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American Society of Addiction Medicine (ASAM)

ASAM Concerns Regarding Methadone Treatment

The American Society of Addiction Medicine (ASAM) recognizes methadone maintenance treatment to be safe, effective, and an integral component of the addiction medicine field. Because ASAM is a medical society, it is primarily concerned with the medical aspects of methadone treatment. ASAM supports the position that these medical aspects, rather than political forces, should determine new directions in methadone policies.

Broad concerns

ASAM has both broad concerns and specific positions regarding treatment program guidelines. The Society's broad concerns pertain to the following areas.

The need for comprehensive services. ASAM sees methadone treatment as vital within the continuum of treatment modalities dealing with addictive disorders. The Society supports the position that methadone treatment should be provided by programs offering a comprehensive range of therapeutic and rehabilitative services in a nonjudgmental and caring atmosphere. Ideally, primary medical care should be provided on site.

Public information. ASAM supports and participates in efforts to inform the public and to dispel myths and prejudices that in the past have impeded the expansion and improvement of methadone treatment.

Training physicians about methadone maintenance treatment. Because methadone maintenance is a medical treatment, ASAM is concerned about the physician's limited and peripheral role in some programs. The Society is also concerned that many program physicians are not well enough informed about the practice of addiction medicine and lack a thorough working knowledge of the laboratory and clinical research that forms the basis for medical treatment.

Because the need for adequate training of physicians is urgent, the Society offers symposia and courses on methadone-related subjects at its annual scientific meetings, regional review courses, and state-of-the-art courses. In short, it is essential that methadone program medical directors and staff physicians understand both the generalities of addiction medicine and the specifics of methadone treatment.

Uneven quality of care. One of ASAM's concerns is the uneven quality of care among treatment programs. The Society supports development of both methadone treatment quality assurance systems and of performance-based standards of care. ASAM hopes that improved evaluation procedures for patients will help individualize treatment and make it more flexible, which would also result in the more efficient use of resources. Efforts to ensure quality care in methadone treatment programs should coincide with steps to increase treatment availability; ASAM believes these goals are indivisible.

Specific issues

ASAM supports the following positions on specific issues important in methadone treatment.

Methadone dose determination. ASAM supports dosing of patients based on individual, clinical, and, at times, laboratory information. Setting dose by program policy or regulation is inappropriate.

Duration of methadone maintenance. ASAM recognizes the need for long-term and even indefinite methadone maintenance treatment in selected cases of chronic, intractable heroin addiction. Such decisions should be made on an individual basis and should involve both the treatment team and the patient. Attempts to set arbitrary limits on the duration of treatment are inappropriate.

The treatment environment should parallel the patient's progress toward making long-term treatment compatible with leading a normal life. Thus, treatment should become less demanding and less disruptive of the patient's family, job, and recreation, moving toward a model that resembles "medical maintenance."

Methadone maintenance patients in the general health care delivery system. A program combining advocacy and education should reduce the problems that commonly occur in the management of methadone patients being treated for medical, surgical, dental, and other conditions. Because the pain experienced by methadone patients undergoing surgical or dental procedures is frequently mismanaged, efforts should be made to address this problem and to prevent patients' unnecessary suffering. Methadone patients should be provided with adequate care without any interruption of methadone treatment. They should be treated with the same dignity and respect as other patients.

Methadone maintenance and pregnancy. There should be special provisions for pregnant, opioid-dependent women to enter methadone treatment rapidly, with comprehensive prenatal and other support services, when appropriate. Waiting lists, financial problems, and other barriers to treatment must be removed.

In summary, ASAM is primarily concerned with the quality and availability of methadone treatment along with other treatment modalities. Methadone treatment should be totally integrated into the continuum of treatment services available for chemical dependency. Regulations should encourage individualized treatment based on sound clinical judgment and scientific data. Regulations should be flexible to allow the most clinical and administrative freedom compatible with operating programs efficiently and providing quality care.

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