Section 440IAC10-4-27. Reduction or discontinuation of medication

   (a) An OTP shall do the following:

(1) Comply with the requirements in this section with regard to the reduction or discontinuation of treatment medication.

(2) Perform routine evaluations to determine the readiness of a patient to reduce or discontinue treatment medication, with the goal of achieving complete abstinence, if clinically appropriate for the patient in the reasonable judgment of an OTP program physician. An OTP is responsible for ongoing relapse prevention treatment for patients who reduce or discontinue medication, either directly or through a referral to an allied clinician or treatment program.

  (b) A medication reduction shall involve the administration of opioid treatment medication in decreasing amounts to an individual for the following reasons:

(1) To alleviate adverse physiological or psychological effects incidental to withdrawal from the continuous or sustained use of opioids.

(2) To withdraw the individual from opioid treatment medication if clinically appropriate for the patient in the reasonable judgment of an OTP program physician.

  (c) A reduction or discontinuation of opioid treatment medication shall meet the following requirements:

(1) Be initiated when requested by the patient unless clinically contraindicated.

(2) Be carried out in a manner that minimizes the psychological and physical effects of the reduction or discontinuation.

  (d) A reduction or a discontinuation of a patient's opioid treatment medication may be initiated by an OTP at any of the following times:

(1) When clinically appropriate for the patient.

(2) If the patient demonstrates noncompliance with therapeutic interventions.

(3) If the patient violates program rules.

  (e) The tapering of opioid treatment medication shall be completed in a manner appropriate to the following:

(1) The patient's level of medication.

(2) The circumstances justifying the action.

  (f) An OTP may immediately discontinue a patient's opioid treatment medication if either of the following exists:

(1) A safety concern.

(2) A concern that opioid treatment medication has been diverted.

  (g) If a patient's opioid treatment medication has been immediately discontinued under subsection (f), the OTP shall offer the patient a referral to another service.

  (h) An OTP may facilitate a transfer to another program or a referral to a medical facility in place of the discontinuation of opioid treatment medication under subsection (f). (Division of Mental Health and Addiction; 440 IAC 10-4-27; filed Dec 30, 2009, 2:00 p.m.: 20100127-IR-440080412FRA; readopted filed May 10, 2016, 11:24 a.m.: 20160608-IR-440160134RFA)