Saturday, June 07, 2008


Deng Xiao Ping once said: It doesn't matter if a cat is black or yellow, as long as it catches rats." Well, in terminology as applied to those treated with methadone, semantics do matter.

Dole and Nyswander loved non-physician staff and considered them essential to optimal care of patients. They employed lots of methadone patients as staff members. When Rockefeller University and Beth Israel and other academic institutions claimed these "non-professionals" didn't fit into any accepted human resource category, Vince decided on the title, "research assistant" - and that's what they were called for many years, then some folks decided these non-physician and non-nurse "support staff" had to be made into "real" professionals = which in turn mandated that they be trained, certified, licensed, degreed, etc etc etc - and this new "profession" then demanded the rubric "client" be used to define those who received their care. I believe the reason is that only in this way could they exert direct power (for good or for bad is not the issue - power is power) over those they "served." Anyone can serve "clients" - but "patients" are generally understood to be under the care of physicians, for whom and with whom, but under whose ultimate authority, non-physician staff work.

In truth, sadly, most programs seem to relegate physicians to doing little more than signing medication orders - and even that I believe is usually done pursuant to the specific instructions of the non-physician staff, who generally decide how much medication, whether there should be take-homes, who should be "terminated," etc. The result: treatment of the disease of opiate dependence is absolutely unique - and lots of practices that would be unthinkable in all other areas of medical care are routine.

One of these days a physician will be faced with loss of medical license because s/he imposed a "cap" on doses, or lowered dosage as "punishment" for infraction of some rule or other, or ordered "taper" and termination because of toxicology results confirming the patient had the problem being treated, or .... And when that doctor states that "the counselor made me to do it," I suspect the current situaiton may change.

Contrary views, as always, welcomed. bob newman


At 11:30 PM, Blogger SB. Leavitt, MA, PhD said...

You're right on target, as usual, Bob.

I wrote about this very same subject 8 years ago in the Summer of 2000 in Addiction Treatment Forum. See:

And, we had results of a reader survey in the Winter 2001 edition. See:

Things haven't changed since then... sadly.

Stewart B. Leavitt, MA, PhD
Former editor, AT Forum


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