EDITIONEN·FR·ქართ

Accréditation Sans Frontières

International Accreditation of Healthcare Facilities

Standards › ASF Health Standards v10 › Standard 38

Standard 38

Substance Use and Addiction Treatment

Substance use and addiction treatment: validated assessment, individual plans and prescribing, harm reduction and naloxone, confidentiality, and discharge with a relapse plan..

5
criteria
9
documents
2
e-learning courses
11
references

Criteria on this page

38.138.238.338.438.5

How to read the colours
Red: Must. Required in every setting. Criteria that protect life are always red.
Green: Medium. Required, adapted to what a transition setting can realistically do.
Yellow: Minimum. The lowest acceptable level in a humanitarian setting, where resources are very limited.

Each criterion is shown in three settings: Humanitarian settings, Transition and fragile, and Standard. In standard settings, every criterion is Must.

Reference, not a requirement. Every policy, SOP, form and course on this page is a draft to help you. Adapt it to your hospital, write your own, or upload your own documents. What the assessor checks is that the standard is met and that you can show how.
Training colours: red means essential, green recommended, yellow optional. Each course shows its level for each setting: humanitarian, transition and fragile, and standard.
38.1Substance Use Is Assessed With a Validated ToolHumanitarian settings: MinimumTransition and fragile: MustStandard: Must

Each person has a documented assessment of their substance use, using a validated screening or assessment tool, before a treatment plan is agreed.

Humanitarian settings
Minimum
Transition and fragile
Must
Standard
Must

Why it matters. Substance use treatment starts with knowing what the person uses, how much and how often. A validated screening tool gives a common starting point that can be compared over time.

How the surveyor verifies this criterion

Sample. Review assessment records for 20 people who started treatment in the last 6 months.

1. Each person has a substance use assessment dated before the treatment plan.

Method. Check each record for an assessment dated before the plan.

Evidence to show. Substance use assessment record (SUB-FRM-001).

Pass when. Every sampled person has an assessment before the plan.

2. The assessment uses a validated screening or assessment tool, and the tool is named.

Method. Check each assessment for the tool named and the score recorded.

Evidence to show. Validated substance use assessment (SUB-SOP-001).

Pass when. Every assessment names a validated tool and records a score.

3. The assessment is repeated at the set interval.

Method. Check each record for the repeat assessment dates against the interval.

Evidence to show. Substance use assessment record (SUB-FRM-001).

Pass when. Every sampled person has repeat assessment at the set interval.

Immediate fail (any one means the criterion is not met). A person starts treatment with no assessment of substance use on file.

Staff responsible

Role Responsibility Level
Nurse (ISCO 2221) Completes the Substance use assessment record Must
Manager (ISCO 1342) Maintains the Validated substance use assessment Must

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SUB-SOP-001 · Validated substance use assessment Manager (ISCO 1342) Chief executive (ISCO 1120) Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344)
SUB-FRM-001 · Substance use assessment record Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Narcology & Addiction Treatment (AMB-21) Manager; Nurse

References

  1. WHO (2023). Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders. Used for: Validated screening and assessment tools for substance use disorders, within a wider mental health guideline. https://news.gmj.ge/guideline/mental-health-gap-action-programme-mhgap-guideline-for-mental-neurological-and-substance-use-disorders/
  2. World Health Organization (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: WHO. Used for: https://news.gmj.ge/guideline/guidelines-for-the-psychosocially-assisted-pharmacological-treatment-of-opioid-dependence/
38.2Treatment Is Individual and Prescribed by a Licensed ClinicianHumanitarian settings: MustTransition and fragile: MustStandard: Must

Each person has an individual treatment plan. Where medicines are part of treatment, they are prescribed and monitored by a qualified clinician, following WHO guidance on the treatment of substance use.

Humanitarian settings
Must
Transition and fragile
Must
Standard
Must

Why it matters. Treatment for substance use must fit the person. A plan built for them, and medicines prescribed by a licensed clinician, keep the treatment safe and effective.

How the surveyor verifies this criterion

Sample. Review treatment plans and prescribing records for 20 people, including any given medicines for substance use.

1. Each person has an individual treatment plan.

Method. Check each plan for goals and interventions specific to the person.

Evidence to show. Individual treatment and prescribing (SUB-POL-001).

Pass when. Every sampled person has an individual plan.

