of medication in the event that the program is temporarily closed due to an emergency.
2024 Edition

Opioid Treatment (PA-OTP) 12: Detoxification Treatment

Detoxification treatment is provided based on the needs of the individual.
NA The agency does not provide detoxification treatment.

Note: In these standards, the term “detoxification” refers to detoxification from opioid drugs and not medical or administrative withdrawal from opioid treatment medication, which is addressed in PA-OTP 15.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 12.01

Qualified personnel determine if short- or long-term detoxification treatment is appropriate for the individual using diagnostic criteria found in the Diagnostic and Statistical Manual for Mental Disorders.
 

PA-OTP 12.02

Persons served are placed in the appropriate level of care and have access to all components of the detoxification process, including:  
  1. evaluation;
  2. stabilization; and
  3. preparation for entry into substance use treatment.

Examples: Agencies can utilize the American Society of Addiction Medicine (ASAM) criteria to determine the appropriate level of care.
 

PA-OTP 12.03

The agency conducts an initial drug test for individuals in short-and long-term detoxification treatment and monthly random tests for individuals receiving long-term detoxification treatment.
 

PA-OTP 12.04

The agency limits individuals to two detoxification treatment episodes per year.
 
Fundamental Practice

PA-OTP 12.05

Individuals who have had two or more unsuccessful detoxification episodes are assessed by a physician to determine the need for other forms of treatment.
 

PA-OTP 12.06

The agency provides 24-hour-a-day supervision, observation, and care tailored to meet the individual’s assessed needs and goals.
Interpretation: Staffing requirements and care ratios can vary depending on the age, developmental level, and service needs of the population, agencies must meet state licensing requirements.
NA The agency does not provide detoxification treatment in a residential setting.
 

PA-OTP 12.07

Residential facilities contribute to a physically and psychologically safe, healthy, non-institutional environment by: 
  1. providing personal accommodations for individuals that are age, developmentally, gender, and culturally appropriate; 
  2. providing private areas for bathing, toileting, and personal hygiene;
  3. allocating rooms for occasional on-site services, as needed;
  4. ensuring accommodations for informal gathering of persons served, including during inclement weather;
  5. having adequate space for administrative support functions, food preparation, housekeeping, laundry, maintenance, and storage; and
  6. being maintained in good, clean condition.
Related Standards:
Interpretation: Accommodations may be adjusted as appropriate to the service provided, therapeutic considerations, level of risk, or developmental appropriateness.
NA The agency does not provide detoxification treatment in a residential setting.
 

PA-OTP 12.08

The agency ensures the comfort, dignity, privacy, and safety of persons served by: 
  1. implementing and communicating policies for searches of individuals or their property; 
  2. prohibiting the use of surveillance cameras or listening devices of persons in bedrooms; 
  3. maintaining doors on sleeping areas and bathroom enclosures; 
  4. providing one- or two-person rooms to individuals who need extra sleep, protection from sleep disturbance, or extra privacy for clinical reasons; and
  5. requiring employees to knock before entering a service recipient’s room unless there is a safety or clinical concern.
Interpretation: When agencies are required to employ alternate practices, documentation must be provided to justify the practice. Documentation may include a judicial order, law, contract, copy of the state's safety plan for a resident, or clear, clinical written justification for a resident. 

Sensitivity should be taken to ensure that all persons served, especially abuse or trauma survivors and the LGBTQ population, feel safe and not violated.
NA The agency does not provide detoxification treatment in a residential setting.
2024 Edition

Opioid Treatment (PA-OTP) 13: Interim Maintenance Treatment

Interim maintenance treatment is provided to support individual functioning and to ensure continuity of care.
Interpretation: Interim maintenance treatment programs must meet the same requirements and standards of care as comprehensive maintenance treatment programs.
NA The OTP does not offer interim maintenance treatment.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 13.01

The program administrator or sponsor places a person in an interim maintenance treatment program:
  1. when the person cannot be placed in a comprehensive treatment program within 14 days of application;
  2. within a reasonable geographic area; and
  3. for a maximum of 120 days in any 12 month period.
 

