A procedure for outpatient monitoring of patients with addictive disorders has been developed

Currently, dispensary observation of people with such diseases is regulated by a procedure with a similar name, which is located as Appendix No. 2 in departmental order No. 1034n of December 30, 2015.

According to the new draft document, dispensary observation will be conducted on an outpatient basis at the patient's place of residence or stay in clinics licensed to carry out medical activities, including work (services) in psychiatry and narcology.

The procedure proposes to establish four observation groups: DN-1 – patients with mental disorders and behavioral disorders caused by the use of psychoactive substances (harmful use); DN-2 – caused by the use of alcohol (dependence syndrome, F10.2); DN-3 – caused by the use of psychoactive substances, with the exception of alcohol; DN-4 – patients who meet the criteria for the above-mentioned dispensary observation groups, who are obliged to undergo examination/treatment by the court, who are convicted persons who voluntarily decided to undergo treatment for drug addiction, or those who have previously undergone such dispensary observation.

A psychiatrist-narcologist will determine the patient's follow-up care and the scope of preventive, diagnostic, therapeutic, and rehabilitative measures in accordance with clinical guidelines. The specialist's responsibilities will include establishing a monitoring group, providing patient information, conducting appointments (including at home), issuing referrals for inpatient care and consultations with a specialist at another medical facility, and summarizing the results.

The draft states that a medical examination will include an assessment of the patient's condition, diagnosis, prescription of additional preventive, diagnostic, therapeutic, and rehabilitation measures, and an explanation of the course of action in the event of the development of life-threatening conditions or an exacerbation of a mental disorder.

Consultations will be held at the following frequency: for patients in all observation groups during the first year of abstinence from psychoactive substance use – at least once a month; for those in groups DN-2, DN-3, and DN-4 with remission of one to two years – at least once every two months; for those in group DN-4 with remission of over two years – at least once every three months. The draft procedure specifies that "achieving remission is considered to be abstinence from psychoactive substance use for a period of at least one year."

During follow-up, an additional examination is conducted at least once every three months and when deciding whether to discontinue follow-up. This examination includes laboratory, chemical-toxicological, and pathopsychological tests. Additional examinations should be conducted more frequently than once every three months if there are indications such as signs of psychoactive substance use, increased cravings for such substances, or the presence of an affective disorder.

The decision to terminate follow-up is made by the medical institution's medical board. A psychiatrist-addiction specialist can make this decision if the patient signs a written refusal, does not return to the medical facility for follow-up appointments for one year, or in the event of the patient's death or departure.

In the latter case, if the departure period is more than three months, the patient must inform their physician within 14 calendar days of their new place of residence and the medical facility (at their new place of residence) where they plan to be monitored. The specialist will then prepare and provide the patient with a discharge summary. The physician at the new medical facility may request information about the patient's health condition, diagnosis, and other information from the previous clinic if the patient has not notified the medical facility within the prescribed timeframe, or if the discharge summary has not been received by the clinic.

Registration of patients with drug addiction will be carried out using the Unified State Information System in the Sphere of Healthcare.

The explanatory note notes that the draft order was developed to “bring it into line with modern trends in the area under consideration.”

This is not the first time the Ministry of Health has proposed updating the standards for providing care in the psychiatric-addiction specialty. In June 2025, the ministry developed two documents that proposed allowing primary pre-hospital medical and high-tech care for specialized patients. Medical rehabilitation for patients with substance abuse disorders could be provided at any clinic holding the necessary license. The outcome of the review of this initiative is unknown.

A major round of reforms to the mental health care system was scheduled for 2024. For example, relevant regulators revised the conditions for organizing such care in hospitals and for participants in special military operations, adjusted training opportunities for specialists, changed the operating parameters of psychiatric boarding schools, and the Russian Ministry of Internal Affairs can now receive classified information from clinics on patients with chronic and protracted mental disorders with severe and frequent exacerbations. For more information on these and other innovations, see Vademecum's review .