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The Behavioral Health Division (BHD) has been provided guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT), Division of Pharmacologic Therapies (DPT) regading what duties a Medical Director can delegate to a program physician or a mid-level practitioner in an OTP. Below is a copy/paste of guidiance recieved from SAMHSA:
“SAMHSA defines a medical director in 42 CFR § 8.2 as a physician, licensed to practice medicine in the jurisdiction in which the opioid treatment program is located, who assumes responsibility for administering all medical services performed by the program, either by performing them directly or by delegating specific responsibility to authorized program physicians and healthcare professionals functioning under the medical director’s direct supervision.
In regards to 42 CFR § 8.12 (h) (4) (i) Unsupervised or “take-home’’ use, 42 CFR § 8.12 (h) (4) (i)(2) states treatment program decisions on dispensing opioid treatment medications to patients for unsupervised use beyond that set forth in paragraph (i) (1) of this section, shall be determined by the medical director. In determining which patients may be permitted unsupervised use, the medical director shall consider the following take-home criteria in determining whether a patient is responsible in handling opioid drugs for unsupervised use.
Thus, the medical director shall determine “take-home” use which encompasses the 8-point criteria. This requirement is not delegable per the federal regulations. Thus, a mid-level practitioner cannot autonomously submit a “take-home” request to SAMHSA without the approval of the medical director.
Currently, SAMHSA has counselor accounts that mid-level practitioners can utilize to make a recommendation of approval to the medical director. The medical director may approve requests remotely. In the future, SAMHSA will create an account for mid-level practitioners to utilize.”
For questions about the above SAMHSA guidance please contact:
Latorie S. Jones, PharmD
LCDR, USPHS
Public Health Analyst
SAMHSA | CSAT | Division of Pharmacologic Therapies
5600 Fishers Lane, Room 13E21-D
Rockville, Maryland 20857
240-276-2905
latorie.jones@samhsa.hhs.gov
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