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medication-assisted treatment for substance use disorders

Two studies of accreditation involving Opioid Treatment Programs (OTPs) have been conducted on behalf of SAMHSA.

The first, often popularly referred to as “MAP I,” or the Methadone Accreditation Project, was conducted from 1998-2002. The study focused on a small sample of OTPs undergoing accreditation on a voluntary basis, with technical assistance provided through SAMHSA funding. The MAP I study was an “impact” study, rather than a feasibility study. This is in part because the decision to implement accreditation was made before the study concluded.

The final results of the OTP Accreditation Impact Study, presented in the Executive Summary (PDF, 318 KB), provide important context in terms of considering the continuing development of the process of accreditation as overseen by SAMHSA. Appendices on the accreditation bodies and the technical assistance provided during that period give additional insight about the "lessons learned" during this important policy change.

Ultimately, final results from MAP I supported the conclusion reached by the Secretary of DHHS to implement the regulatory change, as noted in the Final Rule (published January 17, 2001):

"The Secretary believes that the interim results from the accreditation impact study confirm that the accreditation guidelines, along with the accreditation process itself, are a valid and reliable method for monitoring the quality of care provided by OTPs. The results indicate that most OTPs can achieve accreditation and that treatment capacity has not declined as a result. While SAMHSA intends to continue the study to fulfill its objectives, the Secretary does not believe that it is appropriate or necessary to delay implementation of these new rules until the full study is complete."

In 2002, a second, three-year study of the impact of accreditation was conducted. Beginning shortly after passage of the Final Rule, the second study encompassed the universe of over 1,100 OTPs. Most were undergoing accreditation on a mandatory basis for the first time. The second study, the "Opioid Treatment Program Accreditation Evaluation," had two main components:

  • The first consisted of survey(s) sent to all OTPs. Due to a delay in approval of the necessary paperwork, the first survey could not be sent until many programs had already commenced or in some cases, achieved accreditation. For that reason, this study is not a 'pre-' and 'post' accreditation study, and focus shifted to better understanding the factors involved in maintaining as well as achieving accreditation. The initial survey was accordingly re-designed to emphasize issues related to the impact of accreditation now that it become 'standard operating procedure' for OTPs. However, retrospective items were also included for programs who had very recently achieved accreditation and provided 'near-pre-accreditation' data. Despite some anticipated difficulties, over 400 OTPs returned completed these initial surveys.

    Some six months following their completion of the first survey, programs were asked to complete a second, follow-up survey. The time period was somewhat constricted due to the practical need to complete the study within the three-year timeframe. However, results still suggested stability of changes associated with accreditation.

  • The second component consisted of a smaller in-depth study of 22 OTPs that volunteered. The centerpiece of the study was a site visit, during which interviews were conducted with up to 30 patients as well as staff. In addition, with patients' permission, limited data were extracted from their charts as well as unidentified data on discharged patients. Finally, key program and administrative staff at these programs were asked to provide up to 6 months of weekly logs detailing their use of time and resources in relation to accreditation.

The second study is described in the Final Report (PDF, 839 KB) from the Opioid Treatment Program Accreditation Evaluation, and in a poster (PPT, 369 KB) presented at the 2006 annual conference of the American Association for the Treatment of Opioid Dependence (AATOD).

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