Medication Management in Part 818 Programs

While it is common practice for medical staff of inpatient rehabilitation programs to treat and administer medication for an array of physical and psychiatric conditions which are judged to be safely and effectively managed within the resources of the program, there have been questions raised as to whether it was permissible to address the symptoms associated with mild or persistent withdrawal.  It is OASAS determination that similar to treating manageable diabetes, hypertension, or psychiatric conditions, mild or persistent withdrawal can be addressed in support of continued inpatient rehabilitation services if applied within the following guidelines.

Acute Withdrawal

A patient is admitted from an outpatient program or from home and/or has used substances within the last 24 hours requiring acute detoxification services.

This patient should be transferred to an 816 program for acute management of withdrawal.

Mild or Persistent Withdrawal

The 818 program can provide medication management for symptom relief of sub-acute withdrawal as differentiated from acute detoxification services.

• A patient is admitted directly from a detox unit (816) and has not totally completed detoxification (non- acute/persistent withdrawal symptoms present)
• A patient is admitted from an outpatient program or from home and has used substances several days earlier and it appears that he/she is not in need of acute detoxification services, but does require a degree of medical care to alleviate mild withdrawal symptoms.
• A patient is admitted and is complaining of persistent withdrawal symptoms as can be seen in alcohol dependence, sedative dependence and opiate dependence.
• The 818 program can provide symptom relief medications for the patient in sub-acute or persistent withdrawal. The program can choose to continue a low dose taper of benzodiazepines for alcohol withdrawal symptoms, provide a short course of Buprenorphine or clonidine for opiate withdrawal symptoms, and at times provide a slow taper of sedatives.
• The 818 program must ensure patient safety and institute vital sign monitoring commensurate with the level of withdrawal and the medication being used. The vital signs must be done at a minimum once per shift.
• The 818 must have registered nurses in attendance and have medical staff on call for problems and medication management decisions.
• The 818 program must strive to have the patient fully participate in the program though rest periods can be ordered at the discretion of the medical staff. The patient should be fully participating in the program by 48 hours of admission.
• The 818 program must make every attempt to have the patient complete the medication/medications used for symptom control at least a week prior to discharge.