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OTI's State Methadone Policy Guidelines Ready for Field Review

Because of heightened national interest in the efficacy and cost-effectiveness of methadone treatment, OTI has commissioned the development of policy guidelines for State alcohol and drug abuse agencies. The guidelines will provide meaningful information—based on current research and clinical experience—about effective treatment practices. These guidelines will help States strengthen their planning, development, and oversight of methadone programs that receive Federal Alcohol, Drug Abuse, and Mental Health Services (ADMS) Block Grant funding.

The critical need for this effort was underscored by the U.S. General Accounting Office (GAO) report, Methadone Maintenance: Some Treatment Programs Are Not Effective; Greater Federal Oversight Needed, published in March 1990.¹ The report states, "GAO found that policies, goals, and practices varied greatly among . . . methadone maintenance treatment programs. None of the 24 programs [studied] evaluated the effectiveness of their treatment." Other recent research on methadone programs corroborates the GAO report by finding that some methadone programs are markedly more effective than others in reducing intravenous drug use and needle sharing among their patients and that these differences in treatment outcome are related to definite program variables.

Contents of the new guidelines

To develop the guidelines, OTI is using a process that assimilates information and suggestions from State agencies, recognized treatment experts, and other Federal agencies. These new guidelines will cover critical treatment and policy issues affecting methadone treatment, and are therefore expected to be of major assistance to State agencies as they review and formulate their policies on program licensure, development, and monitoring and evaluation.

As currently proposed, the guidelines will take a comprehensive look at various aspects of methadone treatment, including:

• A history of methadone treatment
• A review of critical methadone treatment issues
• Admission policies and procedures
• Principles of determining methadone dose
• Urinalysis
• Responsible "take-home" medication practices
• Treatment of multiple drug abuse
• Treatment of the pregnant addict
• HIV testing and counseling practices
• Duration of methadone maintenance treatment and patient retention
• Relationships with the community
• Policy implications and future trends

Guideline development process

OTI is pursuing a multi-stage process in the development of the guidelines. In June 1991, a Federal resource panel was convened to recommend topics of discussion for the proposed guidelines and to identify issues of concern in providing, administering, and regulating methadone treatment programs. The panel consisted of representatives from a large number of Federal agencies and national organizations (see sidebar). "We tried to make the meeting as inclusive as possible of all interested and relevant parties," said OTI's Anna Marsh, Ph.D., Chief of the State Technical Assistance Branch. "We feel that broad input is important in terms of the ultimate substance of the final document."

Based on the research literature and on recommendations of the Federal resource panel, an initial set of draft guidelines was prepared under an OTI contract with the American Methadone Treatment Association, Inc. (formerly the Northwest Regional Methadone Treatment Coalition). Coordinated by Mark Parrino, President of the Association, the set of draft guidelines was written by a number of experts in the field.

In late October 1991, OTI convened a consensus panel of treatment specialists, medical and health professionals, researchers, and State alcohol and drug agency officials to review, critique, and recommend modifications to these draft guidelines. Stated Dr. Marsh, "Here again, we selected as many people as possible to participate in order to incorporate a broad spectrum of perspectives." Chaired by Parrino, the panel worked for 2 days to achieve consensus on the policies and recommended protocols contained in the guidelines document.

The various chapters of the guidelines have been modified, based on input from the consensus panel, and are now being edited and prepared for review in the field. After the field review process has been completed and the guidelines are revised and approved by OTI, copies of the State Guidelines for Methadone Maintenance Treatment will be made available to the State alcohol and drug agencies and to all licensed methadone programs.