Missouri Regulations
Department of Mental Health/Certification Standards
Vol. 46, No. 21, Missouri Register 2021-11-01 p.2022
PUBLICATION DATE: 11/01/2021
ACTION DATE: 11/01/2021
EFFECTIVE DATE: 12/30/2021
PUBLICATION TYPE: Register
REGISTER SOURCE: Vol. 46, No. 13, Missouri Register 2021-07-01 pp.1058-1063
PUBLICATION DATE: 07/01/2021
ACTION DATE: 05/28/2021
COMMENT DEADLINE: 07/31/2021
PUBLICATION TYPE: Register

Title 9-DEPARTMENT OF MENTAL HEALTH

Division 30-Certification Standards

Chapter 3-Substance Use Disorder Prevention and Treatment Programs

ORDER OF RULEMAKING

By the authority vested in the Director of the Department of Mental Health under sections 630.192-630.198, RSMo 2016, the department adopts a rule as follows:

9 CSR 30-3.132 is adopted.

A notice of proposed rulemaking containing the text of the proposed rule was published in the Missouri Register on July 1, 2021 (46 MoReg 1058-1063). Those sections with changes are reprinted here. This proposed rule becomes effective thirty (30) days after publication in the Code of State Regulations.

SUMMARY OF COMMENTS: Three (3) comments were received.

COMMENT #1: A department staff member requested "antagonist" be added to the types of medications included in subsection (2)(A). RESPONSE AND EXPLANATION OF CHANGE: The department agrees and will add "antagonist" to subsection (2)(A).

COMMENT #2: A department staff member requested "licensed physician" be changed to "qualified prescriber" in paragraph (2)(B)1.

RESPONSE AND EXPLANATION OF CHANGE: The department agrees and will change the language as requested.

COMMENT #3: A department staff member requested "program physician" be changed to "qualified prescriber" in the second sentence of paragraph (2)(B)3.

RESPONSE AND EXPLANATION OF CHANGE: The department agrees and will change the language as requested.

9 CSR 30-3.132 Opioid Treatment Programs

(2) Medication Administration, Dispensing, and Use. OTPs shall only utilize medications approved by the FDA for the treatment of opioid use disorder.

(A) Opioid agonist, partial agonist, and antagonist treatment medications shall be administered and dispensed by a practitioner licensed in Missouri and registered under the appropriate state and federal laws to administer or dispense opioid drugs.

(B) Written policies and procedures shall be maintained to ensure the following dosage form and initial dosing requirements are met:

1. Methadone is prescribed by a qualified prescriber, administered and dispensed only in oral form, and formulated in a manner to reduce its potential for parenteral abuse;

2. For newly admitted individuals, the initial dose of methadone does not exceed thirty (30) milligrams and the total dose for the first day does not exceed forty (40) milligrams, unless the program physician documents in the individual record that forty (40) milligrams did not suppress opioid abstinence symptoms; and

3. Each opioid agonist medication is administered and dispensed in accordance with its approved product labeling. Dosing and administration decisions shall be made by a qualified prescriber familiar with the most up-to-date product labeling. These procedures must ensure any significant deviations from the approved labeling, including deviations with regard to dose, frequency, or the conditions of use described in the approved labeling, are specifically documented in the individual record.