THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY STACK, RAFFERTY, FONTANA, M. WHITE, D. WHITE, ALLOWAY, GREENLEAF, O'PAKE, EICHELBERGER AND WARD, MAY 26, 2010

REFERRED TO PUBLIC HEALTH AND WELFARE, MAY 26, 2010  

AN ACT

Providing for requirements for methadone use by narcotic

treatment programs, for reducing methadone diversion, for

reducing methadone-related accidents and deaths and for

duties of the Bureau of Drug and Alcohol Programs in the

Department of Health.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Short title.

This act shall be known and may be cited as the Methadone

Addiction Prevention and Treatment Act.

Section 2.  Legislative findings.

The General Assembly finds and declares as follows:

(1)  Methadone is used by some drug and alcohol treatment

programs to treat heroin addiction.

(2)  Some people have lost their lives to primary or

secondary drug interactions with methadone.

(3)  Prescriptions for methadone have increased by nearly

700% from 1998 through 2006.

(4)  Methadone patients have caused motor vehicle

accidents resulting in property damage and loss of life.

(5)  According to the Centers for Disease Control and

Prevention, in 2005 there were 4,462 methadone-related

deaths, representing an increase of 468% since 1999. By

contrast, all poisoning deaths by all drugs increased by 66%

over the same period.

(6)  Methadone is addictive, and most patients develop an

addiction to methadone.

(7)  Methadone withdrawal can be more severe than heroin

withdrawal.

(8)  There is no comprehensive database of drug-related

deaths in the United States.

(9)  Methadone treatment practices must be improved to

protect and prevent the patient and the public from deaths,

injuries and addictions.

Section 3.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Bureau."  The Bureau of Drug and Alcohol Programs in the

Department of Health.

"Department."  The Department of Health of the Commonwealth.

"Drug-free drug and alcohol addiction treatment facility."  A

drug and alcohol addiction treatment program that is not

licensed as a narcotic treatment program by the Department of

Health.

"Methadone."  An opiate-based narcotic that may be used to

treat drug addictions, including heroin.

"Narcotic treatment program."  As defined in 28 Pa. Code §

701.1 (relating to general definitions).

Section 4.  Eligibility for methadone treatment.

(a)  Treatment.--Prior to the administration of an agent,

narcotic treatment programs shall screen each individual to

determine eligibility for admission. In addition to other

Federal and State requirements, the narcotic treatment program

shall:

(1)  Verify that the individual is at least 21 years of

age. An individual 18 to 20 years of age can be approved for

the program using criteria developed by the bureau and with

the approval of the narcotic treatment programs' medical

director.

(2)  Determine that the individual has been

physiologically dependent on opiate-based narcotics for at

least one year prior to the admission and has been unable to

stay drug free from opiate-based narcotics after at least two

substantial attempts at appropriate treatment in drug-free

residential or drug-free outpatient treatment programs.

(3)  Determine that the individual is currently

physiologically dependent upon opiate-based narcotics.

(4)  Determine that other medical considerations, such as

hepatitis, liver or heart disease do not preclude the use of

methadone.

(5)  Conduct a review and document all medications in use

by the individual for potential adverse interactions with

methadone.

(b)  Intake process.--During the intake process, a narcotic

treatment program shall meet with each patient prior to starting

methadone treatment to provide counseling and to develop a

treatment and rehabilitation program. The intake process shall

include the following:

(1)  Providing information to the patient relating to:

(i)  Alternative methods of treatment, risks and

complications of methadone treatment and possible adverse

outcomes.

(ii)  Program policies.

(iii)  Hours of operation.

(iv)  Fee schedule.

(v)  Services provided.

(2)  Obtaining the following from the patient:

(i)  Medical history.

(ii)  Drug and alcohol history, including use of

prescription drugs.

(iii)  Personal history.

(3)  Obtaining consent to treatment.

(4)  Conducting a physical examination.

(5)  Conducting a psychosocial evaluation.

(c)  Preliminary treatment and rehabilitation plan.--The

preliminary treatment and rehabilitation plan shall include a

methadone-to-abstinence schedule. The schedule shall include

dates and goals for the patient to reduce and eliminate

methadone use within two to three years. Exceptions to the

methadone-to-abstinence plan must be approved by the bureau.

