For OASAS Certified, Funded or Otherwise Authorized Programs for Adults

All New York State OASAS certified, funded, and otherwise authorized programs (hereinafter “OASAS programs”) should promote a healthy lifestyle, including becoming tobacco-free, for all patients served. Becoming tobacco-free, however, may not be the goal of all patients, necessitating a harm reduction approach that allows patients to have the limited ability to smoke cigarettes, provides them with effective pharmacological and behavioral treatments for nicotine craving, nicotine withdrawal, and tobacco use disorder, and educates them about the health consequences of tobacco use and the benefits of a tobacco-free life. This guidance provides information to OASAS-programs that provide services to adults who want to be tobacco-limited, as defined by Title 14 NYCRR Part 856 Tobacco Use in Adult Services.

This guidance does not apply to prevention, treatment, or recovery services for children, youth, adolescents, and/or young adults, which must remain tobacco-free.

Additionally, OASAS programs for adults can choose to remain tobacco-free in accordance with the NYS Public Health Law Section 1399-O or return to being a tobacco-free program after becoming tobacco-limited.

All OASAS programs for adults that are approved by OASAS to offer tobacco-limited services must continue to address tobacco/nicotine use and tobacco use disorder as they would any other addiction. Therefore, adult services that want to offer tobacco-limited services must create, revise, and receive OASAS approval for policies and procedures consistent 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 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, and/or other chemicals by inhalation of a non-combustible liquid or gel, and any refills, cartridges, and/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. Using tobacco products or NDS when they are in the program facilities, on facility grounds, or in vehicles owned and operated by the program.
    2. Purchasing tobacco products or NDS for patients, family members, or visitors.
    3. Giving tobacco products or NDS to patients, family members, or visitors.
    4. Using tobacco products or NDS with patients, family members, or visitors.
    5. Giving matches or lighters to patients, family members, or visitors.
  3. Prohibits advertising that the program is tobacco-limited on all media platforms, on program websites, in program brochures, flyers, and other printed media, and during prepared presentations about program services.

Training

  1. Requires 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 on 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 and TUD using evidence-based assessments if the screen is positive.
  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.
  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

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

Additional Criteria for Inpatient, Inpatient Residential, and Residential Stabilization, Rehabilitation and Reintegration (Congregate) Only*

For Inpatient, Inpatient Residential, and Residential Stabilization, Rehabilitation and Reintegration (Congregate) Only 

Facility Grounds
  1. Allows for the limited use of cigarettes only by patients in a designated area on the facility grounds at designated times.
  2. Identifies and designates an outdoor area on facility grounds where only patients may smoke cigarettes.
    1. The outdoor designated smoking area must be 100 feet from all entrances.
    2. OASAS will not incur any expenses to create a new space for this purpose.
  3. Prohibits staff, volunteers, family members, and visitors from using all tobacco products and NDS in program facilities, in program vehicles, and on program grounds, including the outdoor designated area where patients are permitted to smoke cigarettes.
Cigarette Use and Nicotine Dosing Administrations
  1. Determines the number of cigarettes a patient can smoke each day and decreases the number of cigarettes the patient smokes daily during admission if clinically indicated.
    1. Patients who only use NDS will not be permitted to smoke cigarettes and will receive medications for the treatment of nicotine withdrawal, nicotine craving, and TUD.
    2. Patients may not be treated with an FDA-approved NDS other than nicotine inhaler.
  2. Schedules nicotine dosing administrations (NDAs) consistent with the program’s schedule.
    1. The goal of NDAs will be to receive a dose of nicotine by cigarette.
    2. There will be no more than ten (10) NDAs per day.
    3. The time to smoke cigarettes will last no more than five (5) minutes.
      1. Limiting the time for NDAs reinforces the message that the time is to be used for nicotine dosing, only, and not for socializing.
    4. The schedule of NDAs will be for set times each day, cannot be arbitrary, and cannot be during scheduled groups or individual sessions.
    5. The schedule of NDAs will be posted and will be communicated to staff and patients.
Cigarettes, Lighters, and Matches
  1. Prohibits patients from using NDS and tobacco products other than cigarettes.
  2. Accepts only closed and factory sealed packages of cigarettes that the patient has brought to the program.
  3. Limits tobacco products that family members and visitors can bring to patients admitted to the program to closed and factory sealed packages of cigarettes.
  4. Prohibits patients from selling or sharing cigarettes.
  5. Prohibits patients from trading cigarettes for goods or services.
  6. Prohibits staff from using cigarettes as an incentive or a reward.
  7. Establishes procedures for maintaining each patient’s cigarette supply and distributing predetermined cigarette allotments
  8. Provides and monitors matches or lighters that are held by the program and used to light cigarettes during NDAs.
  9. Prohibits patients from bringing matches or lighters to the program or having them in their possession during their admission to the program.
  10. Prohibits family members and visitors from giving matches or lighters to patients.

