Methadone Maintenance:

Some Treatment Programs Are Not Effective; Greater Federal Oversight Needed

HRD-90-104: Published: Mar 22, 1990. Publicly Released: Mar 22, 1990.

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Pursuant to a congressional request, GAO reviewed the: (1) treatment provided to patients in methadone maintenance programs in eight states; and (2) federal government's oversight role for such programs.

GAO found that: (1) many methadone maintenance programs were not effectively treating heroin addiction; (2) 1 to 47 percent of patients in treatment for more than 6 months continued to use heroin; (3) policies, goals, and practices varied greatly among methadone maintenance treatment programs; (4) none of the programs evaluated the effectiveness of their treatment; and (5) there were no federal standards for treatment programs. GAO also found that: (1) federal oversight of treatment programs has been very limited since 1982; (2) interim maintenance, defined as the supply of methadone without any other support services, did not significantly reduce heroin use or the risk of acquired immunodeficiency syndrome (AIDS); and (3) many programs failed to meet minimum urine testing requirements, standards for admissions, and medical evaluation requirements.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: The notice to withdraw the proposed regulations was sent to the Department of Health and Human Services after development by the interagency Methadone Working Group, composed of personnel from NIDA and FDA. However, Public Law 102-321, the ADAMHA reorganization act, meets the intent of the GAO recommendations.

    Recommendation: The Secretary of Health and Human Services should withdraw the proposed interim maintenance regulations until such time as documented evidence demonstrates that demand greatly exceeds treatment capacity for methadone maintenance treatment programs.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: In responding to GAO's recommendations,on January 17, 2001, HHS issued final regulations to improve the quality and oversight of substance abuse treatment programs that use methadone and other medication to treat heroin and similar addictions. Under the final rule, federal oversight of narcotic/opiate treatment programs will be accomplished through an accreditation system administered by SAMHSA's Center for Substance Abuse Treatment (CSAT). The new program relies on the accreditation of treatment programs in accordance with standards established by CSAT. Selected accreditation bodies will survey and periodically inspect accredited treatment programs. SAMHSA officials believe that this accreditation system will obviate the need for states to implement a methadone treatment quality assurance system as the primary mechanism for responding to GAO's recommendations.

    Recommendation: To better monitor and assess methadone maintenance treatment programs, the Secretary of Health and Human Services should direct FDA or NIDA, as appropriate, to ensure increased program oversight oriented toward performance standards.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Implemented

    Comments: Effective March 2001, federal oversight of opioid/narcotic treatment programs will be assisted by an accreditation system administered by SAMHSA's Center for Substance Abuse Treatment (CSAT). The new system relies on accreditation of treatment programs in accordance with standards established by CSAT. Included in these standards is information on the type of services treatment programs should provide and the type of data that should be maintained for assessing the accreditation status of a program. SAMHSA officials believe this accreditation system will obviate the need for states to implement a methadone treatment quality assurance system as the primary mechanism for responding to GAO's recommendations.

    Recommendation: To better monitor and assess methadone maintenance treatment programs, the Secretary of Health and Human Services should direct FDA or NIDA, as appropriate, to provide guidance to treatment programs regarding the type of data that must be collected to permit assessment of programs' performance.

    Agency Affected: Department of Health and Human Services

  4. Status: Closed - Implemented

    Comments: In responding to GAO's recommendations, on January 17, 2001, HHS issued final regulations to improve the quality and oversight of substance abuse treatment programs that use methadone and other medication to treat heroin and similar addictions. Under the final rule, federal oversight of opioid/narcotic treatment programs will be accomplished through an accreditation system administered by SAMHSA's Center for Substance Abuse Treatment (CSAT). The new program relies on the accreditation of treatment programs in accordance with standards established by CSAT. Selected accreditation bodies will survey and inspect accredited treatment programs for compliance with the standards. SAMHSA officials believe that this accreditation system will obviate the need for states to implement a methadone treatment quality assurance system as the primary mechanism for responding to GAO's recommendations.

    Recommendation: To better monitor and assess methadone maintenance treatment programs, the Secretary of Health and Human Services should direct the Food and Drug Administration (FDA) or the National Institute on Drug Abuse (NIDA), as appropriate, to develop result-oriented performance standards for methadone maintenance treatment programs.

    Agency Affected: Department of Health and Human Services

  5. Status: Closed - Implemented

    Comments: The notice to withdraw the proposed regulations was sent to HHS after development by the interagency Methadone Working Group, composed of personnel from NIDA and FDA. However, Public Law 102-321, the ADAMHA reorganization act, meets the intent of the GAO recommendations.

    Recommendation: The Secretary of Health and Human Services should withdraw the proposed interim maintenance regulations until such time as research demonstrates that interim maintenance is significantly better than no treatment at all in preventing intravenous drug use and the corresponding risk of AIDS.

    Agency Affected: Department of Health and Human Services

 

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