Respect and Advocacy

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Respect and Advocacy

• Sabato A. Stile M.D.

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Worldwide, Complex, Public Health Problem

• affects people from all demographic and social
  groups and economic spheres
• Addressing addiction falls largely to society and
  the health profession

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Physicians

• Responsible prescribing practices
• prescribed with the greatest restraint,
  observing the strictest possible generally
  accepted medical indications, carefully
  monitored, fully informed of all potential
  therapeutic and non-therapeutic effects,

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Also

• Physicians should be aware of non-medical factors
  that may predispose patients to addiction.
• Physicians should learn to recognize 'drug
  seekers', addicted patients who attempt to obtain
  psychotropic and opiate drugs under false medical
  pretences.

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Minors

• When prescribing any psychotropic or opiate
  substance to minors, physicians must ensure that
  the parents or guardians of the patient are fully
  informed of the potential misuse of the drug and
  encouraged to monitor the child carefully to
  ensure adherence to the physician's instructions.

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Therefore

• Physicians should be aware of all non-drug
  treatment options for addicts to opiate and
  psychotropic drugs
• Physicians should encourage their patients to
  participate in drug treatment programs at the
  earliest possible stage of addiction

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Above all

• All efforts should be made to respect the dignity
  and autonomy of addicted patients

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• Drug therapy can assist the opiate-dependent
  patient to function in his or her normal
  environment and activities while working to
  overcome the opiate addiction.
• However, it should always be part of a
  multi-disciplinary approach that includes proven
  non-drug treatment elements, such as counselling
  and peer support.
• Drug therapy should be administered according to
  established evidence-based guidelines and
  supervised by specially trained physicians with
  an appropriate support team.

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• Physicians have an important role to play in the
  treatment of drug addiction, both as clinicians
  and as advocates for the treatment, rights and
  dignity of persons addicted to these harmful
  substances.

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• Treatment of addiction, like treatment for any
  disease or condition, should be undertaken in the
  best interests of the patient and according to
  established principles of medical ethics.

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AATOD Canon of Ethics

• Ensure that patients are treated with
  compassion, respect, and dignity regardless of
  race, creed, age, sex, handicaps, or sexual
  orientation.
• Retain competent and responsible personnel who
  adhere to a strict code of ethics, including but
  not limited to prohibiting of fraternization with
  patients, exploitation of patients, and criminal
  behavior.
• Subscribe to the treatment principles published
  in TIP 43, Medication-Assisted Treatment for
  Opioid Addiction in Opioid Treatment Programs,
  which serves as a resource in making therapeutic
  decisions.

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• Provide patients with accurate and complete
  information regarding methadone treatment, the
  nature of available services, and the
  availability of alternative treatment modalities
  before admission and throughout the treatment
  process.
• Ensure that discharge from treatment is
  conducted in accordance with sound and medically
  acceptable practice. The patient is assured of
  due process if the discharge is administrative in
  nature.
• Provide a safe and clean environment for
  patients and staff that is conducive to the
  therapeutic process.

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• Remain in compliance with the required Federal,
  State, and local operating standards.
• Take all necessary and appropriate measures to
  maintain individual patient records and
  information in a confidential and professional
  manner.
• Strive to maintain good relations with the
  surrounding community, and pursue every
  reasonable action to encourage responsible
  patient behavior and community safety.

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Elements of an Ethical Program

• beneficence
• autonomy
• nonmalfeasance
• justice

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Elements of Advocacy

• improving the quality and accessibility of
  pharmacological treatments for opiate addiction,
  specifically opioid replacement therapy
  (including but not limited to methadone
  maintenance treatment)
• eliminating discrimination against patients of
  these treatments
• creating a more harmonious relationship between
  patients, treatment providers, and the community

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As well as

• empowering methadone patients with a strong,
  unified voice
• educating patients, medical personnel, policy
  makers, and the general public about the numerous
  life-saving benefits of opioid replacement
  therapy

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Advocacy Organizations

• National Alliance of Methadone Advocates
  (www.methadone.org),
• International Center for Advancement of Addiction
  Treatment (www.OpiateAddictionRx.info),
• Advocates for Recovery through Medicine
  (www.methadonetoday.org/armhelp.htm)

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The Community

• Learning about the community, its structures, and
  directly affected constituents
• Delineating the community relations mission,
  goals, protocols, and staff roles
• Initiating and maintaining contact with community
  liaisons
• Educating and serving the community
• Establishing effective media relations
• Developing policies and procedures to address
  community concerns about the OTP
• Documenting community contacts and community
  relations activities