Our Association developed criteria for implementing a policy of referring stabilized methadone maintained patients from our treatment programs to off site physician based settings, in advance of the NIH panel recommendations. Our Board of Directors recognizes the challenges of implementing this referral system, especially in view of the history of restricting methadone treatment to licensed and regulated treatment programs.

The underlying motivation for this policy is to provide stabilized patients with an option to receive their continued care in a setting that is different from the methadone treatment program. The Association's criteria, which follow in this report, delineate basic elements of program involvement, physician involvement and the patient referral process. It is not meant to answer every question, however, it provides direction to states, who are interested in expanding the existing medical maintenance experience. The state of Connecticut has a pilot project underway, which would refer stabilized patients to off site medical settings, which is discussed in greater detail in the report from the states.

The Association conducted a survey among the State Methadone Authorities, which was reported in the September 1997 edition of this News Report. We asked if general medical practitioners should be involved in providing methadone treatment in their respective states. Thirty-nine State Methadone Authorities of the existing forty-two responded to the survey. Of this group, 30 State Methadone Authorities supported the use of such off site physician linkages with methadone programs. Eight State Authorities indicated that methadone treatment services should only be provided in our treatment programs, prohibiting such referrals to off site medical practice settings.

A number of methadone treatment providers have expressed considerable concern about implementing this policy. Some program managers and staff have expressed apprehension about referring their best patients to physician practices. It is understood that case loads in treatment programs would be affected by referring some of the "most stabilized" patients away from the program.

Our Association's Board of Directors struggled with these issues and have developed the following criteria to guide the treatment system through an important and necessary evolution. It is critical for us to provide a new access point for our stabilized patients as a method of normalizing the entire treatment process. In meeting with patients, who would qualify for such medical maintenance approaches, they express a great interest in having the option available to them. While many would elect such an option, others would chose to remain in the treatment program. In such cases, stabilized patients have formed strong connections to program personnel.

The point to implementing such a policy is to free up critically needed treatment slots for untreated opiate dependent individuals, who need access to methadone treatment services. The Association's criteria may seem conservative at first sight. This represents the first step in a long term strategic plan.

The Association's Board of Directors firmly believe that specially certified physicians should be involved in treating stabilized patients and they should possess the necessary body of information to treat our patients responsibly. We believe that this process of referring stable patients to off site physician practice settings will help shatter the stigma that has long been associated with methadone maintenance treatment. It is the beginning of a process of positive change for our patients. While it is a challenging process, it is the ethically correct thing to do for patients.