The Role of Program Directors in Treatment Practices: The Case of Methadone Dose Patterns in U.S. Outpatient Opioid Agonist Treatment Programs

Abstract

Demographic characteristics of OAT program directors (e.g., their race) may play a key role in explaining variations in methadone dosage across programs and patients. Further research should investigate the causal pathways through which directors' characteristics affect treatment practices. This may lead to new, multifaceted managerial interventions to improve patient outcomes.

Effective Treatment of Opioid Use Disorder among African Americans

“…Characteristics of patient mix (percentage of African American patients), employment status (percentage of patients who are currently unemployed), and patient age (percentage of patients aged 40 or above) are associated with dosage levels above 60 mg/day. Program factors associated with methadone dose levels below 60 mgs/day also include program ownership (public, private for profit, and private not-for-profit) accreditation by either the Joint Commission (TJC) or the Commission on Accreditation of Rehabilitation Facilities (CARF), the percentage of staff members who are ex-addicts [75] and African American director, particularly in programs serving populations with higher percentages of African American patients [17,64,76]. It is critical to understand the extent to which CLAS may improve OTPs' likelihood of providing adequate MAT dosages in programs serving African American and Latino clients.…”

Management Practices to Enhance the Effectiveness of Substance Use Disorder Treatment

“…The concept of evidence-based health care has led to a significant shift in the way health care professionals use evidence from scientific research and practice. Managers often encourage drug treatment counselors to adopt an EBP approach to practice, yet managers in SUD treatment often lack formal education in management, or the managerial capacity to rely on EBMPs to support delivery of EBPs [11]. The increased interest in developing EBP in the management of health care organizations is mainly due to wide variation in the implementation and effect of clinical EBPs [29].…”

“…The selection, implementation, sustainment, and influence of effective EBPs depend on how health care services are financed, regulated and delivered [11]. Leaders of health and social services system have begun to call for translation of findings from behavioral economics, cognitive and social psychology, management science, and social work, among other disciplines, to inform EBMPs [30].…”

“…Managers consequently play a critical role to develop, implement, and sustain EBPs [9,10]. Although managers tend to rely on personal experience to inform practices used in their organizations, it is critical to develop management capacity to rely on EBMP to enhance the impact of EBPs in SUD treatment [5,11].…”

Improvement of Methadone Maintenance Treatment (MMT) Process Through Development and Implementation of Methadone Dispenser

“…Methadone maintenance treatment (MMT), an evidence-based therapy for opioid dependence, has been associated with numerous benefits. In addition to reducing opioid use, it lowers risky 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r R e v i e w O n l y practices and HIV transmission, improves quality of life, and reduces mortality and criminal behavior [2]. Nonetheless, the relapse rates of drug addicted patients in the MMT program are alarmingly high, with rates approaching 90% [3,4].…”