Quality improvement for methadone maintenance treatment.

Negative community attitudes toward heroin addicts and toward methadone treatment are the major obstacles to providing good treatment. Negative attitudes find expression in inappropriate and constricting regulation of treatment, and in inadequate resources to support programs. They contribute to the ambivalence of patients in treatment. They find expression in a variety of staff behaviors in anxiety and defensiveness about treatment, in staff ambivalence about the value of methadone, and in extreme cases, in cynical and suboptimal treatment practices. These issues are not merely theoretical barriers to quality, but have contributed to serious problems in the quality and effectiveness of treatment. Neither regulations, nor wise prescriptions as to how treatment should be delivered, is an adequate response to these problems. A systematic approach to dealing with these issues is highly desirable. External, peer-based quality improvement provides an appropriate form of accountability, while enhancing the sense of professionalism of clinical staff. Although conventional approaches to quality assurance do not ensure the delivery of good care, benchmarking approaches based on monitoring outcomes can be used to review and improve treatment.