Thông tư 18/2021/TT-BYT

CIRCULAR

DIAGNOSTIC CRITERIA AND PROFESSIONAL PROCEDURES FOR IDENTIFYING NARCOTIC ADDICTION

MINISTER OF HEALTH

Pursuant to the Law on Medical Examination and Treatment No. 40/2009/QH12 dated November 23, 2009;

Pursuant to Law on Prevention and Control of Narcotic Substances No.73/2021/QH14 dated March 30, 2021;

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of Government on functions, tasks, powers, and organizational structure of Ministry of Health;

At the request of the Director General of the Vietnam Administration of Medical Services;

Minister of Health promulgates Circular on diagnostic criteria and professional procedures for identifying narcotic addiction.

Article 1. Scope

This Circular prescribes diagnostic criteria and professional procedures for identifying narcotic addiction of individuals mentioned under Clause 1 Article 27 of Law on Prevention and Control of Narcotic Substances of 2021.

Article 2. Regulated entities

This Circular applies to agencies, organizations, and individuals engaging in identification of narcotic addiction.

Article 3. Diagnostic criteria of narcotic addiction

1. Diagnostic criteria of narcotic addiction consist of the following 6 criteria:

a) Criterion 1: Craving or feeling compelled to take narcotics;

b) Criterion 2: Having difficulty controlling the use of narcotics in terms of starting time, ending time, or use amount;

c) Criterion 3: Developing narcotic tolerance;

d) Criterion 4: Growing increasingly negligent in hobbies or other recreational activities due to the use of narcotics;

dd) Criterion 5: Continuing the use of narcotics despite being aware of consequences of narcotics;

e) Criterion 6: Developing narcotic withdrawal (withdrawal syndrome) when ceasing or reducing the use of narcotics.

2. Identification of characteristic withdrawal state of narcotic substances shall conform to Guidelines on identifying characteristic withdrawal states of narcotic substances under Annex No. 1 attached hereto. Criteria 2, 3, 4, and 6 shall be identified in accordance with Guidelines under Annex No. 2 attached hereto in order to diagnose narcotic addiction.

3. Diagnostic criteria of narcotic addiction shall be identified on the basis of clinical monitor results, information extracted from individuals whose narcotic addiction is to be identified or accompanying individuals (if any), and documents provided by police authority.

4. An individual shall be diagnosed with narcotic addiction when (i) he/she meets at least 3 of the 6 criteria under Clause 1 Article 3 hereof simultaneously for at least 1 month or (ii) he/she meets at least 3 of the 6 criteria under Clause 1 Article 3 hereof simultaneously for less 88than 1 month repeatedly in 12 months' time.

Article 4. Professional procedures for identifying narcotic addiction

1. Step 1: Receiving an individual whose narcotic addiction is to be identified and collecting relevant information of the individual.

2. Step 2: Examining, monitoring clinically, and recording information on medical record and Checklist for general narcotic addiction under Annex No. 3 attached hereto.

3. Step 3: Writing conclusion

a) In case the individual only meets 1 criterion for narcotic addition or 2 criteria for narcotic addiction with one of them being criterion 6, write “không nghiện ma túy” (not addicted to narcotics) in the Checklist for narcotic addiction and promptly issue narcotic addiction results in accordance with Article 5 of hereof.

b) In case the in8dividual meets at least 3 criteria for narcotic addiction, write “có nghiện ma túy” (addicted to narcotics) in the Checklist for narcotic addiction and promptly issue narcotic addiction results in accordance with Article 5 hereof.

c) In case the individual meets 2 criteria for narcotic addiction with none of them being criterion 6 or exhibits unclear signs of narcotic addiction, conform to step 4 under Clause 4 of this Article.