PA-OTP 13.02

The agency establishes written criteria for transferring persons served from interim maintenance to comprehensive maintenance treatment.
 

PA-OTP 13.03

The agency notifies the state health officer when a person begins interim maintenance treatment, leaves interim maintenance treatment, or is transferred to comprehensive maintenance treatment.
 

PA-OTP 13.04

In interim maintenance treatment programs, medication is administered daily under observation.
Interpretation: In interim maintenance treatment programs take-home medication is not permitted; service plans, rehabilitative, educational, and other counseling services are not required; and persons served are not assigned a primary counselor.  
2024 Edition

Opioid Treatment (PA-OTP) 14: Opioid Treatment During Pregnancy

The agency provides comprehensive, coordinated treatment services that address medical, prenatal, obstetrical, psychosocial, and addiction concerns for pregnant women.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 14.01

The agency addresses the special needs of pregnant women, including: 
  1. maintenance at the pre-pregnancy medication dose for women who become pregnant during treatment; 
  2. dosing protocols for newly admitted pregnant women that are equivalent to those used for all other persons served;
  3. carefully monitoring the methadone dose, especially during the third trimester of pregnancy; and
  4. provision of treatment services for pregnant women with concurrent HIV infection.
 

PA-OTP 14.02

The agency coordinates and provides prenatal care for pregnant women, either directly or by referral to outside medical services, to address their special needs including the need for a health evaluation.
 
Fundamental Practice

PA-OTP 14.03

Pregnant women who receive opioid treatment are informed about the possible risks associated with:
  1. the effects of treatment on unborn children;
  2. continued use of drugs; and
  3. withdrawal from opioid treatment medication during pregnancy.
 
Fundamental Practice

PA-OTP 14.04

When withdrawal from opioid treatment medication is initiated for pregnant women, such withdrawal:
  1. is conducted under the supervision of a physician;
  2. takes place, when possible, in a prenatal unit equipped with fetal monitoring equipment and with regular fetal assessments; and
  3. is not initiated before 14 weeks, nor after 32 weeks, gestation.
 

PA-OTP 14.05

The agency provides parent education and support groups, directly or by referral, that address:
  1. healthy mother-infant interactions;
  2. signs, symptoms, and effects of neonatal abstinence syndrome; and
  3. resources to treat neonatal abstinence syndrome.

Examples: Parent education to improve mother-infant interactions can address topics related to maternal, physical, and dietary care, including for example the promotion of breast-feeding.
 
Fundamental Practice

PA-OTP 14.06

The program is responsible for ensuring that newborns are medically evaluated if signs or symptoms of neonatal abstinence syndrome appear following hospital discharge.
Interpretation: Programs that do not have responsibility for the care and treatment of newborns should provide education, information, and referral to ensure that mothers who have infants that may be susceptible to health issues seek comprehensive evaluation and treatment for the infant.
2024 Edition

Opioid Treatment (PA-OTP) 15: Withdrawal

Persons served participate in the development of an appropriate withdrawal schedule and receive the necessary support to prevent relapse.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 15.01

Medical withdrawal from opioid treatment medication is:
  1. a voluntary and therapeutic process planned for by the individual and a physician; or 
  2. conducted in response to an individual's request, but against medical advice (AMA).
 

PA-OTP 15.02

Medical withdrawal practices include:
  1. dose reduction at a rate well tolerated by the person and in accordance with accepted medical practices;
  2. periodic assessments of mental status;
  3. an assessment for pregnancy for women of childbearing age;
  4. availability of counseling and other support services; and
  5. discontinuation of withdrawal and resumed maintenance therapy, in the event of impending relapse.
 

