Narcology & Addiction Treatment

Requires Standards 1–7 verified first

3 criteria

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [92] Established regulatory principles for medications used in the treatment of opioid use disorder, recognized in various forms across many countries, require a written diversion control plan, secure and identifiable take-home medication packaging, and patient education on safe storage and transport.

Controlled medications used in addiction treatment carry real diversion risk precisely because they are effective, sought-after substances, and a defined, written plan — not general care — is what specifically prevents theft, diversion, and unsafe handling at each stage from storage through to the patient's own home.

1 Storage security is strong but dispensing records aren't consistently reconciled against inventory.

Diversion can occur at the dispensing stage even when storage itself is secure.

2 Take-home packaging is used but doesn't consistently include identifying information.

Identifiable packaging is specifically what allows recovery or accountability if diversion is suspected.

3 Education happens for new patients but isn't reinforced for those on long-term take-home regimens.

Household circumstances can change over the course of long-term treatment, and reinforcement matters.

Week 1 Review current controlled substance handling against a specific, written diversion control plan standard.

Week 2 Establish or strengthen identifiable, secure take-home packaging.

Week 3 Establish genuine, documented patient education on safe storage and transport.

Ongoing Reconcile dispensing records against inventory regularly.

Ask for the actual written diversion control plan, not a general description of careful handling.

A specific, written document is the real evidence of a genuine plan.

Ask a patient receiving take-home medication what storage guidance they were given.

This reveals whether education is genuine practice, not just assumed to have happened.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [93] Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84(11):1353-1357 — establishes a validated, standardised scale for withdrawal severity assessment, widely adopted as the clinical standard.

Withdrawal severity can escalate significantly within a short period, and a validated, standardised scale gives a consistent, comparable measurement over time that clinical impression alone cannot reliably provide — this consistency is what allows genuinely early recognition of escalating severity.

1 The scale is used consistently during standard hours but less consistently during off-hours coverage.

Withdrawal risk doesn't diminish outside standard operating hours.

2 Assessment intervals are followed initially but relax as a patient's condition appears to stabilise.

Early stabilisation doesn't eliminate the value of continued, consistent monitoring.

3 The score is calculated correctly but the specific threshold for changing management isn't clearly defined.

A calculated score without a clear action threshold provides limited real guidance.

Week 1 Review current withdrawal assessment practice for validated scale use versus clinical impression alone.

Week 2 Establish or reinforce a defined assessment interval schedule.

Week 3 Define clear thresholds linking specific scores to specific management decisions.

Ongoing Audit consistency of scale use across all coverage periods, including off-hours.

Ask staff working off-hours or covering shifts specifically about assessment practice.

This is where consistency most commonly relaxes relative to standard hours.

Ask for a specific example of a score change leading to a specific management change.

A real example reveals whether the score genuinely drives decisions, not just gets recorded.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [94] Specimen temperature verification and defined chain-of-custody procedures are established practice for preventing urine drug screening substitution and tampering in addiction treatment settings.

A drug screening result that can be substituted or tampered with provides false reassurance that's arguably worse than no test at all, since it creates confidence in a result that doesn't reflect reality — the verification steps exist specifically because good faith alone hasn't proven sufficient.

1 Temperature verification happens but isn't consistently documented in the specimen record.

An undocumented check is difficult to distinguish from a check that didn't happen.

2 Direct observation criteria exist but aren't consistently applied by all staff collecting specimens.

A standard needs consistent application across everyone performing collection to provide real protection.

3 Chain of custody documentation exists but has occasional gaps during transport to an external lab.

Any gap in the chain, however brief, represents a real point where tampering could occur undetected.

Week 1 Review current specimen collection practice for temperature verification and documentation.

Week 2 Establish or reinforce a specific, consistently applied direct observation standard.

Week 3 Close any gap in chain-of-custody documentation, particularly during external transport.

Ongoing Audit chain-of-custody documentation for completeness periodically.

Ask to see the actual temperature verification and chain-of-custody documentation for a recent specimen.

Specific, dated records are the only real evidence of a genuinely functioning process.

Ask staff the specific criteria for when direct observation is used.

A specific, consistent answer reveals a genuine standard rather than inconsistent individual judgement.