(d)  Counseling.--Each narcotic treatment program shall

provide a minimum of two hours of counseling a week to patients

using methadone. After three months' compliance with treatment

program rules and goals, including drug-free urine screens, the

amount of counseling shall be adjusted as recommended by a

physician in the best interest of the patient.

(e)  Drug screening tests.--

(1)  Narcotic treatment programs shall complete an

initial drug screening analysis for each prospective patient

upon intake and at least once every two weeks after

admission. Each test shall screen for opiates, methadone,

benzodiazepines, amphetamines, barbiturates, cocaine and

alcohol. When a patient has tested positive for opiates,

benzodiazepines, amphetamines, barbiturates, cocaine or

alcohol, the patient shall be provided immediately with

additional counseling to address the problem, and the

methadone dosage shall be adjusted as necessary to ensure

patient safety.

(2)  A narcotic treatment program may conduct on-site

drug screening. Screens that are positive must be confirmed

through a certified, independent laboratory with the report

maintained in the patient's file.

(f)  Operation of vehicle.--A patient using methadone is

prohibited from operating a vehicle during the first two weeks

of receiving methadone unless approved by the narcotic treatment

programs' medical director. If a patient tests positive for

other illegal drugs or alcohol, the patient is prohibited from

operating a vehicle for a minimum of one month unless approved

by the narcotic treatment programs' medical director.

(g)  Training of physicians.--A medical director providing

approval for driving or take-home privileges must have

certification in addiction medicine from the American Society of

Addiction Medicine or must have completed training in alcohol

and other drug addictions that has been approved by the Bureau

of Drug and Alcohol Programs and the Pennsylvania Medical

Society.

Section 5.  Reducing methadone abuse and diversion.

(a)  Plans.--Each narcotic treatment program shall develop

plans to reduce methadone diversion and submit the plans to the

bureau. The plans shall list the specific steps that the program

has taken to reduce methadone abuse.

(b)  Review and inspection.--The bureau shall review the

plans and conduct on-site inspections to determine compliance

with the plans.

(c)  Best practices.--The bureau shall develop a list of best

practices for methadone treatment and to reduce methadone

diversion. The best practices shall be published on the bureau's

Internet website. The department shall promulgate regulations

that require all treatment programs to implement the best

practices.

(d)  Take-home privileges.--

(1)  A narcotic treatment program may provide methadone

to a patient for use outside of the drug treatment facility

if consistent with the patient's treatment plan, including,

but not limited to, the methadone-to-abstinence schedule, and

the patient's physician has made a good faith estimate that

the take-home medication:

(i)  will improve the patient's treatment for heroin

addiction; and

(ii)  will not be diverted or abused.

(2)  The physician's good faith estimate shall be written

and maintained in the patient's file.

(3)  No patient shall receive take-home methadone within

six months of any positive test for opiates, benzodiazepines,

amphetamines, barbiturates, cocaine or alcohol.

(4)  No patient who has diverted or abused methadone is

eligible for take-home privileges. After a minimum of three

months' compliance with treatment program rules and goals,

including drug-free urine screens and with the approval of

the narcotic treatment programs' medical director, take-home

privileges may be reinstated.

Section 6.  Drug-free alternatives.

No drug and alcohol addiction treatment program shall be

required by license or contract to provide methadone or

buprenorphine or make them available to patients.

Section 7.  Facility operations.

In addition to other Federal, State and narcotic treatment

program laws, regulations or requirements, a narcotic treatment

program shall:

(1)  Have the right to discharge patients from treatment

who engage in diversion of methadone or violence or threats

of violence.

(2)  Honor patient requests for transfer to another

narcotic treatment program or to other treatment programs

within seven days of request.

(3)  Provide appropriate care and planning to protect the

health and safety of patients and the community during

transfers to other treatment programs or administrative

discharges.

(4)  Remain open seven days a week to reduce take-home

methadone prescriptions and prevent methadone diversion and

abuse.

Section 8.  Penalties.

(a)  Fine.--The Division of Drug and Alcohol Program

Licensure, Pennsylvania Department of Health, may assess a fine

of $1,000 for each violation of this act.

(b)  Public notice of violations.--All violations shall be

posted on the department's publicly accessible Internet website.

Section 9.  Effective date.

This act shall take effect in 60 days.