Medically Assisted Treatment – Visions of the Cross

VOTC, Inc. MAT Participation

VOTC, Inc. is committed to providing quality substance use disorder (SUD) treatment services, including Medication-Assisted Treatment (MAT), in compliance with the guidelines set forth by the California Department of Health Care Services (DHCS) as outlined in HSC Section 11832.9(c) and 11834.28(c). This policy outlines the procedures and protocols to ensure the effective implementation of MAT, including client education, availability, evidence-based assessment, administration, storage, disposal, staff training, client access, and coordination with Narcotic Treatment Programs (NTPs) and buprenorphine providers.

Although VOTC, Inc. does not directly provide MAT services, clients who are under the care of a physician licensed by the state of California to treat opioid addiction with buprenorphine therapy are welcome at VOTC, Inc. programs. Prescribed MAT-medications are securely stored on behalf of Residential clients in the separate MAT Medications Storage cabinet and are made available to Residents according to the Medication Storage and Availability section in these policies and procedures. Additionally, MAT clients are responsible for providing their own medication container that locks in residential treatment services.

VOTC, Inc. is not a detox facility. However, some clients or potential clients will need detox treatment services and to get MAT or supervised medical care before receiving treatment at our Substance Use Treatment Program. Under certain circumstances VOTC, Inc. may require medical clearance upon arrival and admittance into our residential programs. Staff will immediately refer all clients or potential clients exhibiting signs or symptoms of withdrawal from any drug or alcohol and be sent the same day to:

Acute Withdrawal

1.) Mercy Medical Center Redding – Dignity Health Emergency Department – Bridge Program for detoxification from the substance or substances the client is experiencing withdrawal from.

2.) Shasta Regional Medical Center – Emergency Department for detoxification from the substance or substances the client is experiencing withdrawal from.

Non-Acute Withdrawal

1.) If the client is not experiencing acute withdrawal signs and symptoms, they will be admitted into our Residential Treatment facility.

Effective Treatment for Opioid Addiction

Medications, including buprenorphine (Suboxone®, Subutex®), methadone, and extended release naltrexone (Vivitrol®), are effective for the treatment of opioid use disorders.

Buprenorphine and methadone are “essential medicines” according to the World Health Organization.
A NIDA study shows that once treatment is initiated, a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid use disorder. However, because naltrexone requires full detoxification, initiating treatment among active users was more difficult with this medication. Once detoxification was complete, both medications had a similar effectiveness.
Medications should be combined with behavioral counseling for a “whole patient” approach, known as Medication Assisted Treatment (MAT).
MAT Decreases opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission.
After buprenorphine became available in Baltimore, heroin overdose deaths decreased by 37 percent during the study period, which ended in 2009.
MAT Increases social functioning and retention in treatment.
Patients treated with medication were more likely to remain in therapy compared to patients receiving treatment that did not include medication.
Treatment of opioid-dependent pregnant women with methadone or buprenorphine Improves Outcomes for their babies; MAT reduces symptoms of neonatal abstinence syndrome and length of hospital stay.

Prospective Clients

At VOTC, Inc., we take the health and well-being of our clients very seriously. Suppose a prospective client contacts us and self-identifies that they have an Opiate Use Disorder (OUD). In that case, our policy is to refer them to MAT services to ensure they receive the appropriate care and support. Our personnel are trained to handle these situations with sensitivity and compassion, and this policy will help us provide the best possible care for our clients. If the client is pregnant, she will be delivered the utmost attention to ensure adequate referrals for her and her unborn child.

Client Rights

Clients in recovery from addiction or seeking addiction treatment, including those in MAT, are protected from discrimination in employment, housing, public accommodations, and access to government services by the following laws:

Americans with Disabilities Act (ADA)
Fair Housing Act (FHA)
Workforce Investment Act (WIA)

Additionally, clients must be allowed access to medications prescribed for MAT, even if the facility is not directly providing MAT onsite. Clients are made aware and handed literature on what MAT treatment is, how it can help them and where they can obtain MAT treatment locally upon intake at one of our SUD treatment programs. If the client/member is not interested in MAT treatment at the time of intake the client/member will be handed literature on what MAT treatment is and the benefits and risks of being on MAT treatment.

Client & Family Education

Clients referred for MAT services will receive ongoing education about the importance of medication adherence, potential side effects, and the integration of MAT into their overall treatment plan. With consent from the client, the family or authorized caregiver will be provided adequate education to support their loved one suffering from addiction.

