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Federal Guidelines for Opioid Treatment Programs

1. Although federal regulations for opioid treatment programs have not changed since their original adoption in 2001, the real world issues of opioid use disorders, the delivery of healthcare, and the problems impacting the health of the public change continuously and need to be monitored.

A. True

B. False


Federal Opioid Treatment Standards-Telemedicine

2. Medicaid guidelines require all providers to practice within the scope of their state practice, and federal regulations require all providers using telemedicine technology across state lines to have a valid state license in the state where the patient is located.

A. True

B. False


3. E-Therapy can be provided as a sole treatment modality or in combination with other modalities, and encompasses each of following characteristics EXCEPT:

A. It provides greater access to treatment services for populations who rely extensively on electronic devices

B. It includes a range of services, including screening, assessment, primary treatment, and after care

C. It helps people access treatment services who traditionally would not seek services because of barriers related to geography, shame and guilt, stigma, or other issues

D. It is generally covered by most insurance policies and more affordable than traditional therapy.


4. Under an OTP’s organizational structure, it is the responsibility of the _______________ to agree on behalf of the OTP to adhere to all requirements set forth and to follow all regulations regarding the use of opioid agonist treatment medications in the treatment of opioid addiction.

A. Program Sponsor

B. Medical Director

C. Administrative Supervisor

D. Treatment Coordinator


Facility Mnagement

5. Some states allow certain aspects of medication-assisted treatment services to be provided by an authorized healthcare professional other than a physician, such as an advanced practice nurse, physician assistant or advanced practice pharmacist.

A. True

B. False


Facility Mnagement

6. Each OTP must have sufficient space, be well-maintained, assure patient privacy, and provide services during reasonable hours.

A. True

B. False


Medication Unit

7. Medication units are required to be free-standing entities, and cannot be located at a hospital or community pharmacy because of OSHA workplace health and safety standards.

A. True

B. False


Continuous Quality Improvement

8. Which of the following is NOT likely to be included when evaluating OTP treatment outcomes?

A. Use of illicit opioids, illegal drugs, marijuana, and the problematic use of alcohol and prescription medicines

B. Criminal activities and involvement with the criminal justice system

C. Participation in peer and community support

D. Quality of life such as physical and mental health as well as functional status


Diverson Contron

9. As part of its quality assurance program, An OTP must maintain a current Diversion Control Plan (DCP) that contains specific measures to reduce the possibility of diversion of controlled substances from legitimate treatment use.

A. True

B. False


10. DCP’s should address at least four general areas of concern, including dosing and take-home medication, prevention of enrollment in multiple programs, prescription medication misuse, and:

A. Strategies to find discrepancies in medication supplies

B. Program environment

C. Proper training of all staff

D. Accountability practices


11. The responsibility to implement and monitor each aspect of the DCP should always be assigned to medical staff members as they generally have the most appropriate education and credentials to monitor diversion issues.

A. True

B. False


Patient Admission Criteria

12. Patients must be admitted to maintenance treatment by qualified personnel who have determined, using accepted medical criteria such as those listed in the DSM-IV, that the person is currently addicted to an opioid drug, and that the person become addicted at least _______ before admission for treatment.

A. 3 months

B. 6 months

C. 1 year

D. 2 years


Medically Supervised Withdrawal

13. Which of the following is an accurate statement about detoxification:

A. Detoxification is a legal and regulatory term that is preferred by the medical community when describing service provided to patients to address dependence on their opioid drug of choice

B. Most OTP’s provide specific pathway for patients to go directly to a medication free state

C. Most insurances will reimburse for inpatient detoxification services but not for such outpatient programs

D. Medically supervised withdrawal may be either voluntary or involuntary, and its purpose is to eliminate physical dependence on opioid medications


Involuntary Withdrawal from Treatment

14. A major goal of OTP is to retain patients for as long as they can benefit from and express a desire to continue treatment, which may include providing interventions to address disruptive behavior.

A. True

B. False


Required Services

15. OTP’s must provide adequate medical, counseling, vocational, educational, and other assessment and treatment services, and any assessment or treatments not directly provided at the facility must be assured via a formal documented agreement with the appropriate community providers.

