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have been meeting with treatment providers and regulatory officials
throughout the United States since this News Report was last published
during September 1997 and have been influenced by our colleagues'
reactions to the potential impact of changing policies.
The
full scale transition to the proposed
accreditation model, which would involve all licensed methadone
treatment programs, would occur over the course of a three to four
year period. At present, we do not know if states will alter their
respective regulatory guidelines in response to the accreditation
model. We also do not fully understand the cost of implementing
accreditation standards to individual methadone programs, beyond
the cost of paying for the accreditation review.
In
essence, the major difference between accreditation and existing
FDA regulation is in standards that methadone treatment programs
can strive to achieve. Process oriented requirements will be replaced
with outcome related standards. The basic focus is on patient improvement
as measured by specific parameters. The accreditation model seeks
to develop a system of care that will be more responsive to patient
needs. We expect that programs will have to develop patient satisfaction
questionnaires and maintain quality assurance reports, which will
be evaluated by accrediting and other external organizations.
It
is expected that the quality of treatment services will improve
as accreditation replaces FDA regulations. It is important to note
that the proposed accreditation standards will embrace many of the
principles embodied in the State Methadone Treatment Guidelines,
which were published by the Center for Substance Abuse Treatment
(CSAT) in 1992. As many readers know, our Association worked in
conjunction with the American Society of Addiction Medicine (ASAM)
in developing such clinical practice standards.
This
transition in oversight must obtain approval from the White House
Office of National Drug Control Policy (ONDCP) before any change
can be initiated or announced prior to a Federal Register Notice.
CSAT will be at the center in coordinating this transition once
it has been formally approved by ONDCP. The role of the DEA will
not change since their authority will continue under the purview
of the Narcotics Addiction Treatment Act of 1974, which bifurcated
federal oversight authority between DHHS and the Department of Justice.
The
first stage of a specialized accreditation review concept for methadone
treatment is already in progess. The Commission on Accreditation
of Rehabilitation Facilities (CARF), under contract to CSAT, is
in the process of identifying methadone programs to participate
in the first stage of this "working laboratory". CSAT has already
contacted a number of states, seeking program involvement. CARF
is also recruiting surveyors to conduct the accreditation review.
The selected methadone treatment programs will be briefed on this
process on the first day of the national methadone conference during
a training session on the morning of September 26, 1998. This special
training session will be open to all parties in the field.
The
information gathered through this "working laboratory" will provide
additional guidance to the federal agencies on the full scale transition,
which is expected to follow. While CARF will conduct the accreditation
review, the Research Triangle Institute will conduct a separate
evaluation of the processes, barriers and costs associated with
the accreditation system, ultimately determining the impact on patient
care and programmatic structure. It is expected that other behavioral
accrediting organizations will also be involved in this process
as we learn more about the initial "working laboratory". Our Association
has supported this accreditation process since we believe that it
will bring methadone treatment programs closer to the standard of
care in mainstream medicine, ending the isolation that has surrounded
methadone programs for more than 30 years. Accreditation will extend
an opportunity to methadone treatment providers to be evaluated
within the same context as other parts of our healthcare system.
We have also gone on record with representatives of the federal
agencies, expressing our concern about the unanticipated costs of
implementing accreditation. We have expressed concerns about duplication
of effort within state and municipal regulatory authorities as this
process takes hold in the nation's methadone treatment system. While
these matters need to be resolved, we also believe that accreditation
will improve patient care as we standardize best practice treatment
approaches in our programs.
This
News Report highlights a number of our Association’s leading initiatives,
including referring stabilized methadone maintained patients to private
medical settings; recommendations to the field concerning Hepatitis
C practice guidelines, the development of physician training seminars
in conjunction with the American Society of Addiction Medicine; and
the development of a working document regarding best methadone hydrochloride
dispensing/prescribing guidelines for treatment programs in conjunction
with the Drug Enforcement Administration.
All
of these issues will be discussed in greater detail during the course
of our next national methadone conference, which will convene at
the Marriott Marquis Hotel in New York City between September 26-29,
1998. All readers should have received copies of our full registration
brochure during the month of June, 1998. We realize that it is difficult
for all to attend these national meetings, however, we encourage
members of our field to do all that they can to make it possible.
It promises to be a landmark conference coming at a critical time
of transition in our field.
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