When the opioid crisis comes home

When an opioid treatment program opens its doors in a residential area, its neighbors may have concerns, but these programs are providing life-saving treatment that will ultimately strengthen the community.

As local, state, and federal leaders continue to address the opioid epidemic, there is much discussion around access to care. Some of this discussion centers on concerns about programs, particularly those offering medication-supported recovery, opening in communities. Although there may be nuances specific to an opioid treatment program (OTP), there are many similarities to any new business opening in a community with residents asking questions. 

Who are the proprietors? Why this neighborhood? How will this impact traffic, noise, and parking? Can this affect my home’s value? Fortunately, OTPs have federal requirements and accreditation standards to address some of these concerns.

These questions might be especially important if the community has little history or information about the business, or worse, if the community has been misinformed about OTPs or what are sometimes referred to as methadone clinics. OTPs are opening across the nation, including in residential areas, to combat the opioid crisis. Unfortunately, they carry a stigma that can evoke a “Not in my backyard” reaction from community members. Residents may worry the program would bring loitering, crime, active drug dealing, and drug use into their community. 

The reality is OTPs provide life-saving treatment and ultimately strengthen communities. 

What is an OTP?

OTPs provide comprehensive opioid-use disorder treatment that includes FDA-approved medications, such as methadone, buprenorphine, and naltrexone, along with counseling, medical services, and connections to social services.

OTPs are heavily regulated at the federal and often state and local levels. They are licensed (and visited) by the Drug Enforcement Agency. They must also be certified by the federal Center for Substance Abuse Treatment (CSAT), a division of the Substance Abuse Mental Health Services Administration (SAMHSA). CSAT has developed robust regulations included in 42 CFR, Part 8 under which OTPs operate. Additional oversight is provided through national accreditation by an independent accreditor like CARF International. The CARF accreditation process occurs at least every three years to ensure quality treatment services and to assess compliance with CSAT regulations. CSAT is notified if an OTP is not in compliance with a federal regulation or guideline. Beyond this rigorous federal oversight, most OTPs also have the added layer of their state or local licensing body.

Why this community? Will this bring drug use here?

OTPs are required to measure community impact when opening. They must assess the community’s needs and understand both the negative and positive influences of their physical presence on the community. So an OTP moves into a community to address an unmet need as opposed to bringing a problem into the community. It must engage community leadership and other stakeholders throughout the opening process and an ongoing basis. CARF accreditation surveys assess the OTP’s conformance to this requirement.

Will this program bring loitering and traffic?

OTPs with CARF accreditation are required to have an ongoing community relations plan. This plan must include elements of community education on substance use and the use of medications in treatment, identification of staff members to serve in community relations activities, and written procedures to address and resolve problems such as patient loitering and medication diversion. The plan must also ensure that the program’s operation does not adversely affect community life. To conform to this standard, the OTP should monitor traffic flow and loitering and seek input from community stakeholders about the program’s impact on the community. Again, conformance is assessed during the accreditation survey.

Are the medications dangerous; will they be sold illicitly in the community?

Any medication that is not used as intended can be dangerous, and this is especially true of controlled substances. OTPs must have robust controlled-substance diversion control plans with specific measures to reduce the possibility of diversion from legitimate treatment use. They have to assign specific responsibility to medical and administrative staff to carry out the diversion control measures and functions described in the plan.

In addition, individuals served by the program must attend the clinic daily and take their dose in the presence of nursing staff. A person may be eligible for “take-home” medication on a graduated scale based on their treatment progress. Eight-point criteria assess community and individual safety in these cases.

Similar to the community relations plan, the diversion control and take-home systems are reviewed in the accreditation process.

How can I learn more about what is happening in the community?

Engage with the program leadership; learn more about how they plan to operate the program and co-exist in the community. OTPs are required to have a program sponsor whose responsibilities include ensuring compliance with all federal regulations. Community members can ask for the sponsor’s contact information and bring any concerns or complaints to that person. The accrediting body itself can also be a mechanism for sharing feedback and resolving issues.

An OTP’s community relations activities promote recovery and integration of the persons served. Opening the conversation keeps leadership accountable to the community while providing life-saving services to its residents. Informed community members can change public perception and promote recovery.

If you have concerns about a CARF-accredited OTP, please go to www.carf.org/accreditation/public/ for tips and information on how to provide feedback about the provider to CARF.