2. Monitoring is recorded for each prescribed medicine.

Method. Check each record for monitoring entries against the monitoring plan.

Evidence to show. Individual treatment plan record (SUB-FRM-002).

Pass when. Every prescribed medicine has monitoring recorded.

Immediate fail (any one means the criterion is not met). A person prescribed an opioid medicine by phone with no monitoring and no individual plan.

Staff responsible

Role Responsibility Level
Manager (ISCO 1342) Maintains the Individual treatment and prescribing Must
Nurse (ISCO 2221) Completes the Individual treatment plan record Must

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SUB-FRM-002 · Individual treatment plan record Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)
SUB-POL-001 · Individual treatment and prescribing Chief executive (ISCO 1120) Governing body members N/A Chief executive (ISCO 1120) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Narcology & Addiction Treatment (AMB-21) Manager; Nurse

References

  1. WHO (2025). Opioid agonist maintenance treatment as an essential health service: implementation guidance on mitigating disruption of services for treatment of opioid dependence. Used for: Opioid agonist treatment prescribing, take-home doses, naloxone and community links. Opioid-specific. https://news.gmj.ge/guideline/opioid-agonist-maintenance-treatment-as-an-essential-health-service-implementation-guidance-on-mitigating-disruption-of-services-for-treatment-of-opioid-dependence/
  2. WHO (2019). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Used for: Individual assessment and prescribing for opioid dependence, with psychosocial support. Opioid-specific. https://news.gmj.ge/guideline/guidelines-for-the-psychosocially-assisted-pharmacological-treatment-of-opioid-dependence/
38.3Harm Reduction Is AvailableHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must

Harm reduction services are available to people who use substances, including access to naloxone, information on safer use, and referral for testing for blood-borne infections.

Humanitarian settings
Minimum
Transition and fragile
Medium
Standard
Must

Why it matters. People who use substances face serious harm from overdose and infection. Harm reduction services save lives and bring people into care, and they should be available to anyone who needs them.

How the surveyor verifies this criterion

Sample. Review harm reduction records for the last 6 months, including naloxone supply and testing referrals.

1. Harm reduction services are available to people who use substances.

Method. Check the service list for the harm reduction services offered.

Evidence to show. Harm reduction services and naloxone access (SUB-SOP-002).

Pass when. Harm reduction services are listed and available.

2. Naloxone is offered and supplied to people at risk, with the supply recorded.

Method. Check the register for each naloxone supply against the offer recorded.

Evidence to show. Naloxone and harm reduction register (SUB-REG-001).

Pass when. Every person at risk has a naloxone offer and supply recorded.

3. Referral for testing is offered and recorded.

Method. Check each record for the testing offer and the referral.

Evidence to show. Naloxone and harm reduction register (SUB-REG-001).

Pass when. Every testing offer and referral is recorded.

Immediate fail (any one means the criterion is not met). A person who uses opioids is not offered naloxone or a testing referral.

Staff responsible

Role Responsibility Level
Manager (ISCO 1342) Maintains the Harm reduction services and naloxone access Medium
Secretary (ISCO 3344) Keeps the Naloxone and harm reduction register Medium

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SUB-SOP-002 · Harm reduction services and naloxone access Manager (ISCO 1342) Chief executive (ISCO 1120) Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344)
SUB-REG-001 · Naloxone and harm reduction register Secretary (ISCO 3344) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Narcology & Addiction Treatment (AMB-21) Manager; Nurse

References

  1. WHO (2025). Opioid agonist maintenance treatment as an essential health service: implementation guidance on mitigating disruption of services for treatment of opioid dependence. Used for: Opioid agonist treatment prescribing, take-home doses, naloxone and community links. Opioid-specific. https://news.gmj.ge/guideline/opioid-agonist-maintenance-treatment-as-an-essential-health-service-implementation-guidance-on-mitigating-disruption-of-services-for-treatment-of-opioid-dependence/
  2. WHO (2023). Recommended package of interventions for HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for people in prisons and other closed settings. Used for: Harm reduction in prisons: needle and syringe programmes and naloxone. Prison-specific. https://news.gmj.ge/guideline/recommended-package-of-interventions-for-hiv-viral-hepatitis-and-sti-prevention-diagnosis-treatment-and-care-for-people-in-prisons-and-other-closed-settings/
  3. WHO (2026). Consolidated guidance on hepatitis B and C prevention, testing, treatment, service delivery and monitoring. Used for: Harm reduction for people who inject drugs (needle and syringe services) within hepatitis services. Hepatitis-specific. https://news.gmj.ge/guideline/consolidated-guidance-on-hepatitis-b-and-c-prevention-testing-treatment-service-delivery-and-monitoring/
  4. World Health Organization (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: WHO. Used for: https://news.gmj.ge/guideline/guidelines-for-the-psychosocially-assisted-pharmacological-treatment-of-opioid-dependence/
38.4Information About Use Is ConfidentialHumanitarian settings: MinimumTransition and fragile: MustStandard: Must

