Medication-assisted therapy (MAT) is an effective treatment option based on the medical model. As a result, those who practice MAT abide by a code of ethics. These ethics are important safeguards ensuring practitioners provide the appropriate services for each patient. Before you enter a medication-assisted treatment plan, you must ensure the facility follows the ethics of MAT. The following article outlines the clear ethics of medication-assisted therapy.
What are the Ethics of MAT?
In order to outline the ethics of MAT, SAMHSA offers four distinct principles that guide medication-assisted therapy:
The principle of beneficence emphasizes that providers should act for the benefit of patients by providing competent and timely care within the bounds of accepted treatment practice. This principle is satisfied when treatment providers make proper diagnoses and offer treatments that are evidence-based and backed by extensive research. Beneficence is put into jeopardy when providers make questionable diagnoses.
Autonomy actively promotes the patients’ best interests. It emphasizes respect for patients’ rights to decide what is in their best interests regarding treatment. The ethics of MAT places great value on patient autonomy. Usually, patients’ and physicians’ goals for treatment are identical. However, physicians generally allow patients the right to make their own choices if those goals differ. An exception with the practice of autonomy is when a patients’ decisions might endanger themselves or others.
The principle of nonmalfeasance states that providers should not cause harm or injure those under their care. This is crucial in MAT programs. Patients in MAT programs have chronic substance abuse issues. Once enrolled in a MAT program, patients take medications in a regulated setting. These programs carry great risk MAT carries risks of its own, including an increased risk of death if medication dosages are not adjusted in accordance with a patient’s condition. Providers need care programs that safeguard patients’ physical and mental well-being.
The final principle is that guides ethics in MAT is justice. This principle emphasizes that treatment providers need to act with fairness towards their patients. Additionally, the principle of justice imposes a responsibility to proactively advocate for resources to meet the needs of patients in MAT. This includes better treatment options by other providers.
Obstacles for Acting Ethically in Medication Assisted Therapy Programs
While the ethics of MAT programs are solid, there are instances were conflicts arise. One example is when a provider and a patient disagree regarding the course and progress of treatment. This is a result of a lack of balance between the patient’s right to choose the best treatment and a provider’s responsibility for the patient’s well-being. Additionally, there is disagreement whether the patient or provider has the final say regarding a specific treatment.
Conflicts regarding ethics in MAT also arise when the provider is uneasy with the disease model of addiction. The American Society of Addiction Medicine (ASAM) provides the following definition:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
There are providers who may draw on previous experiences caring for patients with other chronic conditions. An example of this philosophy is dealing with non-compliant patients who fail to regulate their condition through lifestyle changes. In MAT programs, immediate abstinence is an ideal but unrealistic goal. Instead, MAT programs focus on the gradual diminishing use of opioids towards abstinence.
Other Factors That Diminish Ethics In MAT
Additionally, there are other factors that jeopardize ethics in medication-assisted treatment programs. SAMHSA outlines these concerns in their guide for medication-assisted treatment for opioid addiction in opioid treatment programs:
The decision of a treatment facility to discharge a patient against his or her wishes calls into question all four ethical principles of MAT. Involuntary discharge appears to breach the practitioner’s commitment to put the patient’s health first. Additionally, involuntary discharge also seems to breach the ethics of doing no harm, and respect patients’ wishes, as well as to avoid harm to the community from reintroducing people back into the community who haven’t been fully treated regarding their addiction. However, practitioners often must balance the interests of those in treatment facing discharge with those of other patients, staff, future patients, and community at large.
Threats to Safety
When patients commit or threaten violence against another patient or staff, come to treatment armed with a weapon, or deals drugs they pose a threat to the safety of staff and patients. Although not in the patient’s best interest, the program has an ethical responsibility to patients, staff and the community. Those who run MAT programs may need to make difficult judgments about what constitutes threatening behaviors. Ultimately, the program as the primary responsibility of providing great treatment.
Failure to Pay
Of the factors that make up the ethics of MAT, the failure of patients to pay for services can be the most difficult. For those who are discharged for lack of funding, they may have been responding well to treatment and well on the road to recovery. while involuntary discharge for failure to pay appears to violate the core ethics of medication-assisted therapy programs, programs must operate under realistic fiscal parameters. If important services are uncompensated, they may face financial hardship which would jeopardize treatment for all patients.
It is important for programs dealing with patients that are unable to pay to operate under the principle of nonmalfeasance. To uphold the ethics of MAT, treatment programs should find every option to provide treatment regardless of an inability to pay. Examples include working out alternative payment schedules, assisting with access to insurance,securing different funding sources, or finding quality facilities that offer treatment at a reduced rate.
The Ethics of MAT Cannot Be Underestimated
Medication assisted treatment is an important tool to combat drug addiction. While these programs are important, you must choose wisely. MAT programs must operate with high ethical standards. Additionally, treatment programs must be proven to work and created through extensive research. If you considering medication assisted therapy, you need the best information to make the best informed decisions.
Medically Assisted Treatment has helped countless individuals find the best treatment options that fit their unique needs. Our experienced professionals will provide you the knowledge and support you need to find lifelong recovery. We work with the best MAT programs nationwide, and we will work with you every step of the way so you can find the help you need.
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