The starting point is supporting the improvement of the quality of methadone treatment services through accreditation. It is also necessary to increase points of referral through drug courts, probation departments and prison facilities.

In addition it is also critical to provide training for physicians, managers, and program staff through conferences and symposia in addition to specialized on-site training and distance training initiatives.
Educating America concerning the value of methadone maintenance treatment is a long-term initiative that will bind all of these elements into a successful blueprint for a long-term future for methadone treatment in the United States.

1. Accreditation (2001-2005)

CSAT implemented new federal standards for accrediting methadone treatment programs on May 18, 2001.

The primary rationale for AATOD's support for accreditation was to increase the legitimacy for methadone maintenance treatment, simultaneously improving treatment quality. Patients would be treated with greater integrity on a "case-by-case" basis.

Need for Technical Assistance

CSAT has committed to offering technical assistance to programs and state agencies throughout the country. The Final Rule alluded to this technical assistance being provided to such entities over the course of the next three to five years. In addition, CSAT has also committed resources to paying for accreditation surveys.

AATOD has been advising State Methadone Provider Associations to work with the designated single state authorities (block grant recipients) to access technical assistance to determine the comprehensive needs of methadone treatment programs within each state's jurisdiction. Illustratively, some states may have methadone treatment programs requiring greater physical plant improvement than others. Other states may have more restrictive regulations without providing resources to pay for such regulatory adherence.

Statewide Technical Assistance would be able to identify the needs of methadone treatment programs within a particular state, providing an action-oriented blueprint and funds, which would be necessary to meet accreditation standards.

AATOD's support for accreditation has been consistent throughout the approval and implementation process. It is also the basis for building an improved treatment system, which will have greater legitimacy. It builds on the principles of the State Methadone Treatment Guidelines and is essential in any long-range plan to create a renaissance in methadone maintenance treatment.

2. Educating Drug Court Judges (2001-2005)

The Office of National Drug Court Policy approved the publication of a Drug Practitioner Methadone Fact Sheet, which was distributed by the National Drug Court Institute to its 12,500 members during April 2002. AATOD developed this Fact Sheet on behalf of AATOD, drawing from references including the State Methadone Treatment Guidelines, CSAT's Community Education Kit and COMPA's "Regarding Methadone Treatment".

The National Drug Court Institute and AATOD have agreed to
cross-train their respective members.

Partnering with other Organizations

AATOD has been speaking with representatives from the American Bar Association and the Legal Action Center to support such initiatives. It is possible that we will work with these organizations to educate Drug Court judges and attorneys regarding the value of methadone treatment practices.

3. Changing the U.S. Department of Probation's
    Anti-Methadone Guidelines (1997-2005)

The Federal Guide to Judiciary Policy Procedures - Probation Manual contains anti-methadone statements. Accordingly, a number of probation officers in different parts of the country are able to force methadone maintained patients to terminate their treatment or be in violation and returned to jail.

AATOD has been working with a number of federal agencies to change this anti-methadone policy. This was one of the major policy points contained in the July 26, 2000 correspondence to ONDCP. Once again, other affiliated organizations, including the American Bar Association and the Legal Action Center, may be helpful to AATOD in changing this policy.

4. Expansion of Methadone Treatment Services in Jails and     Prisons (2000-2005)

AATOD is committed to expanding access to methadone treatment services in jails and prisons of the United States, building upon the success of the Rikers Island experience (KEEP program). Mark Parrino published an article in the May/June 2000 edition of American Jails Magazine, reporting on the success of this program.

We will work with various federal and statewide entities to increase access to this option so that inmates who are opiate dependent and in need of methadone treatment services will get access to care. They will need to be referred to methadone treatment programs upon release, based on the outreach initiative that has been used through Rikers Island.

5. Educating America about Methadone Maintenance Treatment     (2000-2005)

We began educating communities about methadone maintenance treatment through the development of the video "The Joy of Being Normal" and the publication of the Methadone Community Education Kit. The Association's Public Relations Committee developed this Kit for CSAT, which was released during the April 2000 National Methadone Conference.

