Gazette on minimum standards for deaddiction centers in Tamil Nadu: A critical appraisal

Abstract

The Government of Tamil Nadu gazette the Minimum Standards of Care for Deaddiction Centres 2025, marking the significant step in regulating addiction treatment centers in the State. Issued under the Mental Healthcare Act (MHCA) 2017, this notification establishes a comprehensive framework addressing registration, admission procedures, types of treatment, infrastructure, and patient rights. The regulations emphasize the role of psychiatrists in decision-making, differentiate detoxification from rehabilitation, and mandate medical oversight in treatment facilities. They also introduce safeguards against human rights violations and prescribe minimum standards for staffing, documentation, and infrastructure. However, the provision to admit patients with severe dependence (leading to capacity impairment) with harm to self (due to excessive use), as a supported admission (under Section 89 of MHCA), remains contentious and liable to potential misuse. This is because persistent impairment of capacity, seen in severe mental illnesses such as schizophrenia, is not typically seen in patients with substance use disorders. The need for staff training and mechanisms to monitor outcomes and compliance is also not explicitly mentioned. In summary, these regulations provide a much-needed framework for the regulation of addiction treatment centers. The presence of periodic reviews, structured training programs, and robust oversight mechanisms would be critical for its appropriate implementation. This initiative also sets a precedent for other states to follow suit and optimize addiction treatment services across India.

BACKGROUND

The Government of Tamil Nadu on March 12, 2025 gazetted the Minimum Standards of Care for Deaddiction Centres, introducing a regulatory framework for addiction treatment centers.[1] Issued under Section 123 of the Mental Healthcare Act (MHCA) 2017, this notification represents a significant step toward improving the quality and accountability of de-addiction centers.[2] While it establishes essential benchmarks, certain implementation challenges and alignment issues with existing frameworks persist.

STRENGTHS OF THE GAZETTE NOTIFICATION

The 68-point framework introduced by the Tamil Nadu Government provides a comprehensive and structured approach to regulating de-addiction centers. It addresses key components, such as registration, admission procedures, treatment protocols, infrastructure, human resources, and patient rights. Several aspects stand out as particularly progressive and potentially transformative.

Standardization of registration and admission procedures

All deaddiction centers must now register with the State Mental Health Authority (SMHA) under Section 65 of the MHCA 2017. This will reduce the existence of illegal deaddiction centers with the lack of required space, essential services, and required personnel.[3]

The central role of a psychiatrist in determining the need for inpatient (IP) or outpatient (OPD) care is a welcome move that ensures clinical oversight and appropriateness of treatment settings. Informed consent is mandated for all admissions. It also states that for individuals with severe substance dependence, supported admission under Section 89 of the MHCA may be permitted. This creates an opportunity for informed clinical decision-making by treating psychiatrists and enables families to support admissions in cases of severe dependence. However, it also carries a potential risk of misuse, which we address later in the paper.[4]

Clear differentiation between detoxification and rehabilitation

The notification makes an important distinction between detoxification, which is focused on managing acute withdrawal symptoms, and rehabilitation, which emphasizes psychosocial interventions for sustained recovery. This clarity is crucial in the Indian context, where many centers have historically offered vague or overlapping services, often lacking structured medical detoxification protocols. Furthermore, general hospitals registered under the Clinical Establishments Act can now offer detoxification services, provided a psychiatrist supervises treatment. This highlights the growing need for general hospitals to manage acute withdrawal symptoms and medical emergencies related to substance use in consultation with psychiatrists.

Infrastructure, human resources, and documentation requirements

The regulations also mandate a detailed inventory of essential equipment and human resources, ensuring a basic uniform standard of care across all approved facilities. Minimum standards for infrastructure, including adequate space, ventilation, sanitation, and CCTV monitoring, are clearly specified. These ensure both safety and dignity in patient care environments. Rehabilitation centers must have weekly visits by a psychiatrist and daily medical rounds by an MBBS doctor, strengthening medical oversight and continuity of care. Standardized documentation practices have been mandated, with patient records to be maintained for at least 5 years. This not only promotes transparency, but also facilitates clinical audits and accountability. The regulations also address a long-standing gap in human resources by introducing minimum qualification requirements for counselors, helping to mitigate the chronic shortage of trained addiction professionals in India.

