Most Americans can feel secure knowing the medical treatments they receive are safe, effective, and supported by scientific evidence and best practices. Unfortunately, the same cannot be said when it comes to fighting one of the deadliest epidemics our nation has ever faced: the crisis of opioid addiction.
As the rates of opioid use disorder (OUD) and associated deaths have skyrocketed over the past decade, America’s addiction treatment infrastructure has struggled to keep pace with an urgent and growing healthcare need. A chronic, treatable brain disease, substance use disorder (SUD) can be managed by combining appropriate medications with behavioral therapy and ongoing recovery support services.
While there are nationally recognized standards for evidence-based care, treatment programs are not required to follow them, and many lack the resources to do so – leaving patients and loved ones with little assurance that a particular program is equipped to deliver high-quality addiction treatment.
What has been missing is a way for healthcare consumers, insurers, and policymakers to verify that a treatment program provides standardized treatments and services backed by science and known best practices. Matching patients with the right treatment is incredibly important, since patients living with OUD and other addiction disorders are battling a chronic, progressive disease that has a high risk for death if untreated, or inadequately treated.
The recently enacted SUPPORT for Patients and Communities Act (HR 6) – a sweeping legislative package aimed at addressing the opioid crisis – included several important provisions to help promote the delivery of evidence-based care for the treatment of OUD.
But more needs to be done.
Fortunately, the American Society of Addiction Medicine (ASAM) and CARF International (formerly the Commission on Accreditation of Rehabilitation Facilities) will soon pilot a national certification program that evaluates whether a residential treatment program is aligned with nationally recognized standards for addiction treatment – standards known to those in the addiction medicine field as The ASAM Criteria.
A rigorous and continuously evolving compilation of best practices in addiction care, The ASAM Criteria help providers assess a patient’s condition across six dimensions of needs and then match those needs to the appropriate type and intensity of care.
This multidimensional assessment system considers critical recovery factors such as withdrawal potential, medical needs, emotional and behavioral conditions, readiness to change, potential for relapse, and an individual’s living situation and support systems. For each ASAM level of care, there are specific service characteristics, like staffing and treatment requirements, that are necessary to meet an individual patient’s needs.
Through the new certification program, CARF will assess individual treatment programs and certify those that have demonstrated the ability to deliver services consistent with ASAM’s guidelines for a specific level of care. To be clear, certification is not a grading system. Rather, certification designates that a given treatment program is capable of delivering services and treatments at one or more specific levels of care within a broad continuum of treatment needs.
Currently, more than 30 states require the use of The ASAM Criteria. In addition, more than 50 million Americans are covered by insurers that use the Criteria in payment decisions. With ASAM certification, care funders will have independent verification of a program’s fidelity to the Criteria. This will help them make payment and network decisions that promote the delivery of evidence-based care. Certified treatment programs will be able to demonstrate they are trained, capable, and committed to providing care directed toward optimal outcomes. Importantly, patients and loved ones will be able to make more informed decisions when selecting treatment.
Effective addiction care can – very literally – mean the difference between life and death for Americans with substance use disorders. Too often across our nation, many well-intentioned but inadequately trained providers provide suboptimal or incorrect care. Worse, a few unscrupulous proprietors of improperly staffed facilities prey upon the desperation of individuals and their families offering little in the way of effective treatment. Programs should offer their patients the resources and medical care needed to properly treat addiction.
With nearly 200 Americans dying every day from drug overdoses, the time for serious, standardized, and outcomes-based addiction care is now.
Americans trust their healthcare providers to make care decisions that offer the best chances of survival and long-term recovery. It’s time we move the field toward universal adoption of guidelines that will save lives. It’s also time for everyone who is suffering from addiction, directly or indirectly, to have the means to easily identify those programs that can deliver the specialized services they need and to have the best possible chance of meaningful remission and recovery.
Paul H. Earley, MD, DFASAM, has been an addiction medicine physician for 35 years, has authored two books and numerous articles on addiction and its treatment, and is the president-elect of the American Society of Addiction Medicine.