Guidance on Tobacco-Free Services

Although New York State OASAS changed Title 14 NYCRR Part 856 “Tobacco-Free Services” to “Tobacco Use in Adult Services,” OASAS-certified, funded, or otherwise authorized programs (hereinafter “OASAS programs”) can remain or return to being tobacco-free in accordance with NYS Public Health Law Section 1399-O.  

Title 14 NYCRR Part 856 Tobacco-Use in Adult Services does not apply to prevention, treatment, or recovery services for children, youth, adolescents, or young adults.  These services must remain tobacco-free.

All OASAS programs that choose to remain as or return to being a tobacco-free service, and all prevention, treatment, and recovery services for youth, adolescents, or young adults must create and revise written policies and procedures to be consistent, at a minimum, with the following criteria:

Restrictions

1. Prohibits the use of all tobacco products and nicotine delivery systems (NDS) by patients, all paid, unpaid, and contract staff, volunteers, family members, and visitors in the facilities and in vehicles owned and operated by the program.
   1. Tobacco products include but are not limited to cigarettes, cigars, pipe tobacco, loose tobacco, roll-your-own tobacco, and smokeless tobacco.
      1. OASAS reserves the right to revise the definition of tobacco products at any time.
   2. Nicotine delivery systems (NDS) are any electronic or modified mechanical devices that deliver aerosolized nicotine, flavorings, or other chemicals by inhalation of a non-combustible liquid or gel, and any refills, cartridges, or any other components of such devices.
      1. Nicotine inhalers that are Food and Drug Administration (FDA) approved medications for the treatment of tobacco use disorder (TUD) are excluded from the definition of NDS if the nicotine inhaler is prescribed and monitored by a physician, physician assistant, or a nurse practitioner.
      2. OASAS reserves the right to revise the definition of NDS at any time.
2. Prohibits all paid, unpaid, and contract staff and volunteers from:
   1. Purchasing tobacco products of NDS for patients, family members, or visitors.
   2. Giving tobacco products or NDS to patients, family members, or visitors.
   3. Using tobacco products or NDS with patients, family members, or visitors.
   4. Giving matches or lighters to patients, family members, or visitors.

Training

1. Requires all clinical, non-clinical, administrative, and volunteer staff to receive evidence-based training about:
   1. Screening and assessment for tobacco/nicotine use and TUD.
   2. The effects of tobacco/nicotine on physical and mental health.
   3. Counseling for reducing harm from and cessation of tobacco/nicotine use.
   4. Medications for the treatment of TUD.
      1. Trainings shall be described in the program’s policies and procedures
2. Requires that staff receive these trainings when newly hired and annually.
   1. Programs must maintain a log of staff trainings.

Screening and Assessment

1. Includes screening questions about tobacco/nicotine use in intake forms for the program.
2. Screens for current and lifetime tobacco/nicotine use using evidence-based screening instruments as part of the initial assessment and every six (6) months while the patient is admitted to the program.
3. Assesses tobacco/nicotine use or TUD in the diagnoses, problem lists, progress notes, and treatment plans.
4. Documents the results of screenings and assessments in the patient’s record.
5. Documents tobacco/nicotine use or TUD in the diagnoses, problem lists, progress notes, and treatment plans.

Treatment

1. Provides a standardized group curriculum about the physical and psychological effects of tobacco and nicotine.
2. Provides evidence-based group treatments that are aligned with their level of motivation to change their tobacco/nicotine use and that use evidence-based interventions for the treatment of all substance use disorders such as motivational interviewing and relapse prevention.
3. Provides FDA-approved medications for the treatment of nicotine withdrawal, nicotine craving, and TUD.
   1. Provides written information about these medications to patients.
4. Documents the patient’s response to group and pharmacological treatments for tobacco/nicotine use or TUD in the patient’s record.
5. Includes discharge planning and aftercare resources for tobacco/nicotine cessation so patients can continue working towards a tobacco-/nicotine-free life by maintaining the gains made in reducing or ceasing tobacco/nicotine use while in treatment.
6. Describes employee assistance programs and other programs that will be made available to staff who want to stop using tobacco products, NDS, or nicotine-containing products.

Communication

1. Describes how patients, all staff, family members, and visitors will be informed of the tobacco-free policies, including posted notices and providing copies of the policy.

The Center for Practice Innovations offers a wide array of free trainings on TUD that satisfy the provisions of this guidance that programs can use for their staff trainings.

OASAS-certified, funded, or otherwise authorized services for adults, children, youth, adolescents or young adults that remain tobacco-free are not required to complete attestations verifying that the program has fulfilled the requirements of this guidance. However, OASAS reserves the right to review a program’s tobacco-free services policies and procedures at any time to ensure they are being followed. If an OASAS program for adults decides to allow the limited use of tobacco, they must fulfill the requirements of the Guidance on Tobacco-Limited Services and must submit the “Attestation for Tobacco-Limited Services Policies and Procedures in OASAS Certified, Funded, or Otherwise Authorized Programs for Adults” before offering tobacco-limited services.  Prevention, treatment, and recovery services for children, youth, adolescents, or young adults cannot be tobacco-limited and must remain tobacco-free.