Treatment of women with substance use disorders

The number of women seeking treatment for substance use disorders has been steadily increasing. Despite this trend, most treatment centers lack dedicated facilities or wards for women. It is commendable that the document highlights the importance of allowing female attendants to stay with female patients, as well as the need for separate accommodation. Research has shown that gender-specific treatment environments can reduce stigma and significantly improve treatment retention and outcomes.[5,6]

Safeguarding human rights in deaddiction centers

In line with MHCA 2017, the regulations explicitly prohibit physical, mental, and sexual abuse, emphasizing patient dignity and humane care.[7] Patients must be informed of their rights at admission, with this information prominently displayed within the facility. Procedures involving restraint are subject to checks and balances, including documentation and mandatory notification to family members within 24 hours, an essential step toward safeguarding patient autonomy and legal rights.[8]

CHALLENGES AND AREAS FOR IMPROVEMENT

While the gazette notification introduces much-needed regulation, some implementation challenges and policy gaps remain.

Supported admissions in severely dependent patients

The document describes supported admission in cases where there is severe dependence with lost capacity to make decisions, and substance use is excessive and causing harm to oneself. This provision is contentious and is liable to potential misuse, because persistent impairment of capacity seen in severe mental illnesses such as schizophrenia is not typically seen in patients with substance use disorders. Severe withdrawal (like delirium tremens) is one situation in that impaired capacity may be present temporarily, but gets restored in a short span once the condition resolves. Therefore, it is important to assess the capacity to consent regularly in non-consenting severely dependent patients to prevent misuse of the provision.[4,7,9] Further, regular oversight of the use of this provision by the Mental Health Review Boards (MHRBs) is essential to ensure consistency in implementation.[10]

Admission of adolescents

The gazette does not explicitly address treatment provisions for adolescents. While most individuals initiate drug use during adolescence, the onset of dependence typically occurs later in life. However, a small proportion of adolescents do seek treatment, often brought in by concerned family members.

Need for training and accreditation programs

While the document outlines the minimum staffing requirements, it does not mention the need for registration or licensing of qualified professionals (social workers and psychologists) with bodies such as the Rehabilitation Council of India. Similarly, the importance of training staff in addiction care is not addressed. Given that many graduate academic programs (including MBBS) offer limited exposure to the management of substance use disorders, periodic and structured training, ideally conducted through accredited programs supported by government or academic institutions, can help ensure ethical, evidence-based, and effective care.[11] A standardized content applicable to medical and non-medical staff, if made available, would further enhance the consistency and quality of care delivery.[12]

Defining accountability and oversight mechanisms

The notification does not specify the authority responsible for ongoing monitoring and enforcement of the prescribed standards. A system for regular audits, inspections, and compliance checks is necessary to prevent deviations from the regulations. Publicly available compliance reports promote institutional accountability and build trust among patients and families.

INTERSECTIONS WITH EXISTING FRAMEWORKS

Existing supported treatment facilities

In Tamil Nadu alone, over 23 Integrated Rehabilitation Centers for Addicts (IRCAs) and one Addiction Treatment Facility (ATF) operate with support from the Ministry of Social Justice and Empowerment (MoSJE).[13] While the 2009 IRCA guidelines primarily focus on the nature of interventions provided, the new state-level regulations emphasize infrastructure and procedural requirements. Although the MoSJE is a funding agency and not a licensing authority, the centers it supports may face overlapping expectations regarding compliance with both the IRCA guidelines and the state’s regulatory framework. This underscores the need for clear and unified policy directives applicable to all facilities providing treatment for substance use disorders.[14] The issue is not limited to Tamil Nadu but is relevant across India in the context of formulating state-specific regulations. Furthermore, the state regulations should explicitly state that they apply to all treatment centers, regardless of funding source.

