LEADER 08325nam 2200685Ia 450 001 9910817702903321 005 20240416235218.0 010 $a0-309-17658-1 010 $a1-280-19303-4 010 $a9786610193035 010 $a0-309-59862-1 010 $a0-585-15457-0 035 $a(CKB)110986584751592 035 $a(OCoLC)44960724 035 $a(CaPaEBR)ebrary10057046 035 $a(SSID)ssj0000153929 035 $a(PQKBManifestationID)11946761 035 $a(PQKBTitleCode)TC0000153929 035 $a(PQKBWorkID)10406227 035 $a(PQKB)11311572 035 $a(MiAaPQ)EBC3376768 035 $a(Au-PeEL)EBL3376768 035 $a(CaPaEBR)ebr10057046 035 $a(CaONFJC)MIL19303 035 $a(OCoLC)923265953 035 $a(EXLCZ)99110986584751592 100 $a19941206d1995 uy 0 101 0 $aeng 135 $aurcn||||||||| 181 $ctxt 182 $cc 183 $acr 200 00$aFederal regulation of methadone treatment /$fRichard A. Rettig and Adam Yarmolinsky, editors ; Committee on Federal Regulation of Methadone Treatment, Division of Biobehavioral Sciences and Mental Disorders, Institute of Medicine 205 $a1st ed. 210 $aWashington, D.C. $cNational Academy Press$d1995 215 $a1 online resource (250 p.) 300 $aBibliographic Level Mode of Issuance: Monograph 311 $a0-309-05240-8 320 $aIncludes bibliographical references. 327 $aFederal Regulation of Methadone Treatment -- Copyright -- Acknowledgments -- Contents -- Federal Regulation of Methadone Treatment -- Executive Summary -- HOW METHADONE IS REGULATED -- SCOPE OF THE REPORT -- BALANCING THE BENEFITS AND RISKS OF METHADONE -- RECOMMENDATIONS TO MODIFY AND SUPPLEMENT THE REGULATIONS -- Diagnosing Addiction and Determining Dose Levels -- Habilitative and Rehabilitative Services -- Treating Pregnant Opiate Addicts -- Replacing "Detoxification" with "Medically Supervised Withdrawal -- Inpatient Hospital Admissions -- Treating Opiate Addiction and Treating Pain -- ENFORCEMENT OF THE REGULATIONS -- GUIDELINES AND QUALITY ASSURANCE -- PROCESS EVALUATION AND OUTCOME EVALUATION -- FEDERAL GOVERNMENT LEADERSHIP -- REFERENCE -- 1 Introduction -- THE CHARGE TO THE COMMITTEE -- OBJECTIVES OF OPIATE ADDICTION TREATMENT -- EFFECTIVENESS OF METHADONE MAINTENANCE TREATMENT -- Beneficial Outcomes -- Factors Limiting Effectiveness -- Multiple Problems of Methadone Maintenance Patients -- Variability among Methadone Maintenance Programs -- WHY METHADONE IS REGULATED DIFFERENTLY FROM OTHER DRUGS -- THE COMMITTEE'S VIEW -- REPORT ORGANIZATION -- STUDY METHODS -- A NOTE ON TERMINOLOGY -- REFERENCES -- 2 Pharmacology and Medical Aspects of Methadone Treatment -- THE RATIONALE FOR PHARMACOTHERAPY -- History and Practice -- Basic Science -- PHARMACOKINETICS OF METHADONE -- METHADONE MAINTENANCE -- Treatment Regimen -- Effects, Side Effects, and Special Pharmacological Issues -- Physiological Functions Disrupted During Heroin Addiction -- INTERACTIONS OF METHADONE WITH OTHER DRUGS -- IMPACT OF METHADONE MAINTENANCE ON INFECTIOUS DISEASES -- REFERENCES -- 3 Who are the Recipients of Treatment? -- HEROIN USE AND DEPENDENCE -- Prevalence of Heroin Use -- From Use to Dependence -- How Persistent is Heroin Dependence?. 327 $aAge, Gender, and Ethnicity -- Age -- Gender -- Ethnicity -- What Other Substances Do Heroin Users Consume? -- Other Medical and Social Problems of Heroin-Dependent Persons -- How Likely Are Heroin Addicts to Use Treatment? -- CHARACTERISTICS OF UNTREATED AND TREATED HEROIN ADDICTS -- METHADONE PATIENT CHARACTERISTICS -- Historical Trends -- Current Patient Characteristics -- Methadone in Drug Treatment: General -- Use of Methadone in Detoxification -- Use of Methadone in Maintenance Treatment -- Contrast between Detoxification and Maintenance Patient Admissions -- Maintenance Patients in New York State -- 1992 -- Maintenance Patients in California, 1992 -- Differences Between New York and California -- SUMMARY -- REFERENCES -- 4 Methadone Diversion Control -- EARLY CONCERN OVER DIVERSION -- THE NARCOTIC ADDICT TREATMENT ACT OF 1974 -- MORE RECENT OFFICIAL VIEWS ON DIVERSION -- House Select Committee Hearings -- Perspective