Responsibly expanding access to methadone for people with opioid use disorder will save lives

The overdose epidemic continues to ravage communities across the country. In Washington state, where I live and work, more than 2,000 people died from a drug overdoses in 2021; country-wide, the death toll was more than 107,000.

Each loss of life is a preventable tragedy, as well as a missed opportunity for the U.S. health care system to treat addiction and save lives. But many barriers exist that prevent people with opioid use disorder from accessing care they need.

A case in point: Physicians who specialize in addiction treatment and who care for people with opioid use disorder in settings outside of institutional opioid treatment programs are hamstrung by unscientific federal regulations that prohibit them from prescribing methadone for treating opioid use disorder. That’s ironic, because any licensed doctor, physician assistant, or nurse practitioner can prescribe methadone as a treatment for chronic pain without such special restrictions.

These regulations, which restrict access to methadone, needlessly prevent many individuals with opioid use disorder from receiving this lifesaving medication. Most counties in the U.S., including those in my state, do not have an opioid treatment program, making access to methadone difficult, if not impossible, for many people with opioid use disorder. In addition, regulatory requirements governing opioid treatment programs, as well as their self-imposed practices, can be unnecessarily restrictive regarding the ability of patients to take home their medication or reduce the frequency of their counseling sessions. Some people must travel long distances to their opioid treatment program almost daily to receive their methadone medication, even when such close supervision is no longer clinically necessary.

Psychosocial treatment and interventions are important components of quality care that are beneficial to most people with opioid use disorder. But requiring everyone who takes methadone to engage in those services can have the unintended negative consequence of preventing them from receiving any care at all.

Such a closed system of highly regulated clinics is especially problematic for people who are unhoused or do not have access to transportation, as well as for those with jobs or family commitments that make it difficult to attend a clinic daily. Non-evidence-based restrictions on the medical use of methadone for opioid use disorder serve only to limit the medical community’s ability to treat people with it. Compounding the problem, 19 states, including Washington, impose barriers on opening new opioid treatment programs.

When the Covid-19 pandemic emerged, the federal government temporarily relaxed federal rules, making it easier for some people with opioid use disorder to receive methadone. More stable patients were eligible to take home a 28-day supply of methadone, subject to states’ limitations. Such temporary policies helped save lives and did not contribute to an increase in methadone-involved overdose deaths.

Given what’s known about the value of methadone for treating opioid use disorder, it’s time to do more.

Congress is considering legislation to begin untangling the web of federal regulations that largely restrict the use of methadone for treating opioid use disorder to opioid treatment programs. The bipartisan Opioid Treatment Access Act (S. 3629 and H.R. 6279) includes provisions that would allow specially registered opioid treatment program clinicians and physicians who specialize in addiction treatment to prescribe up to one-month supplies of methadone for their patients with opioid use disorder who meet rules governing take-home methadone use set by the federal Substance Abuse and Mental Health Services Administration. It would also enable patients to fill these prescriptions at their local pharmacies, further expanding access to methadone treatment.

The evidence shows that people with opioid use disorder who are engaged in addiction treatment with medications such as methadone are much less likely to die than those who are not being treated. Responsibly expanding access to methadone for individuals with opioid use disorder is a commonsense intervention that will help stem the tide of opioid-related overdose, which is now largely driven by widely available illicitly manufactured fentanyl. Such an expansion will bring methadone treatment to people with opioid use disorder who cannot be reached by opioid treatment programs.

As more addiction experts speak out publicly on the need for further deregulation of methadone in the U.S., Congress should take notice before the year ends. In the ongoing fight against opioid addiction, timely congressional action on the Opioid Treatment Access Act will help save even more lives.

Greg Rudolf is a physician specializing in addiction medicine at Swedish Pain Services — First Hill and president of the Washington Society of Addiction Medicine.

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