Access to methadone is essential to curbing opioid overdoses

Access to methadone is essential to curbing opioid overdoses

As of 2021, more than 100,000 people in the United States have died from drug overdoses each year. Methadone is a proven way to treat opioid use disorder (OUD) and prevent overdose deaths. Research shows that the medication is highly effective at reducing opioid cravings and withdrawal symptoms and improving retention in drug treatment programs. However, methadone also remains highly regulated and can be difficult to access, especially for people who live in rural areas or rely on public transportation to get to treatment providers.

In many places, federal and state rules regarding methadone create barriers to accessing care. In February 2024, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) updated federal rules governing opioid treatment programs (OTPs), currently the only sites that can provide methadone for the treatment of substance use disorder. These changes aim to make methadone treatment more flexible by allowing for increased use of telehealth and reducing restrictions on take-home doses, the practice of allowing patients to take doses of methadone home rather than requiring that each dose be observed at the OTP. Despite these changes, policy barriers to accessing methadone treatment still exist.

In September 2023, a national conference, Freeing Methadone: Building a Roadmap and Community for Change, proposed reforms to create a methadone treatment system that takes a holistic, person-centered approach. More than 800 people, including people with lived and living expertise (people who have been or are currently on methadone treatment), health care providers, researchers, and others attended the conference, which was followed by smaller workshops. This event produced a report with the following recommendations for state and federal policy makers, clinic leaders, and researchers on how to (1) center lived and living expertise in methadone treatment in decision-making, (2) normalize methadone treatment as health care, (3) increase patient empowerment, communication, and decision-making in methadone treatment (patient-centered care), (4) improve methadone treatment practices, (5) create alternatives to the structure of methadone treatment, and (6) shift public thinking about methadone treatment.

Recommendations

1. People with lived and living experience of methadone treatment should be in decision-making positions. They should help shape methadone treatment policies and practices at all levels: the federal and state governments, as well as individual clinics, which can set their own policies and are sometimes more restrictive than the law requires. In addition, all entities should recruit, hire, and retain a more diverse workforce. By facilitating partnerships between academic institutions and community organizations, research funders, such as the National Institute on Drug Abuse, can prioritize the perspectives of people with lived and living experience.

2. To better standardize methadone treatment, OTPs and other health care facilities should train and support their staff to adopt person-centered care. The report’s recommendations define this as “treating patients as individuals and equal partners in recovery.” Outside of OTPs, medical and professional societies should educate and train providers on how to offer and support methadone in health care settings such as hospitals and nursing homes, which can currently distribute methadone in limited circumstances, such as to provide a limited amount of methadone to start a patient on treatment or to help a patient stay on methadone while in a nursing home. The federal government should support the development of provider training materials for OTP and other staff, in partnership with people with lived and real-world experience of methadone treatment.

3. All entities should individualize methadone treatment, framing care around patient-defined goals. These goals do not necessarily include abstinence or stopping methadone treatment, but rather reducing the risk of overdose and improving quality of life. The federal government should play a leading role in establishing a “patient bill of rights” and creating patient-centered outcome measures, such as improving quality of life. Providers and programs should redefine safety from currently focusing on preventing diversion (when a patient’s medication is given or sold to another person) to prioritizing evidence-based retention-of-care practices, such as providing take-home medications.

4. States should improve their single-use passport practices by reducing barriers and burdensome requirements. For example, they can allow longer-term take-home medications and more flexible office hours, expand telehealth, provide comprehensive care, and increase transparency about clinical rules and patient outcomes. States can encourage changes in clinical practices by developing oversight and funding structures to encourage person-centered care, such as take-home medications and office hours based on each client’s needs and desires.

5. The federal government should continue to support the creation of alternatives to the current opioid treatment system. States should then follow suit to ensure that all federally authorized alternatives are authorized at the state level. To support this transition, states and the federal government should provide new methadone providers and methadone pharmacies with training and technical assistance on how to provide this care.

6. All entities should seek to combat public misinformation and stigma regarding methadone treatment by targeting relevant groups. Specifically, anti-stigma campaigns and local discussions on specific topics should involve people of color and underserved rural communities. People working in the criminal justice system, particularly judges, should also be educated on the benefits of methadone treatment for people on probation and parole as well as incarcerated people.

Conclusion

Methadone is a proven treatment for people with substance use disorder (SUD), and policies governing its use should support access to this lifesaving care. By elevating the voices of people with lived and living experience, organizers and participants of the Liberating Methadone conference highlighted the importance of patient perspectives when developing policy recommendations.

Frances McGaffey works on Pew’s Drug Abuse Prevention and Treatment Initiative.