It would be hard to imagine a misery worse than the opioid crisis that claimed almost 5,500 lives in our state in 2017. But this week, Attorney General Josh Shapiro’s filing of criminal fraud charges against a shady rehab company’s cofounders and their associates is another rung down into the hell of addiction. A grand jury found that the Bucks County based “Liberation Way” drug treatment company was operating a scheme to ensure that patients relapsed and that insurers were overbilled. Instead of helping patients to recover, the company profited by operating as a revolving door of treatment, relapse, and back to treatment.

Liberation Way offered patients ineffective treatment, then referred them to poorly supervised recovery homes. In some of these homes, employees had sex with patients; another was known as “the party house” for the abundance of drugs available.

This galling example of a treatment center that maliciously took advantage of people in addiction is a signal to start asking about the standards and enforcement of regulations in the treatment industry.

Drug treatment is a $35 billion a year industry, and it has a lot of room to grow. According to the Substance Abuse and Mental Health Services Administration, 2.3 million people received drug treatment in 2015 — only 11 percent of people who needed it.

Pennsylvania has about 800 state-licensed drug treatment programs, according to the Department of Drug and Alcohol Programs (DDAP). Licensing requirements include staffing, privacy, and infrastructure criteria but they do not require specific types of treatment. For example, the use of medications such as methadone and buprenorphine to treat opioid-use disorder is considered the gold standard by the medical and scientific community. Compared to people in an abstinence program, those who get medications remain in treatment longer. The federal government, through SAMHSA grants, does not fund abstinence treatment. However, Pennsylvania does not require licensed centers to offer medications as an option for patients, although DDAP says it is pushing for more medication programs.

It would take a change in the law in Harrisburg to require that medications be available in all treatment programs.

The DDAP already has its hands full regulating and providing oversight over rehab centers. But there is a need for more scrutiny and regulation of recovery houses, which is where many people transition to from rehab. Because they are not considered treatment centers, recovery houses are not regulated by DDAP and can easily fall through the cracks.

The days after rehab are considered the riskiest time for an overdose death — relapse rates are high and because of the time since the last use, tolerance is low. That is why many people transition from rehab to recovery homes.

A 2017 law gives DDAP the authority to regulate recovery houses that receive state funding or referrals from state-licensed programs. The regulations will be released by the end of 2019.

It doesn’t take the malicious intent of Liberation Way or other bad actors to make treatment a revolving door to suffering. Holes in regulation and oversight can also create a cycle of misery. Fortunately, we know how to fill those holes.