Respect and Advocacy

Sabato A. Stile M.D.

Worldwide, Complex, Public Health Problem

• affects people from all demographic and social groups and economic spheres

• Addressing addiction falls largely to society and the health profession

Physicians

• Responsible prescribing practices:

prescribed with the greatest restraint, observing the strictest possible generally accepted medical indications, carefully monitored, fully informed of all potential therapeutic and non-therapeutic effects,

Also

• Physicians should be aware of non-medical factors that may predispose patients to addiction.

• Physicians should learn to recognize 'drug seekers', addicted patients who attempt to obtain psychotropic and opiate drugs under false medical pretences.

Minors

• When prescribing any psychotropic or opiate substance to minors, physicians must ensure that the parents or guardians of the patient are fully informed of the potential misuse of the drug and encouraged to monitor the child carefully to ensure adherence to the physician's instructions.

Therefore

• Physicians should be aware of all non-drug treatment options for addicts to opiate and psychotropic drugs

• Physicians should encourage their patients to participate in drug treatment programs at the earliest possible stage of addiction

Above all

• All efforts should be made to respect the dignity and autonomy of addicted patients

• Drug therapy can assist the opiate-dependent patient to function in his or her normal environment and activities while working to overcome the opiate addiction.

• However, it should always be part of a multi-disciplinary approach that includes proven non-drug treatment elements, such as counselling and peer support.

• Drug therapy should be administered according to established evidence-based guidelines and supervised by specially trained physicians with an appropriate support team.

• Physicians have an important role to play in the treatment of drug addiction, both as clinicians and as advocates for the treatment, rights and dignity of persons addicted to these harmful substances.

Treatment of addiction, like treatment for any disease or condition, should be undertaken in the best interests of the patient and according to established principles of medical ethics.

AATOD Canon of Ethics

• Ensure that patients are treated with compassion, respect, and dignity regardless of race, creed, age, sex, handicaps, or sexual orientation.

• Retain competent and responsible personnel who adhere to a strict code of ethics, including but not limited to prohibiting of fraternization with patients, exploitation of patients, and criminal behavior.

• Subscribe to the treatment principles published in TIP 43, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, which serves as a resource in making therapeutic decisions.

• Provide patients with accurate and complete information regarding methadone treatment, the nature of available services, and the availability of alternative treatment modalities before admission and throughout the treatment process.

• Ensure that discharge from treatment is conducted in accordance with sound and medically acceptable practice. The patient is assured of due process if the discharge is administrative in nature.

• Provide a safe and clean environment for patients and staff that is conducive to the therapeutic process.

• Remain in compliance with the required Federal, State, and local operating standards.

• Take all necessary and appropriate measures to maintain individual patient records and information in a confidential and professional manner.

• Strive to maintain good relations with the surrounding community, and pursue every reasonable action to encourage responsible patient behavior and community safety.

Elements of an Ethical Program

• beneficence

• autonomy

• nonmalfeasance

• justice

Elements of Advocacy:

• improving the quality and accessibility of pharmacological treatments for opiate addiction, specifically opioid replacement therapy (including but not limited to methadone maintenance treatment)

• eliminating discrimination against patients of these treatments

• creating a more harmonious relationship between patients, treatment providers, and the community

As well as

• empowering methadone patients with a strong, unified voice

• educating patients, medical personnel, policy makers, and the general public about the numerous life-saving benefits of opioid replacement therapy

Advocacy Organizations

• National Alliance of Methadone Advocates (www.methadone.org),

• International Center for Advancement of Addiction Treatment (www.OpiateAddictionRx.info),

• Advocates for Recovery through Medicine (www.methadonetoday.org/armhelp.htm)

The Community:• Learning about the community, its structures,

and directly affected constituents • Delineating the community relations mission,

goals, protocols, and staff roles • Initiating and maintaining contact with

community liaisons • Educating and serving the community • Establishing effective media relations • Developing policies and procedures to address

community concerns about the OTP • Documenting community contacts and

community relations activities