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 counseling available?

• 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.

"We're 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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Educational Activities

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 a priority.

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 dpt.samhsa.gov/treatment.htm. 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: opt@samhsa.hhs.gov.

« See Part 1: Medication-Assisted Treatment: Merging with Mainstream Medicine

See Also—Related Content—One Program's Experience »

See Also—Related Content—Buprenorphine: Expanding the Treatment Toolbox »

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