Programs designed to treat physicians’ substance use disorders have too little oversight and no clear standards, according to two experts from Harvard Medical School. They say the programs help a large majority of doctors to become abstinent and return to work, but they also have the potential for abuse.

“The physicians who are referred to these programs are often so compromised professionally by the time they get to them that, even if they feel that their treatment is not ethically sound, they’re often not in a position to voice them,” Dr. J. Wesley Boyd told The Boston Globe. He and Dr. John R. Knight published a review of the programs this month in the Journal of Addiction Medicine.

The programs may be prone to conflicts of interest, the Harvard doctors note. Physician treatment programs often refer patients for evaluation to specialty centers that pay for conferences for the field. The specialty centers, which rely on state referrals for funding, may tend to recommend treatment, which often lasts 90 days, much longer than inpatient programs for the general population.

Boyd and Knight call for addiction medicine groups to start talking about establishing standards for such programs. They also recommend the creation of a national licensing program.