Back to Graphic Version | SAMHSA News Home

SAMHSA News - Volume X, No. 3, Summer 2002

Medication-Assisted Treatment: Merging with Mainstream Medicine (Part 1)

Imagine you have a chronic condition such as hypertension and have been taking daily medication under medical care for several years. How would you feel if you had to obtain a limited dose of your medication from an inconveniently located treatment program during restricted hours rather than purchasing a 30-day supply from your pharmacy to take every day at home?

These are the kinds of obstacles that patients in treatment for addiction to heroin and other opiates face every day. Unlike the millions of Americans who have some choice in their doctors and hospitals for treatment of chronic diseases such as heart disease or diabetes, people who suffer from the chronic disease of addiction to heroin or other opiates have had to seek care through specialized, federally regulated treatment programs.

Observed urine testing—in which the patient is watched while providing the sample—is yet another hurdle for opioid treatment program patients who've become medically stable in their recovery process.

However, since May 2001, treatment providers and patients nationwide have been witnessing a sea change in opioid addiction treatment. The U.S. Department of Health and Human Services repealed the Food and Drug Administration (FDA)-enforced regulations for methadone treatment, in place for 30 years, and instituted a SAMHSA-directed system that relies on accreditation of treatment programs. Opioid treatment programs now apply to be accredited by one of four accreditation organizations designated by SAMHSA, and they have greater discretion for individualized patient treatment within the parameters of the accreditation standards.

Because accreditation is standard practice for health care providers in nearly all fields of health care, its use for opioid treatment programs should help addiction treatment begin to look more like other areas of health care and reduce widespread prejudice against patients in addiction treatment.

Mark W. Parrino, M.P.A., president of the American Association for the Treatment of Opioid Dependence, explains some of the misconceptions behind this prejudice. "Some critics of methadone treatment believe that it represents substituting one drug for another. Such critics see no distinction between heroin as an illicit drug and methadone as a medication that is used in conjunction with other treatment services."

Other critics, he says, "include people in recovery from other drugs of abuse, including alcohol. They claim that since they are able to be abstinent without pharmacotherapy, methadone maintenance does not represent a ‘true' state of recovery."

In fact, Mr. Parrino says, "methadone treatment has been rigorously studied for more than 35 years and the results are found to be uniformly positive." He adds, "The changes we're seeing under the new accreditation guidelines from SAMHSA may seem small, but they are nothing short of a revolution."

"The new SAMHSA rule puts the patient first. It gets the Federal Government away from directing medical practice in addiction medicine," says Robert Lubran, M.S., M.P.A., Director of the Division of Pharmacologic Therapies within SAMHSA's Center for Substance Abuse Treatment (CSAT). "Rather than dictating how opiate-addicted patients are to be treated, the regulations have made it clear that medical and clinical treatment professionals should be encouraged to apply their training and expertise in making patient care determinations without undue concern about burdensome Federal restrictions—more like mainstream medical care."

Back to Top

Standards, Not Controls

Under the former system of FDA regulation, methadone maintenance treatment programs were monitored by Federal inspectors to ensure their adherence to rules limiting the amount of methadone given to each patient in a daily dose and rules for detailed record-keeping practices. Monitoring the distribution of a controlled substance—methadone—appeared to be the primary objective.

The new SAMHSA rules, by contrast, shift the direction of Federal oversight to ensuring that more than 1,100 opioid treatment programs across the country are applying the best clinical practices as described in the CSAT accreditation guidelines. The guidelines are based on recommendations from the 1997 National Institutes of Health Consensus Statement on Effective Medical Treatment of Opiate Addiction, the 1995 Institute of Medicine report, Federal Regulation of Methadone Treatment, and the deliberations of a panel of field experts. The accreditation bodies have all adopted new standards for the treatment of opiate addiction that emphasize improving the quality of care through individualized treatment planning, greater medical supervision, and assessment of patient outcomes.

CSAT's accreditation guidelines for optimal care in addiction treatment programs have been translated into measurable standards by accrediting organizations. The standards of care are designed to ensure, for example, that patient care is tailored to individual needs. Arbitrary restrictions—such as ceilings on methadone doses and observation of urine tests—have been removed. And, in the Nation's health care system, patients with the disease of addiction are treated with the same respect afforded patients with other chronic diseases.

Back to Top

Back to Graphic Version

SAMHSA Contracts | SAMHSA's Budget | Employment | Site Map
 SAMHSA Home  Contact the Staff  Accessibility  Privacy Policy  Freedom of Information Act
 Disclaimer  Department of Health and Human Services  The White House  First Gov