4. Step 4: Examining, monitoring clinically, and recording information, conclusion in medical record and Checklists for cases under Point c Clause 3 of this Article:

a) Advise and immediately examine, monitor clinically in order to identify narcotic addiction;

b) Examine and fill in medical record;

c) Monitor and fill in the Checklist for narcotic addiction and Checklists for withdrawal of narcotic substance addiction corresponding to different types of narcotic substances namely: Checklist for withdrawal of opioids under Annex No. 4; Checklist for withdrawal of stimulants (amphetamine-type stimulants, cocaine, or other stimulants) under Annex No. 5; and Checklist for withdrawal of marijuana under Annex No. 6 attached hereto;

d) Write “có trạng thái cai các chất ma túy” (exhibiting withdrawal of narcotic substances) or “không có trạng thái cai các chất ma túy” (not exhibiting withdrawal of narcotic substances) in the Checklist for withdrawal of respective narcotic substances. Conclusions regarding withdrawal of narcotic substances shall be written in the Checklist for general narcotic addiction;

dd) Write conclusion regarding narcotic addition in the Checklist for general narcotic addiction and medical record. In case the individual meets at least 3 criteria of narcotic addiction, write “có nghiện ma túy” (addicted to narcotic). In case the individual fails to meet 3 criteria for narcotic addiction or exhibits unclear signs of narcotic addiction due to time constrain, write “không nghiện ma túy” (not addicted to narcotic). Immediately issue narcotic addiction results in accordance with Article 5 hereof.

5. If an individual whose narcotic addiction is to be identified exhibits withdrawal syndrome, mental disorder and/or associated disorders while being identified for narcotic addiction, the individual shall be examined and treated in accordance with applicable regulations on medical examination and treatment.

Article 5. Issuance of narcotic addiction results

1. Write the results in Narcotic addiction form depending on conclusion regarding narcotic addiction on the Checklist for general narcotic addiction.

2. Narcotic addiction results shall be issued to individuals who voluntarily request narcotic addiction identification or to police authority which request narcotic addiction identification within 5 days from the date on which individuals whose narcotic addiction is to be identified.

Article 6. Implementation

1. Responsibilities of Department of Medical Service Administration:

a) Direct, provide guidance, publicize, inspect, and examine implementation of this Circular;

b) Organize professional training and education regarding diagnosis of narcotic addiction for Departments of Health of provinces and central-affiliated cities (hereinafter referred to as “Departments of Health”) and medical establishments.

2. Responsibilities of Departments of Health:

a) Direct, provide guidance, publicize, inspect, and examine implementation of this Circular in medical establishments within their management;

b) Organize professional training and education regarding diagnosis of narcotic addiction for medical establishments and doctors engaging in identification of narcotic addiction;

c) Submit report on narcotic addiction identification results within their competence.

3. Responsibilities of police authority of provinces and central-affiliated cities:

a) Guarantee security and safety for medical establishments and medical personnel during identification of narcotic addiction;

b) Request police authorities to provide adequate applications for narcotic addiction identification as per the law;

c) Guarantee funding for identifying narcotic addiction at request of police authority.

4. Responsibilities of medical sector: Take charge and cooperate with relevant entities in organizing implementation, providing guidance, inspecting, examining, and assessing compliance with this Circular within the sector.

5. Responsibilities of medical establishments:

a) Organize implementation of regulations on diagnostic criteria and professional procedures for identifying narcotic addiction in accordance with this Circular and relevant law provisions;

b) Organize, provide training, educate, publicize, and inform relevant individuals about regulations on identification of narcotic addiction;

c) Organize treatment of withdrawal syndrome, mental disorders, and accompanying illnesses (if any) for individuals whose narcotic addiction is to be identified during identification period;

d) Store documents on narcotic addiction identification in accordance with regulations and law on medical examination and treatment;

dd) Submit reports on narcotic addiction identification works of medical establishments.

6. Responsibilities of individuals whose narcotic addiction is identified:

a) Comply with operating regulations of medical establishments and medical personnel when identifying narcotic addiction;

b) Provide accurate information on money spent on narcotics, symptoms caused by narcotic use, and other relevant information during identification period of narcotic addiction.

Article 7. Entry into force

1. This Circular comes into force from January 1, 2022.

2. Joint Circular No. 17/2015/TTLT-BYT-BLDTBXH-BCA dated July 9, 2015 of Minister of Health, Minister of Labor - War Invalids, and Social Affairs, and Minister of Public Security expires from the effective date hereof.

Article 8. Responsibilities for implementation

Director of Department of Medical Service Administration, Director of Vietnam Administration for Aids Control, Chief of Office of Ministry of Health, Directors, General Directors of Departments, Agencies, General Departments affiliated to Ministry of Health, and relevant agencies, organizations, individuals are responsible for implementation of this Circular.

