Policy Progress for Physician Treatment of Opiate Addiction

Merrill, Joseph O.

doi:10.1046/j.1525-1497.2002.10628.x

Cited by 27 publications

(24 citation statements)

References 54 publications

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“…This standardised prevalence data could allow the determination of factors affecting misuse and diversion and identification of a typology of drug users who could be suitable for supervised dispensing and those who could be suitable for take-home doses. The uncertainties in assessing and responding to diversion and misuse may be a factor deterring physician participation in OST; however, experts note that prescribing more abuse-deterrent forms of medication could serve as one intervention among others within the OST system to potentially increase quality, acceptance and access to treatment [45], as the policy and legal framework concerning opioid addiction treatment is continually under debate [46,47]. …”

Section: Discussionmentioning

confidence: 99%

The Impact of Misuse and Diversion of Opioid Substitution Treatment Medicines: Evidence Review and Expert Consensus

Reimer

Wright

Somaini³

et al. 2015

Eur Addict Res

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Background/Aims: Opioid substitution treatment (OST) improves outcomes in opioid dependence. However, controlled drugs used in treatment may be misused or diverted, resulting in negative treatment outcomes. This review defines a framework to assess the impact of misuse and diversion. Methods: A systematic review of published studies of misuse and diversion of OST medicines was completed; this evidence was paired with expert real-world experience to better understand the impact of misuse and diversion on the individual and on society. Results: Direct impact to the individual includes failure to progress in recovery and negative effects on health (overdose, health risks associated with injecting behaviour). Diversion of OST has impacts on a community that is beyond the intended OST recipient. The direct impact includes risk to others (unsupervised use; unintended exposure of children to diverted medication) and drug-related criminal behavior. The indirect impact includes the economic costs of untreated opioid dependence, crime and loss of productivity. Conclusion: While treatment for opioid dependence is essential and must be supported, it is vital to reduce misuse and diversion while ensuring the best possible care. Understanding the impact of OST misuse and diversion is key to defining strategies to address these issues.

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Section: Discussionmentioning

confidence: 99%

The Impact of Misuse and Diversion of Opioid Substitution Treatment Medicines: Evidence Review and Expert Consensus

Reimer

Wright

Somaini³

et al. 2015

Eur Addict Res

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“…In retrospect, the five-year requirement was probably too restrictive; the present federal regulations permit eligibility for medical maintenance after two years of excellent performance in the methadone clinic. [19][20][21] State regulations may vary and can be more restrictive.…”

Section: Establishment and Rationale Of Medical Maintenancementioning

confidence: 99%

“…[19][20][21] The detailed regulations were more focused on adherence to rules and prevention of diversion than on the clinical outcome of the patient. The orientation was Treatment released a joint advisory on medical maintenance.…”

Section: Regulatory Changesmentioning

confidence: 99%

“…17 Subsequently, on January 17, 2001, new federal regulations on opioid agonist medications were published. [18][19][20][21] Oversight of opioid treatment programs was transferred from the FDA to the Substance Abuse and Mental Health Service Administration (SAMHSA), a division of the Department of Health and Human Services. An accreditation-based system, similar to that for hospitals and other medical facilities, was established, with the focus on treatment outcomes rather than enforcement of regulations.…”

Section: Regulatory Changesmentioning

confidence: 99%

“…18 Yet another policy change was the Drug Addiction Treatment Act of 2000 (PL106-310). [19][20][21] This law allows qualified physicians to prescribe approved schedule III-V narcotic medications for maintenance and detoxification outside of established opioid treatment programs. Such prescribing privileges can be obtained through an approved 8 hour course or 13 certification in addiction medicine or psychiatry.…”

Section: Regulatory Changesmentioning

confidence: 99%

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Methadone Medical Maintenance: An Early 21st-Century Perspective

Novick

Salsitz

Joseph

et al. 2015

Journal of Addictive Diseases

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Methadone medical maintenance is the treatment of stable methadone-maintained patients in primary care physicians' offices under an exemption from federal methadone regulations. Reports from seven such programs in six states show high retention and low frequencies of illicit drug use. Patients and physicians indicate high levels of satisfaction. Although methadone maintenance has a long history of safety and efficacy, most methadone medical maintenance programs are no longer operating or accepting new patients. Federal regulations for standard methadone clinics allow some features of methadone medical maintenance, and advocacy for state approval of these changes is strongly recommended.

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