A. True

B. False


Pregnant and Postpartum Patients

16. Patients who become pregnant during treatment must be re-evaluated for new dosage guidelines, as dosing principles used for non-pregnant patients are generally no longer appropriate.

A. True

B. False


Neonatal Abstinence Syndrome

17. For infants who are prenatally exposed to opioids, signs of withdrawal may begin at any time, but most appear within 24 hours.

A. True

B. False


Clinical Assessment, Treatment Planning and Evaluation of Patient Progress in Treatment

18. The purpose of an assessment is to determine treatment eligibility, develop a treatment plan, and:    

A. Establish a measure for the response to treatment

B. Appraise the patient’s physical/mental capacity and potential

C. Determine current needs in the areas of education, vocational rehabilitation, and employment

D. None of the above


HIV and Hepatitis

19. Patients with opioid use disorders who receive effective medication assisted treatment will likely have improved adherence of pharmacotherapy for HIV or other medical conditions.

A. True

B. False


Chronic Pain

20. In accordance with regulations and treatment guidelines, OTP patients are permitted to receive both medication-assisted treatment and adequate doses of opioids or other analgesics for pain when medically necessary.

A. True

B. False


Aftercare Planning

21. Aftercare planning should begin upon admission, and requires a ______________ approach to facilitate the process.

A. Strengths based

B. Crisis prevention

C. Recovery oriented

D. Problem-solving


Cultural Competency

22. All OTP program staff should be professionally and culturally competent, and be able to work effectively with the local community, accept input from minority community members, and/or receive the advice of individuals with knowledge of gender, ethnicity, and language issues.

A. True

B. False


Orientation to Treatment

23. Topics included in the patient’s orientation will likely include each of the following EXCEPT:

A. Signs and symptoms of overdose, use of the naloxone antidote, and when to seek emergency assistance

B. Guidance and referrals practices for patients wishing to seek alternative treatments

C. The nature of various addictive disorders

D. The benefits of treatment and nature of the recovery process, including stages of treatment


Testing and Screening for Drug Use

24. OTPs must provide adequate testing or analysis for drugs of abuse, including at least one random drug abuse test per month per patient, in accordance with general accepted clinical practice.

A. True

B. False


Records for the Storage, Dispensing and Administration of Opioid Medication

25. OTPs policies and procedures must be consistent with DEA statutes and regulations pertaining to the recording of and accounting for the use of controlled substances, and other medications must be stored separately from methadone and buprenorphine.

A. True

B. False


Pharmacotherapy

26. Which of the following is NOT one of the desired outcomes of medication-assisted treatment for opioid addiction?

A. Prevention of the onset of subjective and/or objective signs of opioid abstinence syndrome for at least 24 hours

B. Reduction or elimination of drug craving routinely experienced by the patient

C. Reinforcement of positive behavior or reduction of negative behavior that impacts addiction

D. Blockage of the euphoric effects of any illicitly acquired, self-administered drug without the patient experiencing or observers noticing undesirable effects


Unsupervised Approved Use (Take-Home) of Medication

27. Any patient in comprehensive maintenance treatment may receive a single take home dose for a day that the clinic is closed for business, including Sundays and State and Federal holidays, but during the first 120 days of treatment, the take home supply is limited to a single dose each week.

A. True

B. False


Interim Maintenance

28. An OTP may place an eligible individual in interim maintenance treatment if the individual cannot be placed in a public or nonprofit private comprehensive program within a reasonable geographic area and within 14 days of the individual’s application for treatment.  

A. True

B. False


Exemptions

29. An example of someone who may be granted a SAMSHA exemption would be a private practitioner who wishes to treat a limited number of patients in a non-metropolitan area that lacks such services, and who requests exemption from some of the staffing and service standards.

A. True

B. False


Exception Request for Variation from Detoxification Standards

30. Federal and State regulations specify that a program may not admit a patient for more than four detoxification treatment episodes in one year, and state that such patients must be assessed by the OTP physician for other forms of treatment.

A. True

B. False


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