Information about a person’s substance use is kept confidential. It is shared only with consent or where the duty of confidentiality allows, and each disclosure is recorded. This criterion adds to the record-keeping and confidentiality rules in Standard 1.

Humanitarian settings
Minimum
Transition and fragile
Must
Standard
Must

Why it matters. A person who uses substances may fear arrest or stigma if their information is shared. Keeping it confidential, and sharing it only with consent or where the law requires, keeps them coming back to care.

How the surveyor verifies this criterion

Sample. Review information-sharing records for 15 people, including any request for information from a third party.

1. Information about substance use is kept confidential.

Method. Check each record for the confidentiality status and the access controls.

Evidence to show. Confidentiality of substance use information (SUB-POL-002).

Pass when. Every record is held under confidentiality controls.

2. Each disclosure is recorded with the person, the reason and the date.

Method. Check the disclosure log for each entry.

Evidence to show. Confidentiality of substance use information (SUB-POL-002).

Pass when. Every disclosure is recorded with its reason and date.

Immediate fail (any one means the criterion is not met). A person’s substance use disclosed to an employer without consent.

Staff responsible

Role Responsibility Level
Manager (ISCO 1342) Maintains the Confidentiality of substance use information Must
Manager (ISCO 1342) Checks the criterion at each review Must

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SUB-POL-002 · Confidentiality of substance use information Chief executive (ISCO 1120) Governing body members N/A Chief executive (ISCO 1120) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Records, Confidentiality and Data Protection (T-11) Manager; Nurse

References

  1. WHO (2025). Global standards for quality health care services for adolescents. Used for: Adolescent confidentiality and privacy standards. Adolescent-specific, not general adult confidentiality. https://news.gmj.ge/guideline/global-standards-for-quality-health-care-services-for-adolescents/
38.5Discharge Is Planned With Links to Community SupportHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must

Discharge and transfer are planned in advance, with referral to community support, and with a relapse plan agreed with the person.

Humanitarian settings
Minimum
Transition and fragile
Medium
Standard
Must

Why it matters. Leaving treatment without a link to community support is a common reason for relapse. A planned discharge with referrals keeps the person connected after the service ends.

How the surveyor verifies this criterion

Sample. Review discharge and transfer records for 15 people who left treatment in the last 6 months.

1. Discharge or transfer is planned in advance.

Method. Check each record for the plan dated before the discharge date.

Evidence to show. Discharge, community support and relapse plan (SUB-SOP-003).

Pass when. Every sampled discharge has a plan dated before it.

2. A relapse plan is agreed with the person and recorded.

Method. Check each record for the relapse plan and the person’s agreement.

Evidence to show. Discharge and relapse plan record (SUB-FRM-003).

Pass when. Every sampled person has a relapse plan agreed and recorded.

Immediate fail (any one means the criterion is not met). A person discharged from treatment with no community referral and no relapse plan.

Staff responsible

Role Responsibility Level
Manager (ISCO 1342) Maintains the Discharge, community support and relapse plan Medium
Nurse (ISCO 2221) Completes the Discharge, community support and relapse plan record Medium

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SUB-SOP-003 · Discharge, community support and relapse plan Manager (ISCO 1342) Chief executive (ISCO 1120) Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344)
SUB-FRM-003 · Discharge and relapse plan record Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Narcology & Addiction Treatment (AMB-21) Manager; Nurse

References

  1. WHO (2025). Opioid agonist maintenance treatment as an essential health service: implementation guidance on mitigating disruption of services for treatment of opioid dependence. Used for: Opioid agonist treatment prescribing, take-home doses, naloxone and community links. Opioid-specific. https://news.gmj.ge/guideline/opioid-agonist-maintenance-treatment-as-an-essential-health-service-implementation-guidance-on-mitigating-disruption-of-services-for-treatment-of-opioid-dependence/
  2. World Health Organization (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: WHO. Used for: https://news.gmj.ge/guideline/guidelines-for-the-psychosocially-assisted-pharmacological-treatment-of-opioid-dependence/

Who is responsible for Standard 38

Each criterion names the positions responsible for it. Every position links to its own terms of reference.

