{'fraction_non_alphanumeric': 0.021072088724584104, 'fraction_numerical': 0.008133086876155268, 'mean_word_length': 5.235023041474655, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 1, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Guideline for Physicians Working in California Opioid Treatment Programs

PREAMBLE This monograph was developed by the Committee on Treatment of Opioid Dependence of the California Society of Addiction Medicine to provide an overview and discussion of the matters of clinical care that fall under the responsibility of the opioid treatment program (OTP) medical director and program physicians. It was prepared and distributed first in 1998 and updated once in 2004. This 2008 edition incorporates current information. OTP is the term used by Federal and state regulating agencies to refer to clinics that are specially licensed to provide opioid pharmacotherapy for addiction treatment. OTPs are commonly known as methadone clinics. Both the Federal and state governments regulate OTPs. Federal regulations are found in 42 CFR Part 8, and California's regulations are found in Chapter 4, Division 4, Title 9 of the California Code. This document will reference these regulations, but it is not designed to summarize all of them. Rather, this monograph is meant to serve as a reference offering practical clinical information and suggestions for the physician working in an OTP. While this document is intended to assist physicians in making clinical decisions, it does not represent regulations or standards of care. Ultimately clinical decisions are made based on the patient's situation, the available resources and a physician's best clinical judgment. Federal regulations require that OTPs be accredited by an agency approved by the Center for Substance Abuse Treatment (CSAT.) In California, in 2008, the approved agencies are the Joint Commission on Accreditation of Health Organizations (JCAHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF.) The CARF standards say that each OTP must have a medical director who is responsible for: a. Administering or supervising all medical services. b. Ensuring that the program is in conformance with all applicable local, state, and Federal regulations regarding the medical treatment of opioid addiction. CARF Standards go on to say that, in order to serve as the Medical Director of an OTP, a physician must have either: a. Demonstrated experience in opioid treatment, or b. Developed a written plan to attain competence in opioid treatment within twelve months (to include continuing medical education in addiction medicine), and be monitored by the designated authority. Although the Medical Director of an OTP has administrative responsibilities in addition to the medical/clinical ones, they are a separate issue. This monograph's focus is on the medical piece. This monograph was circulated for review to interested parties, …