Federal Regulation of Methadone Treatment (1995) / Chapter Skim
Currently Skimming:
Introduction
Introduction
Pages 17-36
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 17... ...
Yet the use of methadone for the treatment of opiate addiction on a long-term (or maintenance) basis has been limited and controversial and remains so.
|
From page 18... ...
Methadone maintenance therapy involves the use of methadone on a sustained basis to reduce or eliminate compulsive opiate use by substituting a drug that produces long-lasting activation of opioid receptors in the brain without causing uncontrolled craving effects or interfering with
|
From page 19... ...
The committee's view of the statement of work evolved over its first three meetings as it deliberated about the nature and purpose of the subject. Consequently, the committee revised its charge at its third meeting as follows: The committee shill study the current Department of Health and Human Services standards for narcotic addiction treatment and the regulation of methadone treatment programs pursuant to those standards: (1)
|
From page 20... ...
OBJECTIVES OF OPIATE ADDICTION TREATMENT The committee distinguished three objectives that guide the use of methadone in the treatment of opiate addiction. Although the relative importance of these objectives has shifted over time, the committee believes that all three should continue to inform policy.
|
From page 21... ...
Patients in methadone maintenance treatment programs have been shown to have markedly reduced criminal activity compared to their pretreatment behavior (Anglin and McGlothlin, 1985; Anglin and Powers, 1991; Anglin et al., 1989; Ball and Ross, 1991~. Compared to drug-free treatment, methadone increases the likelihood of engaging and remaining in treatment, which is in turn correlated with the reduction of criminal activities.
|
From page 22... ...
Three studies discussed below illustrate these points, although several large-scale evaluations of methadone maintenance all show essentially the same results (Dole, Nyswander, 1968; Gearing, Schweitzer, 1974; Hubbard, Marsden, 1986; Sells, Demaree, et al., 1986; Ball, Ross, 1991~. In the most detailed examination of methadone maintenance treatment programs to date, Ball and Ross (1991)
|
From page 23... ...
They compared the rates of AIDS risk behaviors (particularly injecting drug use and needle sharing) between samples of opiate addicts in methadone maintenance treatment and those not in treatment.
|
From page 24... ...
(1993~. The third study evaluated the contribution of counseling and psychosocial services in methadone maintenance treatment, and shows the effect of these services on outcome.
|
From page 25... ...
These are, first, the multiple health and social problems of methadone maintenance patients, and second, the variability in the quality of treatment program management and services. Factors Limiting Effectiveness Multiple Problems of Methadone Maintenance Patients Although drug use (especially use IV drug)
|
From page 26... ...
For example, opiate addicts who have been stabilized by methadone maintenance but have experienced little improvement in their psychiatric, family, and employment situation will always remain in danger of relapse to injecting drug use. This of course has potentially large economic implications for any administrative decisions regarding the expansion of methadone treatment services.
|
From page 27... ...
In general, the patients treated in these programs were quite similar in terms of their demographic characteristics and treatment problems at the time of admission to methadone maintenance across the different geographic sites surveyed. In contrast, the data gathered on the programs themselves revealed major differences in almost all areas of organization and service provision; and these program variables have been closely associated with patient outcome.
|
From page 28... ...
Unfortunately, a comprehensive description of the authorities and agencies of the states that govern medications that may be used for treatment of opiate addiction does not exist. To complicate the picture even further, a fifth tier of regulatory authority over methadone treatment programs is sometimes found at the county and municipal level.
|
From page 29... ...
Ignorance about its effectiveness may stem from the fact that methadone maintenance historically has been poorly linked to the provision of primary and specialized medical care and to mental health services, both of which are often needed by patients.
|
From page 30... ...
Its therapeutic effectiveness has been clearly demonstrated, alone and in conjunction with other treatment activities. Untreated opiate addiction has been shown to be closely linked with other major public health and safety problems, including violent crime, AIDS, drug resistant tuberculosis, and hepatitis, disorders that can then jeopardize the health of those who have never used illicit drugs.
|
From page 31... ...
" describes the drug, the physiology of opiate addiction, and the pharmacology, safety, and rationale of the use of methadone in treating such addiction. Chapter 3 presents an epidemiological perspective on the heroin addict population, the dominant group among opiate addicts, and deals with the characteristics of methadone maintained individuals, who are drawn from this larger pool.
|
From page 32... ...
The chapter also considers federal leadership in research, federal-state relations, financing, and policy guidance. The committee emphasizes that it is not enough simply to recommend changes in the regulations without also addressing these interrelated issues of funding, access, quality assurance, mainstreaming of care, and greater acceptance of methadone maintenance treatment by insurers, the medical community, politicians, and the public.
|
From page 33... ...
Computer runs of data used in chapters 3, 4, and 6 were provided to the committee by the Drug Use Forecasting group of the National Institute of Justice, of the Department of Justice, by the Community Epidemiology Branch of NIDA' by the Office of Applied Studies of SAMHSA, and by the New York Office of Alcoholism and Substance Abuse Services. A series of special computer runs dealing with heroin addiction were performed using the data of the Epidemiological Catchment Area study, arranged by Dr.
|
From page 34... ...
A NOTE ON TERMINOLOGY As chapter 3 in this report points out, there is no official psychiatric diagnosis termed "opiate addiction," and instead Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) , offers four related diagnoses: opiate dependence, opiate abuse, opiate intoxication, and opiate withdrawal; several symptoms whose presence may warrant a diagnosis of dependence, according to DSM-IV, are described.
|
From page 35... ...
1991. The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcomes.
|
From page 36... ...
1979. Comparative Effectiveness of Drug Abuse Treatment Modalities, NIDA Services Research Administrative Report, Washington, D.C.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.