PA-OTP 15.03

Individuals that undergo medically supervised withdrawal AMA:
  1. are provided with information about the risks of discontinuing treatment and information about and referral to alternative treatment programs;
  2. can be readmitted to the program within 30 days without repeating the initial assessment; and
  3. are considered for maintenance treatment when withdrawal fails.
Interpretation: In the case of a pregnant individual the agency should keep the organization providing prenatal care informed of the individual's status consistent with privacy standards.

Interpretation: Reason for seeking discharge and steps taken to avoid discharge should be noted in the case record.
 
Fundamental Practice

PA-OTP 15.04

When other interventions were proven unsuccessful, a program may determine that administrative withdrawal is necessary, including: 
  1. a humane withdrawal schedule based on sound clinical judgement; and
  2. referral or transfer to a suitable, alternative treatment program, whenever possible.
Related Standards:
Interpretation: The agency must determine on a case-by-case basis its responsibility to continue providing services to persons whose third-party benefits are denied or have ended and who are in critical situations.

Interpretation: A suggested schedule for medically supervised administrative withdrawal is a minimum of 30 days with adjustments made depending on clinical factors. Since administrative withdrawal is conducted over a short timeframe and associated with poor prognosis connecting individuals to alternative treatment programs is critical.

Examples: Administrative discharges are usually involuntary and may occur for reasons such as nonpayment of fees, incarceration, or disruptive conduct or behavior such as violence, dealing drugs, repeated loitering, and flagrant noncompliance.
2024 Edition

Opioid Treatment (PA-OTP) 16: Case Closing and Aftercare

The agency works with persons served and family members, when appropriate, to plan for case closing and, when possible, to develop aftercare plans.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 16.01

Planning for case closing:
  1. is a clearly defined process that includes assignment of staff responsibility;
  2. begins at intake; and
  3. involves the worker, persons served and others, as appropriate to the needs and wishes of the individual.
 

PA-OTP 16.02

Upon case closing, the agency notifies any collaborating service providers, including the courts, as appropriate.
 

PA-OTP 16.03

When appropriate, the agency works with persons served and their family to develop an aftercare plan, sufficiently in advance of case closing, that: 
  1. identifies short- and long-term needs and goals; and 
  2. facilitates the initiation or continuation of needed supports and services.
Interpretation: The aftercare plan must include relapse prevention. The plan should also address re-entry into maintenance treatment in the event of relapse. Plans for meeting the individual’s physical and mental health needs following medically supervised withdrawal should also be indicated, as appropriate.
 

PA-OTP 16.04

The agency follows up on the aftercare plan, as appropriate, when possible, and with the permission of the service recipient.

Examples: Reasons why follow-up may not be appropriate include, but are not limited to, cases where the person's participation is involuntary, or where there may be a risk to the service recipient such as in cases of domestic violence.
2024 Edition

Opioid Treatment (PA-OTP) 17: Diversion Control

The agency implements mechanisms to support diversion control and demonstrate accountability to persons served and the community.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 17.01

Medical and administrative personnel implement a plan to reduce the risk of diversion of controlled substances from legitimate treatment use that addresses:
  1. measures to reduce the possibility of diversion of controlled substances; 
  2. specific responsibilities assigned to personnel for plan implementation; 
  3. mechanisms for surveillance and continuous monitoring; and 
  4. a process for corrective action when problems are identified.
 

PA-OTP 17.02

The agency prevents loitering by persons served and maintains a well-managed and fully operational security system.
2024 Edition

Opioid Treatment (PA-OTP) 18: Program Administration

The agency's administrative activities support program operations.

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
 

PA-OTP 18.01

The agency conducts annual reviews of program policies and procedures.
 

PA-OTP 18.02

The agency's record-keeping system:
  1. documents and monitors client care in conformity with all federal and state reporting requirements relevant to opioid treatment;
  2. complies with the approved central registry system, when available; and
  3. supports provision of PDMP reports, when applicable.
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