Similarly, the nearly ubiquitous requirement that licensed residential treatment facilities be accredited by a private accreditation body may give the impression that all is well. Approximately half of the states require this for state licensure, and it is also required by Medicaid, most private insurers and for SAMHSA grantees.

It may be reassuring that one of the accreditation standards by The Joint Commission (TJC) is “Evidence‑based treatment approaches including access to medication for OUD …”  Yet, most accredited facilities do not allow the use of maintenance MOUD. The failure of accreditation is related to the fact that the big two accreditation bodies each have over a thousand standards or components of standards, updated annually or twice a year.  It is probably impossible for providers to be aware of, let alone comply with this volume. The health policy literature has also critiqued the practice of outsourcing regulation to private entities that operate as paid vendors  that compete for market share, hired by the entities they oversee. There is a well-known focus on written policies over  actual practices. If a deficiency is recognized, the remedy is typically a requirement to update policies to show how the program intends to fix the problem in the future, a paperwork exercise. 

In a secret shopper study of a national sample of 368 residential treatment programs, over a third of accredited programs used clearly inappropriate admission procedures over-the-phone without an evaluation, while over half used inappropriate recruitment techniques, both at higher rates than non-accredited programs. (Beetham T, et al. 2021, below)

In a secret shopper study of a national sample of 368 residential treatment programs, over a third of accredited programs used clearly inappropriate admission procedures over-the-phone without an evaluation, while over half used inappropriate recruitment techniques, both at higher rates than non-accredited programs. (Beetham T, et al. 2021, below)

In a secret shopper study of a national sample of 368 residential treatment programs, over a third of accredited programs used clearly inappropriate admission procedures over-the-phone without an evaluation, while over half used inappropriate recruitment techniques, both at higher rates than non-accredited programs. (Beetham T, et al. 2021, below)

The wide variation between states in MOUD access is striking. The percentage of *accredited* addiction treatment facilities providing medications for opioid use disorder ranged from 15 percent (Colorado, N. Dakota) to 89 percent (Alaska, Wyoming). Half or fewer offered MOUD (Tami L, 2020, below). This is one factor that points to state regulations of licensed facilities as being perhaps the most likely path to enforcement of MOUD access, along with education and support of providers. However, not all state regulations are effective, as described by Beetham T., et al. 2021, below).