adolescent medicine) should be taught the principles of diagnosing and treating patients with opiate dependence. Nurses, social workers, psychologists, physician assistants, and other health care professionals should also be trained in these areas. The greater the number of trained physicians and other health care professionals, the greater the supply not only of professionals who can competently treat the opiate dependent but also of members of the community who are equipped to provide leadership and public education on these issues.

Reducing Unnecessary Regulation

Of critical importance in improving MMT of opiate dependence is the recognition that, as in every other area of medicine, treatment must be tailored to the needs of the individual patient. Current Federal regulations make this difficult if not impossible. By prescribing MMT procedures in minute detail, FDA's regulations limit the flexibility and responsiveness of the programs, require unproductive paperwork, and impose administrative and oversight costs greater than what are necessary for many patients. Yet these regulations seem to have little if any effect on quality of MMT care. We know of no other area where the Federal government intrudes so deeply and coercively into the practice of medicine. For example, although providing a therapeutic dose is central to effective treatment and the therapeutic dose is now known to be higher than had previously been understood, FDA's regulations discourage such higher doses. However well-intended the FDA's treatment regulations were when written in 1972, they are no longer helpful. We recommend that these regulations be eliminated. Alternative means, such as accreditation, for improving quality of MMT programs should be instituted. The U.S. Department of Health and Human Services can more effectively, less coercively, and much more inexpensively discharge its statutory obligation to provide treatment guidance to MMT programs, physicians, and staff by means of publications, seminars, Web sites, continuing medical education, and the like.

We also believe current laws and regulations should be revised to eliminate the extra level of regulation on methadone compared with other Schedule II narcotics. Currently, methadone can be dispensed only from facilities that obtain an extra license and comply with extensive extra regulatory requirements. These extra requirements are unnecessary for a medication that is not often diverted for recreational or casual use but rather to individuals with opiate dependence who lack access to MMT programs.

If extra levels of regulation were eliminated, many more physicians and pharmacies could prescribe and dispense methadone, making treatment available in many more locations than is now the case. Not every physician will choose to treat opiate-dependent persons, and not every methadone



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