Assessment & Screening

Upon intake, each client will undergo a thorough assessment and screening process within the first twenty-four hours to determine the appropriate level of care and identify their specific treatment needs. This includes an assessment of the client’s substance use history, medical history, mental health status, and any previous experiences with MAT.
Clients will be provided with information about MAT services, including the benefits, potential risks, and the available medications. The importance of informed consent will be emphasized, and clients will be encouraged to ask questions and actively participate in the decision-making process.
A qualified SUD Counselor or LPHA will conduct a comprehensive clinical evaluation to assess whether MAT services are clinically indicated based on the client’s individual circumstances. Factors such as the severity of the substance use disorder, history of relapse, and medical conditions will be considered.

VOTC, Inc. MAT Community Collaboration

Clients on MAT medications, such as Methadone, will be driven in the morning to the AEGIS clinic to be supported for proper dosing or with-take-home doses (if the AEGIS provider sees fit) for MAT medications. Before leaving our treatment facility for transport to the MAT medication clinic, authorized and trained staff will take each client’s individual locking medication box out of the locked cabinet, and the locking box will be taken with the client(s) to the clinic.

Upon arrival at the clinic, the designated staff member will take the client(s) inside and wait inside with the client(s) until dosing and possibly take-home doses are provided to the client or clients.

Take-home doses may be stored and transported using the client(s) personal lock box with keys, or a lock box with a combination box, once received by the prescribing provider at the AEGIS clinic. Upon departure from the clinic, the box will be transported back to our residential treatment facility and handled by authorized staff. The authorized staff will count the doses, document the count and secure the methadone or other prescribed MAT medication in the clients’ lock box, within a locked cabinet.

The program has established collaborative relationships with local NTP providers and MAT treatment clinics to facilitate timely and appropriate referrals ensuring that clients have access to evidence-based MAT services.
If the clinical evaluation indicates that MAT services are appropriate, the client will be provided with a referral to a local NTP provider or MAT treatment clinic. The referral process will include contacting the chosen provider, sharing relevant client information (with the client’s consent), scheduling an appointment for the client, and providing transportation.
Aegis Treatment Center, 1147 Hartnell Avenue, Redding, CA 96002, (530)222-7213, Methadone and Suboxone Treatment, pinnacletreatment.com, 1.6 Miles From VOTC, Inc.
Renewed Life Medical Group, 376 Hartnell Avenue, Redding, CA 96002, (530)413-5692, Opioid, Methamphetamine and Alcohol Addiction Recovery, Renewed Life Medical Group (renewedliferecovery.com), 2.3 Miles From VOTC, Inc.
Mercy Medical Center Redding, Emergency Department, Bridge Program, 2175 Rosaline Avenue, Redding, CA 96001(866)764-7440, Methadone/Naltrexone/Suboxone/Opioid Treatment, dignityhealth.org, 6.8 Miles From VOTC, Inc.
Shasta Community Health Center, 1035 Placer Street, Redding, CA 96001, (530)246-5710, Suboxone Treatment, shastahealth.org, 5.2 Miles
Churn Creek Health Care, 3184 Churn Creek Road, Redding, CA 96002, (530)768-2436, Suboxone Treatment, rrths.org, 1.4 Miles From VOTC, Inc.
Hill Country Care Center, 1401 Gold Street, Redding, CA 96001, (530)691-4446, Suboxone Treatment, hillcountryclinic.org, 5.8 Miles From VOTC, Inc.

Community Partners MAT Procedures

Clients on MAT medications such as Methadone or Suboxone, will be driven in the morning to the AEGIS clinic to be supported for proper dosing or with-take home doses (if the AEGIS provider sees fit) for MAT medications.
Before leaving our treatment facility for transport to the MAT medication clinic, authorized and trained staff will take each clients individual locking medication box, out of the locked cabinet and the locking box will be taken with the client(s) to the clinic.
Upon arrival at the clinic, the designated staff member will take the client(s) inside the clinic and wait inside with the client(s) until dosing and possible with-take home doses are provided to the client or clients.
Take-home doses may be stored and transported using the client(s) personal lock box with keys, or a lock box with a combination box, once received by the prescribing provider at the AEGIS clinic.
Upon departure of the clinic, the box will be transported back to our residential treatment facility to be handled by authorized staff.
The authorized staff will count the doses, document the count, and secure the methadone or other prescribed MAT medication in the clients’ individual lock box, withing a locked cabinet.

Methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for opioid addiction, the medication dosage does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery.

Established MAT Prior to Admissions

Clients receiving MAT treatment prior to admission into our Residential SUD treatment facility will continue to be able to take their prescribed medication(s).
Once consent is provided our SUD Counselors will contact the clients referring MAT provider and receive dosing and relative information regarding that client’s MAT treatment.
Our facility will take the client for dosing at Aegis with all other clients.

