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Treatment leaders continue to examine gray areas around ethics

June 30, 2015
by Rebecca Flood
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In the last few weeks, I participated in the National Association of Addiction Treatment Providers (NAATP) Conference, hosted in mid-May in Carlsbad, Calif., followed shortly by the Recovery Plus/ Intervention Plus Conference, hosted in London, England. Both of these conferences covered the topic of the last blog we published (ethics) in different ways. For example, at the NAATP conference, ethics in the treatment field was discussed at two breakout sessions: “NAATP Ethics Update—'Into Action'” and “Internet Marketing and Ethics.” Both were led by Bobby Ferguson, Founder and CEO of Jaywalker Lodge, who is also a fellow NAATP board member and most recent past chair of the NAATP Ethics Committee. At the Recovery Plus/Intervention Plus Conference, I led a workshop specific to ethics in the profession of Intervention. All of the workshops were thought-provoking, intriguing, and, to some extent, leaving us with more questions than answers; but then again, isn’t that always the case when discussing ethics?

As humans, we tend to look at things as either black or white. However, the truth is that life happens in a gray area. From my perspective, we didn’t come up with cut and dried answers to the ethical concerns plaguing our profession. Some of these concerns include: dishonest Internet marketing, overbilling on urine drug screens and other questionable billing practices, how interventionists and call centers get paid for referrals and by whom—the list goes on. Yet, what I think we did accomplish is the creation of conversations in an open setting. People are expressing their thoughts, feelings and the facts so that professionals in our field can weigh in with clearer direction. In many ways, this allows us to understand varying viewpoints and complexities of business models. My hope is that someday we can have a fair and level playing field where we can decide professionally to agree to disagree. We will ultimately become clearer in determining where the “line in the sand” is on each of these varied issues.

We have identified several proverbial elephants in the room in the addiction treatment field. Once we begin to talk to the elephant in the room, positive change can occur.

As I mentioned earlier, one of the primary elephants in the room is the overall concern about urine drug screens, and that of the toxicology labs maybe overbilling insurance companies for both the collecting and analyzing of UAs. Some are doing more urinalysis than a physician would necessarily agree is best practice, and therefore doing more than are necessary based on the patient’s diagnosis. Is that illegal? Is it unethical?

In the discussions we had at the recent conferences, as well as in personal conversations with colleagues in the field, treatment providers mentioned that lab companies offer to send their own representative to their facility to do their screens. This means that the providers’ staff would be relieved of the workload of taking UAs. It is understandable how we could see this as almost miraculous when our overburdened staff are relieved of a daily task. However, they don’t realize that some lab companies are charging patients’ insurance $2,500 for a simple $150 screen. They don’t realize this because providers aren’t asking to see the Explanation of Benefits (EOB). Whose responsibility is it to teach people and providers that they are maybe doing something unknowingly wrong?

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Please get rid of that new sidebar with the social media links; I can't read the article properly. It's easily done too.

I come from the "other side" of the SUD treatment field - the public sector. Two things in the article concern me: 1) our cost for a drug test is $21 for a 5 panel test with creatinine confirmation. This includes staff collection and administration time. We run our own lab, do over 24,000 tests per year, and have no issue with accuracy/credibility. When we need to have a positive test confirmed, the cost of the initial test and the confirmation are still under $100. I get the profit margin issue, but forget $2500 for a test, but $150? That still sounds excessive. Secondly, NAATP Code of Ethics - I believe that each member agency should be required to create and submit their own agency code of professional conduct to be reviewed and approved by NAATP prior to being allowed to become a member. (I teach ethics for substance abuse counseling students at Utah Valley University)

The lead clinicians stubbornly refuse to change this life threatening protocol of chest compressions only for drug OD. Causing an increase in in morbidity and mortality as well as making the clinicians and everyone else victims.
Live human study chest compressions only for drug overdose.
My letter Emergency Medicine News Dec. 2015
http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

Beyond grey medical literature live human study in Ontario, chest compressions only for respiratory emergency Can. J. Public Health 2013;104(3):e200-4
'Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.' http://static.smallworldlabs.com/hsf/user_content/files/000/000/169/355cc02324a166bb8abf31174c141f69-cjph-20131043200-4.pdf

Was also published in the 2015 AHA & ILCOR CPR guidelines about this life threatening intervention.
Read all comments under this deputation Toronto Board of Health https://youtu.be/QhsDjmI9H9c

Best Wishes
@GaryCPR

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Rebecca Flood

Executive Director/CEO of New Directions for Women

Rebecca Flood

@NDFW

http://www.newdirectionsforwomen.org/

In more than 3 decades of experience in the health care industry, Becky Flood has demonstrated...