Magazine article Clinical Psychiatry News

New Standards Improve Care at Methadone Clinics

Magazine article Clinical Psychiatry News

New Standards Improve Care at Methadone Clinics

Article excerpt

BALTIMORE -- Waiting lists for heroin addicts seeking treatment at methadone clinics are expected to shorten under new regulations issued by the Center for Substance Abuse Treatment, a panel of speakers reported at a press conference held by the Substance Abuse and Mental Health Services Administration.

For the first time since the Comprehensive Drug Abuse Prevention and Control Act of 1970 and the Narcotic Addict Treatment Act of 1974 were enacted, methadone clinics will be required to become accredited as health care facilities. Oversight of the clinics will be transfered from the Food and Drug Administration to the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA).

Based on methadone-specific accreditation standards established between 1996 and 1998 by the Commission on Accreditation of Rehabilitation Facilities and the Joint Commission on Accreditation of Healthcare Organizations, SAMHSA will rely on independent organizations and states for facility accreditation. In a press release, SAMHSA said that the standards will be updated as new information and technology are made available.

One effect of the new regulations is to treat methadone users more like people with health problems and less like criminals. Since clinics currently administer only single doses, in either pill or liquid form, and under staff supervision, heroin addicts must visit their clinic daily. The new regulations, which took effect in May, use a more flexible, individualized approach. To prove that they are stable enough to qualify for this convenient dosing, patients must endure a lengthy 2-year process to show that they are unlikely to abuse a 30-day take-home supply. (See box at left.)

Dr. H. Westley Clarke, CSAT director in Rockville, Md., said the regulations do not change a clinic's status as the only source of methadone. But that may change--further regulatory modifications that allow stable patients to get methadone from private practitioners allied with a methadone clinic are still possible. Methadone's status as a schedule II narcotic is the primary reason clinics are its sole distributors.

The FDA also is considering approval for at least one less tightly regulated drug--buprenorphine--that can be used in place of methadone. Approval of such a drug would allow psychiatrists to treat their patients rather than referring them to a public clinic, Dr. Clarke said.

According to Mark Parrino, president of the American Methadone Treatment Association, there are 950 methadone programs in the U.S. treating 200,000 heroin addicts at a time. But there are long waiting lists, with at least 1 million other heroin users who need care.

The average age at which patients first seek treatment for heroin addiction has dropped from 27 years about 10 years ago to 17.5 years in 1999. The new emphasis on treating methadone users more like patients and less like criminals is not because many are children. …

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