Challenges & Solutions Part 2 The Challenge: Critical Reports of the Treatment System
Methadone treatment programs were being seen in an increasingly critical light through research and external federal oversight reports. Dr. John Ball and his associates published a series of seminal articles indicating that program characteristics, as opposed to patient characteristics, formed a critical basis of predicting patient success in treatment (“Reducing the Risk of AIDS Through Methadone Maintenance Treatment”: Journal of Health and Social Behavior, 1988). Dr. Ball cited stable program management, the implementation of therapeutic dosing practices, hiring and retaining trained personnel, and having sound fiscal management as a basis for greater patient success in treatment. The General Accounting Office (GAO), at the behest of the Congressional Select Committee on Narcotics Abuse and Control, published a report in 1990, “Methadone Maintenance - Some Programs Are Not Effective; Greater Federal Oversight Needed”, which delivered a particularly stinging commentary about the efficacy of methadone treatment programs in the United States. The GAO evaluated 24 programs in eight states and determined that there was widespread subtherapeutic dosing so that patients continued to abuse heroin and other drugs. They were also critical of the Food and Drug Administration (FDA) for its lack of oversight of treatment programs, and recommended a more outcome-based series of federal oversight initiatives, which would guide and improve patient care. Additionally, the Drug Enforcement Administration (DEA) was imposing significant fines against OTPs for lack of compliance with DEA regulations. Solution
AATOD created the blueprint for the first comprehensive clinical practice guidelines, which would be used to guide treatment programs and other practitioners. AATOD brought the concept to the Center for Substance Abuse Treatment (CSAT), which formed the basis of publishing the first Treatment Improvement Protocol (TIP), “State Methadone Treatment Guidelines”, which were officially published in 1993, but were released during the American Methadone Treatment Association (AMTA) conference in 1992 in Orlando Florida.
This represented the first comprehensive clinical compendium to guide treatment programs in therapeutic decision-making, including Treating Pregnancy, Infectious Disease, Methadone Dose Determination, and Treating Multiple Substance Abuse, to cite a few of the chapters. SAMHSA/CSAT later emerged as the entity which would assume federal oversight responsibility for OTP clinical practices from the FDA following the publication of the Institute of Medicine Report of 1995 (Federal Regulation of Methadone Treatment). The oversight transition was officially concluded during 2001, and CSAT published a broad series of TIPs and Technical Assistance Publications (TAPs) to guide therapeutic decision making for the field. AATOD supported this regulatory transition.
It is reasonable to conclude that SAMHSA/CSAT’s publication of the State Methadone Treatment Guidelines laid the groundwork for a more outcome-based system of federal regulatory oversight, and improved treatment for patients.
The Association also worked with the leadership of the DEA from 1998-2000 in developing DEA’s “Best Practice Guideline for Narcotic Treatment Programs”, which were released during AATOD’s national conference in 2000 in San Francisco. This publication built on AATOD’s long-term relationship with the DEA, both in Washington and in regional offices throughout the United States, and led to improved program compliance with DEA regulations governing OTPs. What May Have Happened If AATOD Had Not Acted
In the opinion of the AATOD Board of Directors, had the first TIP not been published, the field would have continued to drift toward more idiosyncratic and substandard treatment practices, which would have resulted in poor patient outcome in addition to more restrictive federal regulatory intervention. Quality of care would have continued to deteriorate and the integrity of the treatment experience would have been compromised.
The DEA fines against programs would have continued. The public perception of the quality of methadone maintenance treatment would have further eroded. Treatment and therapeutic decision making within the OTP environment would have steadily worsened, and a greater number of lawsuits would have probably driven many of the treatment providers out of the system, limiting access to care.
Link to part ONEhttp://methadone.forumotion.net/t887-part-1-message-from-aatod-american-association-for-the-treatment-of-opiod-dependence-inc#1815
I received these as emails so I don't have an actual link to refer you to for the "original" posting of these articles. However, I will be more than happy to forward the original emails to you if you would like to see the originals.