Abstract
<title>Abstract</title> <p> <italic> <bold>Background:</bold> </italic> <italic>Bangladesh's Private Level Rules 2021 regulate private drug rehabilitation facilities primarily through infrastructure and security requirements while providing limited guidance on clinical governance and safeguards for vulnerable populations. Whether this regulatory framework aligns with internationally accepted treatment standards has not been systematically examined.</italic> <italic> <bold>Objective:</bold> </italic> <italic>This study evaluates the extent to which the Private Level Rules 2021 conform to international standards for evidence-based addiction treatment and identifies regulatory gaps affecting women, adolescents, and older adults in private rehabilitation facilities.</italic> <italic> <bold>Methods:</bold> </italic> <italic>A qualitative normative policy analysis was conducted using a comparative legal audit framework. The Private Level Rules 2021 were systematically compared with the</italic> <italic> <bold>WHO/UNODC International Standards for the Treatment of Drug Use Disorders (2020)</bold> </italic> <italic>,</italic> <italic> <bold>SAMHSA clinical guidance (2021)</bold> </italic> <italic>, and</italic> <italic> <bold>India's Ministry of Social Justice and Empowerment (MSJE) standards (2019)</bold> </italic> <italic>. The analysis incorporated regulatory text decomposition, comparative matrix mapping, institutional capacity data, and preliminary field observations from regulatory officials, clinicians, rehabilitation personnel, and anonymous patients.</italic> <italic> <bold>Results:</bold> </italic> <italic>The analysis identified a pattern of</italic> <italic> <bold>regulatory blindness</bold> </italic> <italic>, whereby the framework extensively prescribes infrastructural compliance while omitting essential clinical governance provisions. Three major structural gaps were identified: (1) the</italic> <italic> <bold>Gender Gap</bold> </italic> <italic>, characterized by the absence of reproductive health protocols and trauma-informed care; (2) the</italic> <italic> <bold>Age Gap</bold> </italic> <italic>, reflected in the lack of child-specific safeguarding and developmentally appropriate treatment environments; and (3) the</italic> <italic> <bold>Geriatric Gap</bold> </italic> <italic>, demonstrated by the absence of geriatric assessment, polypharmacy management, and accessibility standards. Field observations further revealed inconsistent clinical staffing, inadequate safeguarding practices, and substantial variation in treatment quality across private rehabilitation centers.</italic> <italic> <bold>Conclusions:</bold> </italic> <italic>Bangladesh's current regulatory framework remains predominantly infrastructure-oriented and insufficiently addresses the clinical needs of vulnerable populations. Transitioning from a custodial regulatory model to a clinically governed, human rights–based framework requires the introduction of standardized treatment protocols, age- and gender-responsive care, workforce competency requirements, and integrated clinical oversight. Such reforms are essential to improve patient safety, treatment quality, and regulatory accountability within Bangladesh's private addiction treatment sector.</italic> </p>