Criterion Responsible Supports
38.1 Substance Use Is Assessed With a Validated Tool Mental health nurse
Clinical psychologist
Psychiatrist
38.2 Treatment Is Individual and Prescribed by a Licensed Clinician Psychiatrist
Consultant physician (internal medicine)
Mental health nurse
38.3 Harm Reduction Is Available Mental health nurse
Social worker
Infection prevention and control (IPC) lead
38.4 Information About Use Is Confidential Data protection officer
Mental health nurse
Social worker
38.5 Discharge Is Planned With Links to Community Support Social worker
Mental health nurse
Family physician (GP) lead

Role details: reporting, supervision and training

Training shown is the general recommendation. Role-specific training is set in the next improvement round.

Role Reports to Supervises Recommended training
Data protection officer Chief executive officer (CEO) None Facility induction; safeguarding adults (general recommendation)
Infection prevention and control (IPC) lead Quality manager IPC nurse Facility induction; safeguarding adults (general recommendation)
Consultant physician (internal medicine) Head of department (per specialty) Resident physician / house officer Facility induction; safeguarding adults (general recommendation)
Psychiatrist Head of department (per specialty) None Facility induction; safeguarding adults (general recommendation)
Mental health nurse Head of department (per specialty) None Facility induction; safeguarding adults (general recommendation)
Clinical psychologist Head of department (per specialty) None Facility induction; safeguarding adults (general recommendation)
Social worker Patient services manager None Facility induction; safeguarding adults (general recommendation)
Family physician (GP) lead Medical director Practice nurse (immunisation, chronic care), Walk-in clinic physician, Same-day procedure nurse Facility induction; safeguarding adults (general recommendation)

Questions and answers

The criterion text is the authority. These answers summarise it.

Who does Standard 31 apply to?

Services that assess and treat substance use and addiction, including outpatient and inpatient treatment and the prescribing and harm reduction services that go with it.

What do the colours mean for this standard?

Red (Must) is required. Green (Medium) is recommended. Yellow (Minimum) is the lowest acceptable level in humanitarian settings. Standard setting is Must on every criterion.

Is a validated tool required for every person?

Yes. Under 38.1 each person has a documented assessment of their substance use with a validated screening or assessment tool before a treatment plan is agreed.

Who can prescribe treatment medicines?

Under 38.2 treatment is individual and prescribed by a licensed clinician, and the plan and prescribing records are reviewed.

Is naloxone part of the service?

Under 38.3 harm reduction is available, including naloxone supply and access, and is recorded in the harm reduction register.

Can information about a person’s substance use be shared?

Under 38.4 information about substance use is confidential and is shared only within the rules set out in the confidentiality policy.

What happens when a person leaves treatment?

Under 38.5 discharge is planned with a relapse plan and links to community support.

Guidelines for this standard

11 guideline(s) are held in the GMJ Guidelines Library and listed here. Each link opens the full guideline on news.gmj.ge. The complete library, grouped by standard, is at Guidelines.

  1. Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence (WHO)
  2. Recommended package of interventions for HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for people in prisons and other closed settings (World Health Organization)
  3. Opioid agonist maintenance treatment as an essential health service: implementation guidance on mitigating disruption of services for treatment of opioid dependence (World Health Organization)
  4. Insomnia — MSF Clinical guidelines (Médecins Sans Frontières)
  5. Urethral discharge — Clinical guidelines — Diagnosis and treatment manual — MSF Clinical guidelines (Médecins Sans Frontières)
  6. Making every school a health-promoting school: implementation guidance for school health services (World Health Organization)
  7. Guidance for countries to assess adolescent health and well-being (World Health Organization)
  8. Guidelines on lenacapavir for HIV prevention and testing strategies for long-acting injectable pre-exposure prophylaxis (World Health Organization)
  9. Competency and outcomes framework for adolescent health and well-being (World Health Organization)
  10. Consolidated operational handbook on sexually transmitted infections (World Health Organization)
  11. Consolidated HIV guidelines: service delivery (World Health Organization)

Also relevant to this standard: