Monday, November 22, 2010

Terminating Patients as Disciplinary Measure:

The following is an exchange that appeared recently on a international website linking colleagues involved in addiciton treatment:

Initial posting: I was wondering if any of you were aware of, or have come across any data/research/information that discusses how long any period of client exclusion from drug treatment service should last? This is in the context of disciplining a client who has transgressed while in treatment.

Response from USA (Robert Newman): forgive an unsolicited comment from far off New York: I wonder if there is any other field of medicine (let alone one with potentially life and death consequences such as opiate dependence) where patients are "excluded" as a "disciplinary" measure because of "transgressions". What "transgression" would lead a doctor to deny further treatment to a patient with tuberculosis, or severe asthma, or diabetes? Would failure on the part of a diabetic to adhere to a prescribed diet, signaled by "catching" a patient stuffing himself with pavlova and two scoops of vanilla ice cream on the side be a sufficient "transgression" to warrant disciplinary action in the form of therapeutic abandonment?

NOTE: I am very painfully aware that precisely these practices are the norm in most methadone "programs" in the USA. I've never heard of any program pursuing this policy being sanctioned by the federal or state regulatory authorities or by the agencies charged with setting and enforcing standards. But for sure that doesn't make any of this right.