Overlap with the clinical establishments act

The Clinical Establishments Act also outlines minimum standards for deaddiction centers.[15] Although these standards are similar in intent to the new Tamil Nadu regulations, discrepancies exist in certain areas. The overlapping jurisdiction and applicability across different types of establishments create ambiguity, underscoring the need for clearer regulatory harmonization.

Variability in state regulations and the need for a national policy framework

State-level regulations governing de-addiction centers vary considerably across India. Before the implementation of the MHCA, 2017, states were empowered under the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985, to formulate and notify rules to regulate de-addiction services. Punjab and Haryana were the only states, who utilized this provision. The regulations from Punjab had a strong focus on opioid dependence and opioid agonist maintenance treatment, reflecting its specific epidemiological context.[16,17] Other states did not issue such regulations under the NDPS Act, resulting in a lack of formal oversight for de-addiction centers until more recently.

While a detailed comparison is beyond the scope of this article, some key differences in state-level frameworks are worth noting. For instance, Punjab’s regulations include provisions for the use of controlled medications such as buprenorphine, whereas Tamil Nadu’s recent regulations do not reference the NDPS Act or explicitly address the use of such medications. These variations likely reflect differences in local substance use patterns as well as the legislative context in that each state’s regulations were developed.

Following the enactment of the MHCA, states such as Delhi (2018) and Himachal Pradesh (2022) have taken a lead and issued regulations and minimum standards for addiction treatment centers.[18,19] The Delhi regulations recognize short-term treatment including detoxification centers (<1-month treatment duration), long-term treatment/rehabilitation centers (>1-month treatment duration) and treatment centers for SUDs and comorbid psychiatric disorders (i.e., dual diagnosis facilities). However, the Tamil Nadu regulations go one step further and explicitly define the types of facilities that can provide short term acute care, offer a clear direction that long term rehabilitation centers should not attempt to provide acute care and emphasize the key role of the psychiatrist in determining the locus and intensity of care.

At the national level, standards exist for government-funded de-addiction centers under specific schemes, but no uniform regulatory framework applies to private or NGO-run facilities. Given the federal structure of health governance in India, states are empowered to develop their own regulations. Therefore, following the examples of Tamil Nadu, Delhi, and Himachal Pradesh, all states should be encouraged to frame context-specific standards under the MHCA. In parallel, a national policy framework, aligned with the MHCA and specific to addiction treatment, could serve as a guiding reference, offering minimum benchmarks, promoting equity, and supporting evidence-based practices across the country. Rather than limiting state autonomy, such a framework would enhance it by providing structured guidance for consistent quality assurance.

International standards

In 2020, the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO) released the International Standards for the Treatment of Drug Use Disorders to help Member States expand ethical, evidence-based, and effective treatment services.[20] These standards emphasize accessible, coordinated, and person-centered care that is scientifically informed, ethically sound, and responsive to diverse population needs, with a focus on strong clinical governance and integrated service delivery. To an extent, the gazette aligns in achieving these standards, addressing key aspects like ethical care, evidence-based treatment, and clinical governance. While it establishes a robust regulatory framework within treatment centers, broader systemic linkages and tailored approaches for diverse populations need further development.

CONCLUSION

The Tamil Nadu government’s initiative represents a significant advancement in the regulation of addiction treatment centers, addressing long-standing gaps in infrastructure, medical oversight, and patient rights. However, regular training, and well-defined monitoring mechanisms are critical to ensuring these standards translate into meaningful improvements in patient care. Further, a documentation of the process undertaken to formulate these regulations may serve as a guide for other states looking to implement similar provisions. To conclude, with rigorous implementation and continuous improvement with feedback from different stakeholders, these regulations have the potential to significantly enhance the quality of deaddiction centers, setting a national precedent for reforms in addiction care.

FUTURE DIRECTIONS

• Periodic reviews and stakeholder Consultations: State governments should conduct periodic reviews and engage stakeholders, including addiction specialists, healthcare administrators, and civil society, to assess the impact of these regulations.

• Strengthening Accreditation and Monitoring: Establishing an independent body to oversee accreditation, monitoring, and enforcement would improve compliance and quality assurance.

• Enhancing Training Frameworks: Developing structured training programs for medical and non-medical personnel would enhance service delivery.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.