of the Drug Enforcement Administration -- THE DATA ON DIVERSION -- Drug Abuse Warning Network Data -- Harris County, Texas -- Harris County Medical Examiner Data -- Methadone Maintenance Treatment Data -- Independent Pathologists' Review -- Drug Abuse Warning Network (DAWN) Medical Examiner Data -- Other Data on Diversion -- Drug Use Forecasting Data -- National AIDS Demonstration Research (NADR) Data -- HOW IS METHADONE DIVERTED? -- Production and Distribution System -- Sale by Patients: Who Sells and Why? -- WHO USES DIVERTED METHADONE AND WHY? -- CONSEQUENCES OF METHADONE DIVERSION -- Public Safety Issues -- Public Health Issues -- Is Diverted Methadone Dangerous? -- Is Diverted Methadone a Major Drug of Abuse? -- SUMMARY -- APPENDIX -- REFERENCES -- 5 Federal Regulation of Methadone Treatment -- THE 1960S -- THE NIXON ADMINISTRATION -- 1970 Legislation -- Special Action Office for Drug Abuse Presentation. 327 $aDEFINING THE REGULATORY REGIME: 1970-1974 -- Research, Treatment, and Regulation -- Methadone IND Regulations -- 1972 Regulations -- Legal Challenge to the FDA -- Narcotic Addict Treatment Act of 1974 -- Summary: 1970-1974 -- THE CURRENT REGULATORY REGIME -- 1980 Revision of the Regulations -- 1989 Revision of the Regulations -- 1983 Regulatory Reform Initiative -- 1987 Notice of Proposed Rule-Making -- 1989 Final Rule -- 1989 Guidance Document -- 1989 Interim Methadone Maintenance Proposal -- Assessment of Program Performance -- LEVO-ALPHA-ACETYL-METHADOL -- SUMMARY -- REFERENCES -- 6 Methadone Treatment -- THE PROVIDER COMMUNITY -- Number of Treatment Facilities -- Regional Variation -- Number of Patients -- Capacity and Utilization Rate -- Waiting Lists -- Facility Ownership -- FINANCING OF METHADONE TREATMENT -- Department of Veterans Affairs -- Out-of-Pocket and Private Insurance -- STATE SUBSTANCE ABUSE AGENCIES -- New York -- Financing -- Regulations -- California -- Financing -- Regulations -- Florida -- Financing -- Regulations -- Illinois -- Financing -- Regulations -- Massachusetts -- Financing -- Regulations -- SUMMARY -- REFERENCES -- 7 Treatment Standards and Optimal Treatment -- DEFINITION OF TERMS -- PATIENT EVALUATION AND ADMISSION CRITERIA -- Admission to Medically Supervised Withdrawal -- Admission to Maintenance Pharmacotherapy -- Proper Patient Placement -- Two Conclusions -- MAINTENANCE PHARMACOTHERAPY -- Dosing -- Comprehensive Treatment Services -- Take-Home Medication -- Urine Testing -- Implications for Regulations -- Opiate Addiction in Pregnant Women -- MEDICALLY SUPERVISED WITHDRAWAL -- INPATIENT TREATMENT -- Maintenance Pharmacotherapy in Hospital Inpatient Settings -- Inpatients with Untreated Opiate Addiction -- PAIN MANAGEMENT -- Non-Opiate-Addicted Pain Patients -- Methadone Patients. 327 $a''Recovering" Opiate and Other Substance Dependent Patients -- CONCLUDING COMMENTS -- REFERENCES -- 8 Implementing Standards-and Beyond -- REGULATIONS AND THEIR ENFORCEMENT -- CLINICAL PRACTICE GUIDELINES -- FORMAL QUALITY ASSURANCE SYSTEMS -- WHAT CAN BE DONE NOW? -- Process Evaluation -- Outcome Evaluation -- FEDERAL GOVERNMENT LEADERSHIP -- Research Issues -- Clinical Research -- Health Services Research -- Federal-State Relations -- Financing of Treatment -- Policy Guidance -- SUMMARY -- REFERENCES. 606 $aMethadone maintenance$xGovernment policy$zUnited States 606 $aDrug monitoring$xGovernment policy$zUnited States 606 $aMethadone hydrochloride 615 0$aMethadone maintenance$xGovernment policy 615 0$aDrug monitoring$xGovernment policy 615 0$aMethadone hydrochloride. 676 $a353.0084/29 701 $aRettig$b Richard A$01616181 701 $aYarmolinsky$b Adam$0675792 712 02$aInstitute of Medicine (U.S.).$bCommittee on Federal Regulation of Methadone Treatment. 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910817702903321 996 $aFederal regulation of methadone treatment$94003982 997 $aUNINA