Doctor DeLuca's Addiction Website

http://www.doctordeluca.com/Documents/CSAT_OpioidInitiative.htm


TIE: Opioid Addiction Special Topic - This information is provided by CSAT's Opioid Addiction Treatment Improvement Project (OATIP) - [http://www.treatment.org/Topics/opioid.html]

Opioid addiction treatment is the generic term used to refer to the various treatment modalities employed to treat opioid dependent individuals. Therapeutic communities; abstinence-based programs, both residential and outpatient; and opioid addiction treatment programs that use a pharmacotherapeutic approach have experience treating these patients, who are addicted to heroin or another opiate derivative, such as morphine or synthetic opioids. To date, treatment using methadone or LAAM has been demonstrated to be effective with patients having a history of opiate dependence of more than one year. Medication modalities include maintenance, short term detoxification and long term detoxification.

The Food and Drug Administration has approved more than 830 narcotic treatment programs, serving approximately 150,000 patients on any given day. These programs are also required to be registered with the Drug Enforcement Administration and are subject to regulation by both the federal and state government as described in CSAT's Technical Assistance Publication (TAP) 12: Approval and Monitoring of Narcotic Treatment Programs: A Guide on the Roles of Federal and State Agencies. Each state designates a State Methadone Authority who is responsible for the development and monitoring of narcotic treatment programs in their state.

Listing of State Methadone Authorities
CSAT's Office of Pharmacologic and Alternative Therapies (OPAT) is conducting a "working laboratory" which will test out and fine tune a new accreditation-regulatory system in the monitoring of methadone and LAAM treatment programs. The Commission on Accreditation of Rehabilitation Facilities (CARF) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have been selected as contractors to develop new accreditation standards to meet the specific needs of treatment programs. The Research Triangle Institute (RTI) will evaluate the impact of accreditation on program operations, quality, cost and other parameters.

CSAT Guidelines for the Accreditation of Opioid Treatment Programs
These guidelines form the basis for the new accreditation standards. They are the federal source from which CARF and JCAHO are developing their respective sets of opioid accreditation standards. The guidelines were developed through a series of meetings with federal and state officials, treatment experts, and patient/consumer advocates.


CARF Opioid Treatment Program Accreditation Standards
These standards are based on the CSAT Guidelines (above) and transform the language of the guidelines into CARF operational language. The CARF Opioid Standards are being used by Opioid Treatment Programs accredited by CARF.

Ray Hylton is the CSAT project officer for the CARF Accreditation Contract and may be reached on the INTERNET at rhylton@samhsa.gov or by telephone at 301-443-6502.

JCAHO Opioid Treatment Program Accreditation Standards
These standards are also based on the CSAT. Guidelines (above) and transform the language of the guidelines into JCAHO operational language. The JCAHO Opioid Standards will be used by Opioid Treatment Programs accredited by JCAHO.

Mike Bacon is the CSAT PROJECT officer for the JCAHO Accreditation Contract and may be reached on the INTERNET at mbacon@samhsa.gov or by telephone at 301-443-7749.

The most researched treatment modality, methadone is delivered within a comprehensive treatment program which includes a complete physical, individual and group counseling, HIV risk reduction counseling, and treatment or referral for ongoing health issues. Patients are usually referred to other agencies for vocational, legal, or other human services. CSAT has published several documents in its Treatment Improvement Protocol series (TIPs) which cover topics related to policy and clinical issues of narcotic treatment.

Narcotic treatment programs receive funding from several sources. The Substance Abuse Prevention and Treatment block grant, administered by the Center for Substance Abuse Treatment, is a major source of funding for many narcotic treatment programs. In some states, eligible patients can also access Medicaid funds and state and local governments often help to support the cost of treatment. Patient fees and health insurance are collected by both publicly funded and private for-profit programs.

Ongoing research regarding methadone, LAAM, and other pharmacological agents for the treatment of opiate addiction is a continuing mission of the National Institute on Drug Abuse(NIDA). NIDA is currently in Phase II of the Methadone Treatment Quality Assurance System (MTQAS), a feasibility study which uses program data to evaluate outcome measures for methadone patients. Seven states have chosen to participate in this phase of MTQAS: Pennsylvania, Arizona, Washington, Colorado, Georgia, North Carolina, and Massachusetts.

There are two national organizations which represent narcotic treatment providers and patients. The American Methadone Treatment Association, Inc. (AMTA) is a national provider organization, representing providers in 17 states. Sponsor of a bi-annual conference which routinely draws over 1000 treatment professionals, this association is also at the forefront of policy and legislative initiatives enhancing the quality and expanding access to narcotic treatment. The National Alliance of Methadone Advocates (NAMA) is an organization whose membership includes many current and former patients. Their mission is to increase awareness of issues facing the methadone patient by educating patients, providers and policy makers.

 

Alexander DeLuca, M.D., FASAM.
Copyright 2001. All rights reserved.                                [Top of Page]
Revised: April 12, 2001.