Difficulties that arise during the implementation of this Circular should be reported to the Ministry of Health (Vietnam Administration of Medical Services)./.

ANNEX NO. 01

GUIDELINES ON IDENTIFYING CHARACTERISTIC WITHDRAWAL OF NARCOTIC SUBSTANCES
(Attached to Circular No. 18/2021/TT-BYT dated November 16, 2021 of Minister of Health)

1. Signs for identifying withdrawal of opioid

a) Exhibit proof recent stop or reduction in use of opioid after using these substances repeated over a long period of time;

b) Exhibit at least 3 of the 12 withdrawal symptoms below for several minutes to several days:

- Craving for narcotic substances;

- Blocked nose or sneezing;

- Watery eyes;

- Muscle pain or muscle contraction;

- Abdominal stiffness;

- Nauseating or vomiting;

- Diarrhea;

- Pupil dilation;

- Goosebumps or chills;

- Increased heart rate or hypertension;

- Yawning;

- Sleep disturbances.

c) These withdrawal symptoms cannot be associated with any internal medicine illness that is not related to the use of opioid and cannot be associated with any mental disorder or other behavioral disorder.

2. Withdrawal symptoms of stimulants (amphetamine-type stimulants, cocaine, or other stimulants):

a) Exhibit proof recent stop or reduction in use of opioid after using these substances repeated over a long period of time;

b) Experience mood disorder (sad or lost sense of pleasure);

b) Exhibit at least 2 of the 6 withdrawal symptoms below for several minutes to several days:

- Drowsy or exhausted;

- Slowed or heightened motor nerve;

- Craving for stimulants;

- Increased appetite;

- Insomnia or oversleeping;

- Experiencing strange or confusing dreams.

d) These withdrawal symptoms cannot be associated with any internal medicine illness that is not related to the use of stimulants and cannot be associated with any mental disorder or other behavioral disorder.

3. Signs of marijuana withdrawal

a) Exhibit proof of recent stop or reduction in use of marijuana after using marijuana repeatedly over a long period of time.

b) Exhibit at least 3 of the 7 symptoms below within up to 5 days:

- Agitated, angry, or aggressive;

- Tensed or nervous;

- Sleep disorders (insomnia or having nightmares);

- Decreased appetite or losing weight;

- Fidgety;

- Decreased mood;

- Any of the followings: stomachache, limb-shaking, sweating, fever, chills, headache.

c) These withdrawal symptoms cannot be associated with any internal medicine illness that is not related to the use of marijuana and cannot be associated with any mental disorder or other behavioral disorder.

ANNEX NO. 02

GUIDELINES ON IDENTIFYING CRITERIA 2, 3, 4, AND 6 FOR DIAGNOSING NARCOTIC ADDICTION
(Attached to Circular No. 18/2021/TT-BYT dated November 16, 2021 of Minister of Health)

1. Criterion 2: Having difficulty controlling the use of narcotics in terms of starting time, ending time, or use amount means any of the following 2 signs:

a) The narcotic substances are taken in a greater amount and in a longer period of time than originally anticipated;

b) Persistent craving or unsuccessful attempts to reduce or control the use of narcotic substances.

2. Criterion 3: Developing narcotic tolerance means any of the following 2 signs:

a) The need to use significantly more narcotic in order to achieve desired effects or cause poisoning;

b) Drastically reduced effects when continuing to use the same amount of narcotic substances.

3. Criterion 4: Growing increasingly negligent in hobbies or other recreational activities due to the use of narcotics means any of the following signs:

a) Multiple hobbies altered or multiple concerns, interests abandoned or reduced due to the use of narcotic substances;

b) A great amount of time spent on searching and/or using narcotic substances and/or recovering from the use of narcotic substances.

4. Criterion 6: Developing narcotic withdrawal (withdrawal syndrome) when ceasing or reducing the use of narcotics means any of the following signs:

a) Characteristic withdrawal of narcotic substances: withdrawal signs of opioid; stimulants (amphetamine-type stimulants, cocaine, or other stimulants) and marijuana. Guidelines on identifying characteristic withdrawal of narcotic substances shall conform to Annex No. 2 attached hereto;

b) Using the same or similar narcotic substances in order to reduce or prevent withdrawal syndrome.