Medication Labeling

All prescribed medications to be stored at VOTC. Inc. must be labeled in compliance with federal and state laws, containing, but not limited to, the following information:
Name of Resident
Name of Prescriber
Name of the medication
Dosage/Strength
Route of administration
Frequency
Quantity of contents
Indications and Usage
Date of expiration

Sample medications, dispensed by a physician or other licensed medical professional qualified to issue prescriptions, may be stored at VOTC, Inc. if they are accompanied by a written order from the provider, which includes all the above information. The original written order shall be kept with the sample(s) and a copy shall be placed in the Med Log.
All over-the-counter (OCT) medications must be labeled in conformance with state and federal food and drug laws. The medication of each Resident shall be kept and stored in their original, properly labeled, individually received containers. No medication shall be transferred between containers, except for take-home bottles.
Medications not meeting these labeling requirements shall not be permitted at VOTC, Inc. programs. If the Resident to whom such medications belong does not make other arrangements, such medications shall be destroyed.

Assurance of Access to Medications

Clients will not be denied access to MAT medications solely based on their participation or non-participation in substance use disorder (SUD) treatment classes. Our organization recognizes that MAT is a critical component of a comprehensive treatment plan, and access to medications will not be contingent upon engagement in program.

Medication Storage

Only Staff designated in writing by the Program Manager shall have access to the Medication Storage cabinet. Prescribed MAT medications shall be stored in a locked cabinet, separate from the cabinet used to store other Resident prescription medications.

After relevant information is recorded in the Resident’s Centrally Stored Medication and Destruction Record, it must be surrendered, placed in the Resident’s bag, and locked in the fireproof Medication Storage cabinet.

The Med Log binder is to be kept in the Medication Storage cabinet and updated whenever there are changes in information relating to that medication. A re-count of the contents of individual containers shall be regularly conducted and recorded, with any discrepancies noted and accounted for.

At no time is this storage to be unlocked by a Resident or left unlocked when a Staff member is not present in the office. Absolutely NO medications, including OTC meds, shall be in the personal possession of Residents other than as described in the following procedures.

Documentation Procedure

All referrals, communications with NTP providers or MAT treatment clinics, and client consent forms will be documented in the client’s record. This documentation will comply with privacy and confidentiality regulations.
All client documentation for MAT treatment will be noted in the client’s electronic health record or hard file.

Medication Documentation

Using the information contained on each medication container label, a separate Medication (Med) Log sheet is to be completed for each prescription medication brought into the program, including the same medication of varying dosages. Before counting any medications, the top portion of both sides of the Med Log are completed. Using all the completed Med Log sheets, a Centrally Stored Medications Log is to be created for the individual Resident – listing all their prescription(s) information.

Once these sheets are completed, they will be utilized when clients are taking their prescribed medications or OTC medications. The staff member will monitor the process with the client present while the client is taking their medication(s), the quantity is entered on the appropriate Med Log sheet, and both the Resident and the Staff member shall initial the entry on the Med Log.

The Med Logs are then placed behind the divider created for the Resident in the Med Log binder along with the Resident’s Centrally Stored Medications Log sheet. A copy of the Centrally Stored Medications Log is also placed in the Resident’s file. Every time there is an addition to (including prescription refills) or deletion from the Centrally Stored Medications Log, an updated copy is to be replaced with the previous copy in the Resident’s file.

When a Resident leaves the program, he/she has the option of taking any remaining meds with them. In this event, a final count is made, noted, and initialed with the Resident signing and dating the bottom of the Med Log sheet to indicate acceptance of the medication and the closing of that medication’s Log sheet. Should a Resident decline to take a med(s) with them, that is noted, with the departing Resident signing, and dating, and the medication(s) will follow suit for destruction. Additionally, when a client’s medication is completed or discontinued – the copy of the Med Log sheet will be placed into the client’s file.

At discharge, all the files related to a Resident’s medications, both Med Log sheets and the Centrally Stored Medications Log, are to be placed in the Resident’s file.

Availability of Prescription Medications

Under standard conditions, medications shall be made available to be self-administered at regular times, i.e., once in the morning, once in the evening, and, when necessary, at midday. However, if the doctor’s prescription calls for times or frequencies other than those noted above, that medication will be made available to the Resident in accordance with the physician’s direction as indicated on the prescription container label.

Self-Administered Medication Procedure

Individual Residents are responsible for ensuring that they take their prescribed medication(s) as directed. However, Staff shall monitor the Med Log and bring any deficiencies or irregularities to the Resident’s attention and appropriate documentation will be recorded if necessary.

