Unethical practices are increasingly disrupting the quality of substance use disorder (SUD) treatment in the U.S., putting individuals seeking recovery at heightened risk of relapse and mistreatment. While evidence-based SUD treatments exist, there are gaps in regulatory oversight that allow unethical actors to exploit the current system.
These unethical practices include patient brokering, deceptive marketing, and fraud. Patient brokering, for instance, involves third parties profiting from referring individuals to treatment facilities, while deceptive marketing misrepresents services to attract patients and their families. These unethical practices harm those seeking care, resulting in unsafe treatment environments, inadequate care, and, in some cases, overdose deaths.
Unethical actors have exploited the increased insurance coverage of SUD treatment provided by the Affordable Care Act. Although some states have taken steps to combat these unethical practices, there is limited evidence on the effectiveness of these efforts.
New Research
In the study, “State-level actions targeting unethical substance use disorder treatment practices: A qualitative study,” we examined state-level efforts to address unethical SUD treatment practices. We explored the types of actions taken, factors that facilitate successful interventions, and barriers that hinder effective policy implementation. The goal was to better understand the variety of state-level efforts (e.g., certification requirements for recovery homes and trainings to raise awareness and improve education around SUD) to address unethical practices in these settings in the U.S.
Methods
From June 2022 to February 2023, we conducted semi-structured interviews with 15 key informants from 11 organizations, including national and state-level advocacy groups and state agencies. We selected the informants for their expertise in SUD treatment, policy implementation, or regulation. We analyzed the data by identifying recurring themes across interviews. This method helped identify patterns in responses related to the scope of unethical practices, the state actions taken to address them, and the context in which these actions were implemented.
Findings
Informants described several unethical practices in the SUD treatment field, such as patient brokering, deceptive marketing, overbilling and insurance fraud, and poor practices in recovery housing. These issues were often interrelated with both individuals and organizations working together to exploit vulnerable patients for profit.
Some states, such as Florida and Colorado, have made progress in addressing unethical practices by establishing task forces and enacting legislation; in total, twelve states have enacted laws targeting patient brokering or deceptive marketing. Informants viewed task forces or coordinating bodies with clear objectives to improve SUD treatment or prevent unethical practices as relatively effective. Legislation was seen as most effective when paired with more centralized efforts (e.g., national quality standards), strategic leadership, and a clearly designated agency responsible for regulation and enforcement. Informants also suggested stronger federal enforcement, since many unethical actors operate across state lines in the U.S., which limits the effectiveness of state-level responses.
Additionally, informants stressed the importance of adequate resources (i.e., funding and staffing) and highlighted how public awareness plays a key role in prompting action against unethical practices. While task forces and advocacy groups help raise awareness, they often lack the authority to enforce change without stronger regulatory support.
Conclusion
The siloed nature of SUD treatment from other medical services in the current health system has led to fragmented, inconsistent care and service gaps for patients with SUD. While laws targeting patient brokering and deceptive marketing may help deter unethical practices, the desired effect may be unlikely without adequate funding, clear regulatory authority, and the ability to coordinate across state lines. To address these challenges, states looking to implement new policies can learn from existing legislation but must also ensure they have the necessary tools and coordination to tackle this complex issue effectively.
