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Recommendation 3c: Public and private payors and regulators should curtail provision of addiction-focused health care services that have significant potential for harm.

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      One of the tragedies of the opioid epidemic is that even though treatment funding is in short supply, it is sometimes expended on approaches that likely make patients worse off.  This includes treatment programs that actively discourage patients from using approved medications or offer bogus medications (e.g., cannabis as a cure for heroin addiction). It also includes detoxification-only services with no follow-up, which may actually increase harm by lowering tolerance and thereby increasing overdose risk. Disappointingly, treatment programs accredited by external auditors are as likely to offer ineffective services as those accredited.  

     The most potent route to curtailing harmful services is to stop purchasing them. The Commission recommends that government insurance programs like Medicare and Medicaid, treatment block grants, and drug court funding no longer reimburse such services, and encourage private insurers to follow the same course. It also recommends that public and private accreditation bodies prioritize elimination of services that have significant potential for harming patients.