Medication-Assisted Treatment: Merging with Mainstream Medicine (Part 2)
The Accreditation Process
Each treatment program must apply to a SAMHSA-approved accrediting
organization. Four organizations were approved by SAMHSA in December
2001 for the purpose of accrediting opioid treatment programs.
To date, the Washington State Department of Social and Health
Services is the only government accrediting organization. The other
three accrediting bodies are the Commission on Accreditation of
Rehabilitation Facilities, the Commission on Accreditation of Services
to Families and Children, and the Joint Commission on Accreditation
of Healthcare Organizations. Treatment programs may choose to apply
to any one of these four accrediting organizations.
Ray Hylton, a CSAT public health advisor, explains that "Each
accreditation survey involves a 1- to 3-day site visit, when the
surveyors review clinic records, interview staff members and patients,
and meet with community representatives and the local government."
The surveyors look at such factors as:
- Is each patient receiving the amount of medication and
counseling best suited to his or her needs? Are various types of
- Are all members of the treatment staff adequately trained?
- Are patients referred for infectious disease testing, social
services, and other community resources when appropriate?
- Are treatment decisions based on medical factors? Are co-occurring
conditions taken into account?
- How well is the program working for patients? Are the patients
holding down jobs and abstaining from illicit drugs? Has criminal
activity been reduced?
Programs may be accredited for 1 year or 3 years, depending on
their level of compliance to the standards.
Some patients and advocates have expressed concern about how clinic
operations could be affected by the extra work involved in accreditation.
hearing reports that clinics are raising fees to pay for their accreditation,"
says Chris Kelly, director of the Washington, DC, chapter of Advocates
for Recovery through Medicine. "One local clinic is closing down
for all but 2 hours a day, just to handle the paperwork," she added.
"The CSAT guidelines are great in principle, but the clinics and
accreditation groups are going to have to work hard to make it work."
"Preparing for accreditation may seem daunting, but it's
doable and affordable," Mr. Hylton says. "In our impact
study, conducted from 1997 to 2002 and involving 129 representative
programs in 15 states, more than 99 percent earned their accreditation
using the standards and survey system now in place."
To ease the transition, CSAT has provided grants to SAMHSA-approved
accrediting organizations to reduce the cost for treatment programs
of the initial cycle of accreditation inspections. CSAT is also
offering technical assistance from experts and consultants and has
convened a series of training workshops to help treatment centers
meet the new standards.
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Along with oversight of the accreditation process, CSAT is supporting
innovative treatment models that are attempting to make services
more accessible to populations or areas currently underserved. Educational
activities geared to patients and health practitioners are also
CSAT established a detailed Web page in spring 2002 devoted to
opioid addiction and treatment. The Web page, dpt.samhsa.gov,
provides up-to-date, reliable information on opioid treatment medications
(including methadone, LAAM, naltrexone, and buprenorphine), guidelines
for medications and alternative therapies, and standards to ensure
the highest possible quality of care. Program administrators and
accrediting bodies will find comprehensive information on the opioid
treatment programs accreditation process with helpful links to relevant
studies, legislation, and regulations.
In September 2000, CSAT brought together the leading national
organizations for patient support and education for a 2-day meeting
to discuss opioid dependency and the stigma associated with its
related medication-assisted treatments. Through this effort, the
Methadone Patient Support and Community Education Project was formed.
More information about this project is available on CSAT's
Web page on medication-assisted treatment.
Educating health professionals about addiction treatment will
also be an important part of getting opioid treatment patients into
the mainstream, according to Malcolm Dickson, national director
of Advocates for Recovery through Medicine. "Better education
about addiction treatment is needed in medical schools," says
Mr. Dickson, "and family practitioners should be required
to have continuing education in managing methadone patients."
For more information about medication-assisted treatment, go to
Or contact CSAT's Division of Pharmacologic Therapies at 5600 Fishers
Lane, Rockwall II, Suite 740, Rockville, MD 20857. Telephone: (301)
443-7745; Fax: (301) 480-3045; E-mail: email@example.com.
Part 1: Medication-Assisted Treatment: Merging with Mainstream Medicine
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