Alternatives to Non-Clinical Regulation: Training Doctors to Deliver Methadone Maintenance Treatment

Abstract

In most countries, methadone maintenance is a highly regulated form of treatment. Driven by financial considerations, and by the wish to make treatment more flexible and accessible, state authorities in Australia have in recent years relaxed the level of regulation, increasingly leaving details of treatment delivery to clinicians. In an attempt to provide a sounder footing for such treatment, training programs for doctors involved in delivering treatment have been developed. Evaluation of the training program in New South Wales, the largest state, has revealed many difficulties. The training is presented in a “medical” framework, with the assumption that clinicians approach methadone prescribing with the same sense of adhering to established clinical standards. However, doctors often share the confused and contradictory assumptions about addiction which are prevalent in the community. In particular, many doctors share the community assumption that methadone maintenance is not a form of treatment at all, but a pragmatic compromise. To address these problems, the training program has been progressively modified. However, it is clear that initial training is not adequate to produce sustained behaviour change. Accreditation of methadone clinics offers the most flexible means of monitoring the structure, processes and outcomes of treatment.

Key Words:

• Methadone
• addiction treatment
• staff training
• education
• quality assurance