Patient-centered care is a good way to describe how medicine works for most people with most health problems. If you go to your family physician and a health problem arises, the doctor works to make decisions that fit your personal circumstance. If you have glaucoma, and medical cannabis is a good treatment option, but you do not agree with the medical use of cannabis, your doctor will look for the best treatment options that are acceptable for you as a patient. There are thousands of examples for patient-centered care because patient-centered care is the gold standard in medicine and has been proven to be effective. In substance use disorder treatment, the best drug rehabs in Florida and Alabama also try to implement a patient-centered care approach. However, in most places, intensive inpatient rehabilitation is not the treatment option that most people will experience. In urban areas, methadone and suboxone treatment clinics often have 10 to 50 times as many patients as an inpatient rehab facility. Patient-centered care would have to be the standard in these types of facilities in order for most people with substance use disorder to benefit from patient-centered care, and currently, that is not the case. In Indiana and Alabama currently, a prospective methadone maintenance patient must give a urine sample on camera in order to qualify for treatment. What is the reasoning for the camera? Good question. Somebody somewhere must think that a person who is not opiate tolerant is going to show up for methadone treatment with someone else’s urine in order to get a small dose of methadone, a drug that in nearly all cases does not produce a high and makes a person unable to achieve a high from doing other stronger opiates for 24 hours after a single dose. Suboxone patients must go through the same process, which is maybe even more strange as most opiate users report that suboxone does not produce a high the way that other opiates do. Regardless of the reasoning, certainly, the camera that records the patient who must give a urine sample is not there for the patient’s comfort and wellbeing. I would struggle to find a better example of non-patient centered care in the health care field, but I will still try to find one. Right now, normal family physicians cannot prescribe methadone or suboxone for substance use disorder. Therefore, not only are the large facilities designed to provide medication-assisted treatment not ascribing to the patient-centered care approach, but family physicians are not able to fill in the gaps and treat substance use disorder with the best-known medications available to them. Opiate use disorder, a disease that has become an epidemic in the United States and is killing tens of thousands of Americans, is not allowed to be fought by the doctors that people go-to for all other medical needs. This puts more money in the hands of corporations that own methadone facilities, sending more patients to over-crowded facilities where they will wait in line for hours every day to get a single dose of their medication. Of course, that is only after they have given a urine sample on camera, for whatever purpose that might serve.
I often talk about some of the best facilities, the best drug rehabs in Florida or Alabama, but only very lucky people will find an open space at a great facility. There is a roadmap for treatment providers to improve on their own approaches and center their own methods around individual patients. I found a research survey that intends to improve the best practices in substance use disorder treatment, and make patient-centered care I priority around the industry. Here is a quote from that study,
“Shared decision-making was identified in 36% of references and was primarily defined by client and provider strategies of negotiation in the treatment planning process. Individualized care was described by 30% of references and included individualized assessment and treatment delivery efforts. Holistic care was identified in 23% of references; it included an integrated delivery of substance use, health, and psychosocial services via comprehensive care settings or coordination.”
Shared decision making, individualized care, and a holistic approach were the 3 main things that people believe need improvement in substance abuse treatment. The problems I have mentioned in the methadone and suboxone industry would fall under individualized care. The facilities also tend to stray from holistic methods, as often-times the medication is paramount, but at some facilities counseling and mental health services can fall by the wayside. I know from talking to experts that the best drug rehabs in Florida, Alabama, and Indiana already use many of these approaches of patient-centered care. We need all popular substance abuse treatment providers to follow suit and define their own goals for a more patient-centered approach.
By T.A. Cannon (Contact me at TACannonWriting@gmail.com)
MARCHAND, K. et al. Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Substance abuse treatment, prevention, and policy, [s. l.], v. 14, n. 1, p. 37, 2019. DOI 10.1186/s13011-019-0227-0. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=31511016&authtype=geo&geocustid=s8475741&site=ehost-live&scope=site. Acesso em: 8 out. 2020.