*Inpatient, inpatient residential, and outpatient programs located in or on the grounds of hospitals or medical centers must continue to follow the tobacco use policies and procedures of the hospital or medical center.

 

Additional Criteria for Residential Reintegration (Scatter Site) and Outpatient Programs Only*

Facility Grounds

If a residential reintegration (scatter site), or an outpatient program chooses to allow cigarette smoking by patients on facility grounds, the program must:

  1. Identify and designate an outdoor area on program grounds where only patients may smoke cigarettes.
    1. The designated outdoor smoking area must be 100 feet from all entrances.

    2. OASAS will not incur any expenses to create a new space for this purpose.

       

  2. Prohibits all paid, unpaid, and contract staff, volunteers, family members, and visitors from using tobacco products and NDS on program grounds.

*Inpatient, inpatient residential, and outpatient programs located in or on the grounds of hospitals or medical centers must continue to follow the tobacco use policies and procedures of the hospital or medical center.

More Information

Recommended Trainings

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.

Attestation Form for Tobacco-Limited Services

OASAS programs serving adults that are interested in offering tobacco-limited services must submit a form attesting that their tobacco-limited policies and procedures meet the criteria outlined in this guidance.

OASAS reserves the right to review a program’s tobacco-limited services policies and procedures at any time, and if the policies and procedures are out of compliance with the guidance criteria and/or do not meet the standard of care for any reason, to request revisions of the policies and procedures and initiate regulatory action as necessary and appropriate.

Tobacco-Limited Services Policies and Procedures Examples

Examples of nicotine dosing administrations (NDAs) and the storage and distribution of cigarettes are below. These are only examples and are not intended to represent perfect protocols or to be adopted word for word, but rather to guide programs in creating protocols and procedures that work in their program setting, align with local resources, and meet the needs of the population they serve. 

Example: Nicotine Dosing Administrations (NDAs)

At designated times during the day, patients will meet as a group in the recreation room according to the smoking schedule. The group will be escorted by a staff member to the outdoor designated smoking area that is at least 100 feet from all entrances. Once at the smoking area, the patients will be given five (5) minutes (timed) for nicotine administration, only, and will then return to the building. Lighters will be given out by staff to be shared among the group to light cigarettes. The lighters will be returned to staff at the end of the smoking period. Patients who do not have cigarettes for the designated smoking times will not go with the group to the designated smoking area.

The five-minute limit for smoking minimizes the social aspect of smoking since it does not allow for much more than cigarette use. Fifteen minutes, which is the current time between activities in the program schedule, will be the total time for patients to gather, go to the designated area, smoke, and return to the facility.

Examples: Storage and distribution of cigarettes
  • Example 1: Program holds cigarettes and distributes them at the time of each designated nicotine dosing administration (NDA):
    • Each patient will have an assigned container with an attached inventory sheet.
    • Cigarettes will be inventoried daily by staff with the patient, and the sheet signed by the patient as evidence of a correct inventory count by staff and the patient.
    • Cigarettes will be stored in a secure location in the health coordinator’s office.
  • Example 2: Program holds cigarettes and distributes the patients’ daily allotments each morning.
    • Closed and factory sealed packages of cigarettes given to staff by patients will be stored in a secure location in the health coordinator’s office.
    • Each patient will be assigned a case when admitted and the case will be kept with the patient’s cigarettes.
    • Overnight staff will fill each patient’s case according to the predetermined number of  cigarettes per day and give each patient their case with their daily allotment of cigarettes each morning.
    • Patients will turn in their cases each evening for the process to be repeated for the following day

Attestation Form