Continuing Methadone Maintenance

Question

Can a patient in a Long Term Care Facility (LTCF) receive methadone for maintenance purposes?

Answer

There are several ways that a patient who is enrolled in an OTP and subsequently is found to need long term care in a nursing home or other LTCF, can be maintained on their usual methadone dosing regimen.

• If an LTCF is registered with DEA as a hospital / clinic, it need not be separately registered as an OTP to administer or dispense methadone as an adjunct to medical or surgical treatment of conditions other than addiction. [21 CFR 1306.07(c)]
• If an LTCF that is not registered with DEA as a hospital / clinic has a patient who is also currently enrolled in a licensed OTP, the OTP may transfer medication to the LTCF. All OTPs are permitted to dispense to a visiting nurse or nursing home personnel without prior approval; in other instances, approval from the OASAS State Opioid Treatment Authority is required. This is considered a “Designated Other” exception request, whereby the LTCF may send a staff person to pick up the medication on behalf of the patient. There is no ability to bill Medicaid for this service. This may be accomplished by using a “Chain-of-Custody Record,” which is a document containing the signatures of all people who have handled the medication.
• If an individual not currently enrolled in an OTP is in an LTCF that is not registered with DEA as a hospital / clinic or an NTP, a practitioner may administer narcotic drugs to the individual for relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment. No more than one day's medication may be administered to the individual or for the individual's use at one time. Such emergency treatment may be carried out for no more than three days and may not be renewed or extended. [21 CFR 1306.07(b)]