Dr. Christy Waters, a psychiatrist in San Francisco, is chairman of the public policy committee for the California Society of Addiction Medicine.

Viewpoints: Ban on doctors at rehab sites outdated

Published: Sunday, Feb. 10, 2013 - 12:00 am | Page 5E
Last Modified: Sunday, Feb. 10, 2013 - 9:56 am

In an antiquated California regulation that needs to change, medical doctors are blocked from stepping foot inside alcohol and drug residential treatment facilities. The dangerous detoxification period prior to treatment can take place without any medical protocol.

According to a recent report, "Rogue Rehabs," released by the California Senate last year, the failure to allow appropriate medical oversight of sick patients at some California treatment centers has resulted in deaths.

Doctors also are needed to prescribe FDA-approved medications to treat addiction. But state regulations of licensed residential treatment facilities are so outdated that they ignore national best practices for addiction treatment, which includes providing multiple forms of treatment to find the right response for individual patients.

The responsibility for changing these outdated regulations rests in the hands of the California Department of Alcohol and Drug Programs. However, for many years the department has failed to make the necessary changes. The state of California has for decades maintained regulations for licensing addiction treatment facilities that favor certain treatment modalities and obstruct others. The regulations that can prohibit doctors from attending patients inside treatment facilities were put in place in the 1960s to inhibit medical model programs, which were out of favor at the time.

But progress has led to treatment regimens that are patient-centered, not program-centered. Today, there are a number of successful treatments for substance-use disorders, including Twelve Step facilitation, therapeutic community, cognitive-behavioral therapy, motivational-enhancement therapy and FDA-approved medications.

Treatment experts throughout the world now recommend rigorous individual assessment and treatment modeled to fit the patient, instead of favoring one treatment modality over another for all. Best practices for treatment match patients to the most promising therapy for the individual. If one modality doesn't work, another is tried – the same as with other chronic diseases.

Prescribing medication-assisted treatment isn't the only reason addicts need doctors. Following years of abusing their bodies with alcohol and drugs, alcoholics and drug addicts often have greater medical needs than people without substance use disorders. The toxic effect of alcohol and drugs, the failure of addicts to recognize their own health problems, and the risky lifestyles many lead may result in immediate need for medical care.

Today's evidence-based principles of addiction treatment also call for addressing other needs of the patient. Leading those other needs are care for medical and psychiatric problems. But that can't be effectively accomplished if doctors are not allowed inside treatment centers.

Since doctors can't see patients at residential treatment centers, then patients must be sent out from the treatment facility to a doctor's office or emergency room. That's certainly not the best or most cost-effective way to treat acute and chronic health problems. At the same time, doctors can be refused from attending people during the dangerous period of detoxification from drugs and alcohol. A detox patient experiencing complications must be sent from the treatment facility to a medical facility, usually by ambulance. Again, that's not good for the health of the patient, and it's also very costly.

California's treatment center licensure regulations are clearly out-of-date, and an effort is afoot to alter them. But opposition still remains, despite overwhelming expert opinion that providing all evidence-based treatments is the best practice for treating those suffering from the disease of addiction, and so is providing on-site medical care.

State licensing regulations for addiction treatment facilities need to protect the lives of addicted patients by allowing doctors to provide the care they need, when and where they need it.

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Read more articles by Christy S. Waters

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