The NYT recently published an article on allegations of ethics violations and fraud in Acadia Healthcare’s methadone clinics. It’s a big deal because Acadia is big, really big. “The for-profit chain of 165 methadone clinics — the country’s largest — has generated more than $1.3 billion in revenue since 2022.”
The allegations include not providing required services, exceeding caseload limits, falsifying records, and billing fraud.
The allegation I’m most concerned about relates to misdiagnosis and treating patients who don’t have an opioid use disorder (OUD).
Clinic directors can get bonuses when their patient enrollment goes up, an incentive that has led Acadia to treat people who do not have opioid addictions but are dependent on other drugs, according to current and former executives and employees. People who are not addicted to opioids can get high from methadone.
“I’m not proud of it, but our clinic has admitted patients who shouldn’t have qualified for treatment because we were under pressure,” said Jeannie Taylor, who was a counselor at an Acadia clinic in Oregon until she retired last year.
Employees at clinics in at least 13 states warned their supervisors about Acadia’s practices, according to the employees and complaints reviewed by The Times.
Acadia’s practices sometimes jeopardized patients’ safety. Clinic employees were discouraged from turning anyone away, even if the person did not meet the criteria for methadone treatment, according to current and former employees, including doctors, in 12 states.
To be eligible for treatment at a methadone clinic, people need to meet medical criteria for being addicted to opioids. Acadia sometimes accepted patients who did not meet that standard.
A former manager in West Virginia said her boss excoriated her last year after she turned away a patient who had tested negative for opioids and admitted to using only methamphetamine. The boss demanded to know why she had let a potential patient walk out the door, she said. Two other employees corroborated the manager’s account.
Thomas, K., & Silver-Greenberg, J. (2024, December 7). Acadia Healthcare’s Methadone Clinics Face Fraud Complaints. The New York Times. https://www.nytimes.com/2024/12/07/health/acadia-methadone-clinics-fraud.html
This made me reflect on historical criticism that treatment providers had improperly diagnosed patients with addiction and treated them at inappropriately high levels of care.
Harm from false positives can occur when transient increases in alcohol and drug use that do not meet diagnostic criteria for a substance use disorder are diagnosed as a substance use disorder, resulting in a stigmatized diagnosis, the cost and life disruption of unneeded treatment, and other potential consequences ranging from loss of driving privileges, lost custody of children, and hiring disqualification based on a prior history of addiction treatment. It is unclear, for example, how many adolescents involved in transient alcohol and other drug experimentation have been misdiagnosed as having a substance use disorder as a result of professional misjudgment or institutional (financial) exploitation of the adolescents’ families.
White, W.L. & Kleber, H.D. (2008). Preventing harm in the name of help: A guide for addiction professionals. Counselor, 9(6), 10-17
That patients are inappropriately diagnosed and placed on methadone maintenance, is of great concern. In the Counselor article quoted above, White and Kleber note the populations most vulnerable to this kind of mistreatment.
Members of historically disempowered groups are particularly vulnerable to iatrogenic injury, e.g., women, children, elderly, ethnic minorities, prisoners, and persons experiencing stigmatized conditions, e.g., mental illness, addiction. Iatrogenic injury most often comes to light when it is inflicted on a person/family of power and influence as occurred in the exposure of harm from Carbon Dioxide Therapy. Extra efforts must be made to protect the historically disempowered from such injury.
White, W.L. & Kleber, H.D. (2008). Preventing harm in the name of help: A guide for addiction professionals. Counselor, 9(6), 10-17
Of greater concern is Acadia obtaining contracts to provide methadone maintenance in correctional settings across the country.
It’s not just a matter of people being referred to care and being misdiagnosed. Correctional settings are full of bored people with high levels of fear and sadness. Opioids can have a lot of appeal for people in those circumstances. (Even Tylenol may reduce existential dread.) Combining this appeal with a captive patient population, a profit motive, and a provider with a history of deliberate misdiagnosis seems like a recipe for problems.
Recovery Review 