other financing limitations create serious barriers to treatment for many patients and limit the type and quantity of provided services.

The committee notes two developments pertaining to treatment financing. First, the fiscal year 1995 budget submission sent to Congress by President Clinton in early 1994 requested increased funding for drug treatment services relative to law enforcement activities. Second, the omnibus crime bill adopted by Congress in 1994 emphasizes prevention and treatment of substance abuse. It may be expected that increased federal funds will flow to substance abuse treatment services as a result of these actions. Therefore, the committee recommends that DHHS conduct a review of its priorities in substance abuse treatment, including methadone treatment, in a way that integrates changes in regulations and the development of practice guidelines with decisions about treatment financing.

With respect to drug abuse policy within the DHHS, current organization as revealed in the area of methadone, results in department policy emerging from the independent activities of the several pertinent Public Health Service agencies—SAMHSA, NIDA, and FDA—and from coordination between these agencies. The committee concludes that federal policy on methadone treatment, and in all likelihood broader areas of drug abuse treatment, would benefit from sustained department-level policy oversight, informed by a clinical perspective, on all issues related to regulations, practice guidelines, and treatment financing.

The committee does not believe that such a policy oversight role requires a major organizational change within DHHS, but that one official in the Office of the Assistant Secretary for Health should be designated to serve this function for the department. The committee recommends that the Secretary of HHS direct the Assistant Secretary for Health to designate a senior official in the Office of the Assistant Secretary for Health to be responsible for policy oversight and guidance on methadone treatment and on related drug abuse prevention and treatment issues.


Institute of Medicine. 1995. Development of Medications for the Treatment of Opiate and Cocaine Addictions; Issues for the Government and Cocaine Addictions; Issues for the Government and Private Sector, CE Fulco, CT Liverman, and LE Earley, eds., National Academy Press, Washington, D.C.

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