The Staff shall only facilitate the use of self-administered medications in accordance with the prescribing physician’s orders as indicated on the medication label. Residents’ use of self-

administered medication will be recorded on the appropriate form in the daily Med Log.

In the presence of a Staff member, the unopened medicine container is to be provided to the Resident to enable their medication to be self-administered. The Staff person should witness the exact amount taken and note it in the Med Log.

Should a Resident enter the program with a medication that must be self-administered by injection (such as insulin), the used hypodermic syringe shall be disposed of in the following manner by the client:

The needle is to be carefully broken off the support and the syringe bent or otherwise made inoperative.

All parts are to be placed in the hazard container that is kept in a locked office cabinet until it can be taken off the facility to be disposed of properly.

All medication, including OTC medications, will be self-administered by the Resident in clear view of the Staff on duty. To facilitate observation of these procedures, separate disposable paper cups will be provided for water and for the Resident’s medication(s). As appropriate, Staff will follow these procedures in making Residents’ medications available:

For methadone, staff will hand that client’s individual unopened and locked MAT medication box from inside the MAT medications locking cabinet.
For other medications residential clients will remove an individual medication container from the bag. After allowing the Staff member to see the label to confirm that the Resident has the correct medication, the Resident shall open the container and place the appropriate dose of the medication in a provided disposable cup.
So that Staff can confirm the number and type of med to be taken, Residents will be asked to display to Staff the medication they placed in the disposable cup.
If more than one med is to be taken, then each resealed container shall be placed upside down on the table.
Once the medication is placed in the cup, Residents shall initial the appropriate form in the Med Log to confirm the medication was removed. Staff will also initial the form(s) to witness the Resident’s action.
If the Resident is taking more than one med at the same time, repeat steps 1-5.
When all meds to be taken have been placed in the cup, Residents shall replace the sealed containers in the zip-lock bag.
Residents shall then consume their meds in full view of Staff. After drinking the water provided, Residents may be asked to open their mouth and show that the medication(s) has indeed been swallowed.

Drug Medi-Cal (DMC) Residents

Medications for DMC-funded Residential Residents will be stored in a separate location and kept under a double lock.

Used Prescription Medication Container Disposal

When a prescribed medication is exhausted, the prescription label must be removed and destroyed. The Resident shall, under the supervision of a Staff member, remove the label from the container and give the label to the Staff person for disposal. If the Resident is unable, for whatever reason, to personally remove the label, this task shall be performed directly by a Staff member.

Because labels may contain confidential information, they must be disposed of in a manner that protects such information from exposure. If a shredder is to be used, the label should first be affixed to a sheet of paper to minimize the possibility of its adhesive fouling the shredder. The unlabeled empty container shall then be disposed of along with other recyclable materials.

Client’s Right to Choose MAT Medication

Clients have the right to choose their preferred MAT medication in consultation with their healthcare provider. The decision-making process will involve an open and collaborative discussion between the client and their healthcare team, considering the client’s medical history, preferences, and treatment goals.

Non-Discrimination in MAT Services

No client seeking MAT services will be denied access to treatment based on personal characteristics, history, or any other discriminatory factors. Our organization is committed to providing equitable and inclusive care to all individuals seeking MAT for SUD.

Support for Client Preferences in MAT Treatment

Clients will be supported in their decision to receive MAT treatment. Our healthcare providers will work collaboratively with clients to develop individualized treatment plans that align with the client’s goals, preferences, and medical needs. The organization will provide resources and information to help clients make informed decisions about their MAT journey.

Respect for Client Autonomy

Our organization is committed to respecting and upholding the autonomy of clients. Clients will never be confronted or compelled to taper, discontinue, decrease dosage, or abstain from MAT medications against their will. The decision to adjust medication regimens will be made collaboratively between the client and their healthcare provider.

Staff Training

At VOTC, Inc., we prioritize the safety and well-being of our clients/members enrolled in our SUD treatment programs. We have implemented an annual training requirement conducted by our Medical Director to ensure that our staff and volunteers are equipped with the necessary knowledge and understanding of our MAT policies and procedures. Additionally, training will be provided whenever a policy or practice changes to ensure everyone is updated. Educating our team on the benefits of medically assisted treatment is crucial in providing the best possible care for our clients/members. All training certificates will be stored in personnel training files.

Other Services

VOTC, Inc. is NOT a detoxification facility. However, once an individual receives detoxification services and is on MAT (Medically-Assisted Treatment), they can be admitted into one of our Residential SUD Treatment Programs.

If you are struggling with an opiate use disorder, here are our recommendations:

Local Detoxification Service Providers:

1.) Empire Recovery

2.) Mercy Hospital Bridge Program