Literature Review: Access to Care for Addicts

Hettema, J., & Sorensen, J. L. (2009). Access to Care for Methadone Maintenance patients in the United States. International Journal Mental Health Addiction. 7 (3) 468-474.  DOI:10.1007/s11469-9204-6

This paper was presented to increase the awareness of individual with Opiates treatment programed Dependency are denied access to residential treatment.  Although, Methadone Maintenance Therapy has been proven to reduce illicit drug use, improve psychosocial functioning, ability to keep employment, decrease criminal activities, and contracting HIV, AIDS, and Hepatitis.  There are great concerns for those clients in Methadone Maintenance Therapy who need more intensive treatment.  MMT does provide basic medical screening, dosing, and outpatient counseling. The more services provided for the client leads to a better outcome.  The study found that “treatment dose “measured by number of days in treatment, number of treatment session attended and number of services received leads to a positive outcome.

Some factors to consider are limited availability of residential treatment, insurance payment and the impact of abstinence philosophy. Mainstream views addiction as a moral problem rather than a medical issue.  Hettema & Sorensen (2009) identifies philosophical differences separates mental health and addiction services is hard to integrate.  Society regards methadone as a necessary evil.  There are ongoing empirically evaluated treatment approaches who do not follow an abstinence oriented philosophy.

There are issues with the Americans with Disability Act because client is being denied services because of their use of a prescribed for their substance dependency.  There are ambiguities in the interruption of that.  The author is not aware of any litigation now.

Ducharme, L.J., Knudsen, H.K., Roman, P. M. (2006). Evidence-based treatment for Opiate-Dependent clients: availability, variation, and organization correlates. The American Journal of Drug and Alcohol Abuse. 32.569-576. DOI: 10;1080/009529906000920417

This article examines the availability and correlates with evidence-based practices for opiates dependence in the United States.  This research sampled addiction treatment with and without MMT services. This article also examined community based treatment programs with MMT units as one of their modalities.  The researchers included both methadone available and non-methadone setting, then compared the number and type of service available to users.

The method used was a data analyses collected in 2002-2003 national representative sample of addiction treatment centers  in public and private sector. There was extensive face to face interviews conducted with administrators and clinical directors of 763 treatment center.  The data collected in 2002-2003 face to face interviews included organizational characteristic, size, ownership, accreditation, staffing, treatment practice methadone availability, level of care, pharmacotherapies, wraparound service,

The findings suggested the majority of opiate dependents clients are not in Methadone Clinics.  Many agencies are not willing to refer opiates dependent patient. to MMT.  The opiate dependence client would benefit from the referral that uses evidence practices if referred.  The research suggests further study to determine which opiate dependence client would benefit from evidence client care.

Parks, C., Fullerton, C.A., Kim, Meekee, Montejano,, L., & Lyman, Russell, Dougherty, R. H., Daniels A. S., Ghose, S. S., Delphin- Rittmon, M. E.., (2013). Medication-Assisted Treatment with Buprenorphine: assessing the evidence. Psychiatric Services in Advance.DOI10.1176/appi.ps201300256

This article reviews Buprenorphine treatment as an alternative to Methadone Maintence Treatment for long term treatment of Opioid Use Disorder. Buprenorphine is not considered as abstinence treatment.  The purpose of buprenorphine is to reduce or eliminate opioid use. The authors conducted the research that examined abstracts of identical articles for compliance with the review.  The research provided evidence of the effectiveness of improving treatment retention and decreasing illicit opioid use.  The evidence is growing both BMT and MMT improved pregnancy outcomes. Ongoing treatment is necessary.