Methadone Access Reform Needed to Address the US Opioid Crisis

Over the past 5 decades, the opioid crisis has become more widespread. Methadone, which is a synthetic opioid agonist medication, has been proven to be clinically effective at treating opioid use disorder (OUD) for over 60 years. This medication may reduce the use of illegal drugs and improve patient’s health while they are in recovery. However, for the past 5 decades, regulations from the US government created a system so that methadone is only available at opioid treatment programs (OTPs), making it difficult for individuals with OUD to receive methadone if they do not have an OTP within an easily travelable distance daily. Only 5% of the 7.6 million diagnosed with OUD receive methadone treatment. This inaccessibility has led to increased stigma around OUD and worsening rates of overdose while other developed countries have operated successful and accessible systems for methadone treatment.

In 2023, the US Substance Abuse and Mental Health Services Administration (SAMSHA) created a new rule regarding methadone treatment. This rule loosened the restrictions on when patients can begin to take home doses of methadone. However, this change is not impactful enough to mitigate the number of overdoses or increase the accessibility for OTPs. The rule that only OTPs can prescribe methadone is one of the biggest barriers to methadone treatment. Many patients must either endure the hardship of going without methadone treatment or have to take the risk of getting methadone illegally, which is a greater risk if the patient is from a marginalized group.

Furthermore, a solution to reduce overdoses would be making methadone available from pharmacies and offices, not just OTPs. Doing so would reduce the amount of stigma around OUD. Other developed countries such as Australia, Canada, and the United Kingdom have already taken this approach. However, patients still need to be supervised due to the high risk of death if the patient is experiencing withdrawal at the start of methadone treatment.

These ideas are not new goals for the US government to implement into its health care systems. The Office of National Drug Control Policy recommended that methadone should be dispensed from pharmacies in 2022. The National Institute on Drug Abuse’s director, Dr Volkow, has also stated that patients should be able to get a methadone prescription from a physician. Studies show patients with fentanyl addictions demonstrate significant improvements when prescribed methadone as a part of recovery.

Loosening the restrictions on methadone access would also have a domino effect on how OUD patients are treated at other institutions such as hospitals, prisons, and nursing homes. However, this can only be accomplished through access reform. The barriers towards methadone treatment need to be lifted by not limiting patients to only getting treatment from an OTP. Patients should not have to suffer or struggle to access an OTP in their community with methadone treatment when there are easier ways to make the treatment more accessible.

Reference

Krawczyk N, Joudrey P, Simon R, et al. Recent modifications to U.S. methadone treatment system are a band-aid - not solution - to the nation’s broken opioid use disorder treatment system. Health Affairs Scholar. Published online June 20, 2023. doi:10.1093/haschl/qxad018