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State tightens addiction center rules

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Massachusetts public health officials are imposing new standards on people who work with recovering addicts, reining in programs that have operated under the radar — and sometimes caused problems in their communities.

Under regulations approved Wednesday, the state's licensing authority over substance abuse treatment programs is being extended to doctor practices that treat more than 300 patients with medications to control addicts' cravings.

And "sober homes," group housing that promises an alcohol- and drug-free environment for those in recovery, will be invited to obtain certification from independent agencies showing they have met certain standards. Certification is voluntary, but the regulations require state-funded treatment facilities to refer patients only to certified sober homes.


The Department of Public Health's regulations — which were approved Wednesday by the Public Health Council, an appointed board of physicians, academics, and consumer advocates — stem from a 2014 law intended to increase access to substance abuse treatment. Last year, more than 1,200 deaths in Massachusetts were linked to opioids.

The certification program for sober homes aims to address an especially thorny problem. Federal housing regulations preclude the state from licensing or otherwise regulating what is essentially a group housing arrangement among people with a shared concern.

But the homes sometimes exploit people who recently left treatment and need a place to live, collecting rent but doing little to support them, according to Richard Winant, president of the Massachusetts Association for Sober Housing.

"You're talking about a vulnerable population, men and women who are just looking for a safe, supportive, sober environment," Winant said. "Many times they're not getting that."

For example, last year, a Brookline doctor was jailed and fined $9.3 million for a scheme in which he bribed sober house owners to funnel their residents' urine tests to his laboratories and to do the tests, intended to monitor sobriety, more often than recommended.


Winant said the association started in 2007 in an effort to set standards and improve conditions. But only 14 of the estimated 300 to 400 sober homes in Massachusetts agreed to adopt the association's code of ethics and quality standards.

That could change with the state's program. The Department of Public Health has contracted with the National Alliance for Recovery Residences to provide training to two organizations that will handle the certification process.

Those groups will use standards set by the National Alliance for Recovery Residences, which include a code of ethics, requirements for the physical layout of the home, supports for people in recovery, financial and documentation rules, and grievance procedures, said Cheryl Kennedy-Perez, manager of housing and homeless services at the Health Department.

Kennedy-Perez said sober houses in Dorchester and Lynn are expected to be the first to receive certification, by the end of January.

Winant said he is pleased the state has adopted the certification program, but cautioned, "We don't know how it's going to be received, and how many sober houses are going to respond." There is also concern the new process will reduce the number of sober houses.

But Dave Sheridan, president of the National Alliance for Recovery Residences, called it "really, really exciting. The best thing we can do is exactly what Massachusetts is doing right now. . . . This is going to bring recovery services to people who've never had access to them before."


The regulations adopted Wednesday also address a different aspect of addiction care: large outpatient practices that offer treatment involving medication. These physician practices must now meet licensing standards that include measures to prevent overdoses, coordination among patients' health-care professionals, and support services for relatives. They must check the patients' urine samples to make sure they are taking the prescribed drugs rather than selling them.

The licensing requirement emerged from legislators' concerns about medical practices that were providing large numbers of patients with buprenorphine, best known as Suboxone, which controls addicts' cravings and enables them to stay off opioids.

In some cases, said state Senator Benjamin B. Downing, a Pittsfield Democrat who sponsored the legislation, "Patients were paying in cash. They didn't have the follow-up or wraparound services that we know are so important.''

Vic DiGravio, president of the Association for Behavioral Healthcare, whose members are already licensed, said his group supports the move to require certain physician practices to be licensed, too. "We're concerned that high levels of diversion create a backlash against treatment providers prescribing Suboxone responsibly," he said.

Dr. Amanda Wilson, president of CleanSlate Centers, a chain of physician practices that offer outpatient medication-assisted treatment, welcomed the opportunity to get licensed.

"I think it's perfectly reasonable," she said of the regulations, adding that CleanSlate already meets 98 percent of the requirements.

Erica Piedade, director of quality assurance and licensing at the state Bureau of Substance Abuse Services, did not know how many doctor practices would need licenses, but estimated it was fewer than 10.


Felice J. Freyer can be reached at felice.freyer@globe.com.