Both educational tools have been used in educating communities about the value of methadone treatment programs. Some treatment programs have also reported success in getting programs sited as a result of these educational tools.

We have already submitted a funding request to foundations in order to develop three ten-second public service announcements on methadone maintenance treatment, which could be pilot-tested on different cable networks in the Northeastern corridor.

We will work to expand on these educational initiatives, informing Americans that methadone maintenance treatment is a valuable treatment option in responding to opiate dependence. The message will be positive and consistent.

6. Increasing Access to Medical Maintenance Treatment
    (1998-2005)

AATOD developed criteria in referring stabilized methadone maintained patients from treatment programs to off-site physician practice settings. The final version of these criteria was published in the December 1999 AATOD News Report. CSAT's Final Rule on Accreditation referenced the fact that medical maintenance treatment would be based upon a hub referral site concept, where stable methadone maintained patients would be referred from methadone treatment programs to off-site practice settings.

AATOD will work with treatment providers and state agencies throughout the United States over the course of the next several years to increase access to this treatment option.

It will offer an option to stable methadone maintained patients while admitting new individuals in need of treatment. Finally, it will establish methadone treatment programs as critical hub sites within an integrated network.

7. Expansion of Physician Training Initiatives (2001-2005)

AATOD began its initiative of training physicians about best clinical practices in methadone maintenance treatment during the National Methadone Conference of 1994. We began this initiative in conjunction with the American Society of Addiction Medicine (ASAM) and later included the American Academy of Addiction Psychiatry and the American Osteopathic Academy of Addiction Medicine.

We have increased the frequency of this training opportunity with the support of NIDA and CSAT to convene in different regions of the United States. The primary thrust of this expansion occurred in 2001 and we plan to produce these training events over the course of the next several years.

In this regard, we also provide physicians who have not been part of methadone treatment programs access to critical information as a means of encouraging physicians to enter our field and be included in the roster of medical maintenance physicians.

8. Management Training Initiatives (1998-2005)

AATOD began training program managers during the December, 1998 Training Symposium in DC. The primary thrust was to offer risk management information to methadone program managers in addition to preparing for accreditation.

We will seek corporate funding to increase such management training opportunities over the course of the next several years, focusing on the need to improve staff attitudes towards methadone maintenance treatment and improving the overall structure of methadone treatment programs as accreditation is implemented.

9. Staff Training Initiatives (2002-2005)

Our Association is committed to providing on-site and distance training to methadone program personnel in meeting new challenges to our patient population.

HCV is affecting a significant number of patients within our treatment programs. Accordingly, we are working with the Hepatitis C education and training groups to provide on-site education for treatment personnel in order to treat HCV infected patients more effectively.

As other treatment challenges come to surface, AATOD will work with the Board and treatment providers throughout the country to offer similar training opportunities in addition to our National Methadone Conferences. In this way, we will keep treatment personnel informed through on-site training and distance education (Internet) by using other training vehicles, including the Addiction Technology Transfer Centers.

10. Organizing the Methadone Treatment Community
      (1984-2005)

AATOD will continue to organize treatment providers in the United States and throughout the world over the course of the next five years.

AATOD will encourage methadone treatment providers to organize State Methadone Treatment Associations where viable. We will continue to build our organization upon new member states while continuing to respond to the needs of current member states.
AATOD has also embarked on an aggressive initiative to recruit individual methadone treatment providers as members of AATOD in non-member states.

These two initiatives are linked since an increasing number of methadone providers in any given state might lead to the development of a new statewide Association as more individual programs join AATOD from a particular state. This will evolve over the next several years and we will encourage such growth.

We will also work with our Conference International Committee to increase the coordination among methadone treatment providers in a number of designated countries. Initially, we will work with EUROPAD to broaden our organizing initiatives that have evolved during the course of our National Methadone Conferences.

Other critical countries will be identified over the course of the next two years as we develop a worldwide federation of methadone treatment programs.