NCCHC News

Commission Receives SAMHSA Grant to Aid 
Opioid Treatment Education, Programming
By R. Scott Chavez, PhD, PA-C, CCHP-A

An important public health strategy to reduce HIV and viral hepatitis is to treat heroin addiction and thus eliminate needle-sharing behavior. In line with this strategy, the community standard of care for opioid dependency has evolved to include initiation and maintenance of methadone.

But what happens when a participant in a community methadone program is confined in a jail or other correctional facility? As revealed on page 1 of CorrectCare’s Winter 2005 issue, the answer often is “nothing.”

The use of methadone to manage opioid addiction in correctional settings is controversial. Such treatment raises unique clinical, ethical and legal dilemmas for jail and prison administrators. Because of these concerns and the stigma associated with methadone, many administrators won’t even consider such programs.

Troubling Issues
Instead, many correctional institutions require complete abstinence when opioid-dependent individuals are admitted. But abrupt withdrawal from methadone creates a dangerous physiological response. Thus, it should be done only as a last resort and only with informed consent.

From an ethical perspective, an institution’s restrictions on opioid treatment hamper the physician’s ability to provide patient-centered care at community standards. When correctional policies dictate health services, medical decision-making autonomy is violated, and the trusting, therapeutic relationship between physician and patient is threatened.

As for legal issues, many correctional institutions operate under the “shadow of the law.” For example, methadone patients could be considered disabled under the Americans with Disabilities Act, so failure to provide methadone maintenance may be interpreted as a violation of this law.

Also, due to concerns about keeping methadone on site, some jails allow it to be dispensed but only by external agencies, whose staff bring in the methadone, administer it and leave. This approach, however, does not meet federal opioid treatment standards found in 42 CFR Part 8.12.

Getting Past the Hurdles
The federal Substance Abuse and Mental Health Services Administration recognizes that correctional methadone maintenance programs are both humane and practical. That’s why two years ago SAMHSA asked NCCHC to develop standards for opioid treatment programs in correctional facilities.

Along with the publication of the OTP Standards in 2004, SAMHSA authorized the Commission as an accrediting body. Accreditation by NCCHC allows the OTP to seek the federal certification required for its legal operations. NCCHC is the only approved accrediting body focusing on the correctional health care field.

Now, SAMHSA has awarded NCCHC a three-year grant to make clinically sound opioid treatment services more available in correctional facilities, with the ultimate goal of improving patient outcomes.

Our “Project to Improve Opioid Treatment Services in U.S. Correctional Institutions” has two major goals: To educate corrections and health administrators on the importance and advantages of proper opioid treatment, and to fund activities that will help correctional facilities establish accredited OTP programs.

This project addresses these needs in a cost-efficient and realistic manner. First we will conduct an analysis to identify gaps in understanding of opioid treatment and programs. We will provide information and education through means such as national mailings and conference presentations. This will build awareness of appropriate addiction therapy, as well as an appreciation of the federal rules and regulations governing methadone administration.

The grant also provides two forms of financial assistance to facilities seeking to establish and accredit OTPs. First, it can pay for on-site technical assistance to help facilities prepare for accreditation. It also can pay for the initial and annual accreditation fees for at least the three-year duration of the grant. This assistance permits facilities to concentrate on the clinical issues in setting up an opioid treatment program.

While jails are expected to be the primary target for this assistance, prisons also may be interested, especially those that take parole violators and those that specialize in substance abuse programming.

— About the author: R. Scott Chavez, PhD, PA-C, CCHP-A, is NCCHC’s vice president and director of the OTP education project. To learn more about the project or OTP accreditation, contact us at (773) 880-1460 or OTPinfo@ncchc.org.

(Spring 2005)