Access to Methadone Is Critical to Curbing Opioid Overdoses

Editor's note: This article was updated on July 11, 2024, to clarify the subhead.

Since 2021, more than 100,000 people in the U.S. have died annually from drug overdoses. Methadone is a proven way to treat opioid use disorder (OUD) and prevent overdose deaths—research shows that this medication is highly effective in reducing opioid cravings and withdrawal symptoms and in improving retention in substance use treatment programs. However, methadone also remains tightly restricted and can be difficult to access, especially for people who live in rural areas or who rely on public transportation to travel to treatment providers.

In many places, the state and federal 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 treating OUD. These changes are intended to make methadone treatment more flexible by allowing for increased use of telehealth and lowering restrictions on take-home dosing—the practice of allowing patients to take doses of methadone home rather than requiring that every dose be observed at the OTP. Despite these changes, policy barriers to accessing methadone treatment still exist.

In September 2023, a national conference, Liberating Methadone: Building a Roadmap and Community for Change, proposed reforms to create a methadone treatment system that embraces a holistic, person-first approach. More than 800 people, including individuals with lived and living expertise (people who have experienced or are currently in methadone treatment), healthcare 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 policymakers, clinic leaders, and researchers on how to (1) center lived and living expertise of methadone treatment in decision-making, (2) normalize methadone treatment as healthcare, (3) increase patient empowerment, communication, and decision-making in methadone treatment (patient-centered care), (4) improve OTP practices, (5) create alternatives to the OTP structure, and (6) shift public thinking about methadone treatment.

Recommendations

1. People with lived and living expertise in receiving methadone treatment should be in decision-making positions. They should help set policies and practices for methadone care at all levels—federal and state government and 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 views of people with lived and living expertise.

2. To better normalize methadone treatment, OTPs and other healthcare settings should educate their staff and support them in embracing person-centered care. The report recommendations define this as “treating patients as individuals and equal partners in the business of healing.” Outside of OTPs, medical and professional societies should educate and train providers on offering and supporting methadone in health care settings like hospitals and nursing homes, which can currently dispense methadone in limited circumstances, such as providing a short supply to start treatment for a hospitalized patient or to help a patient continue methadone treatment during a nursing home stay. The federal government should support the development of provider training materials for OTP and non-OTP staff, in partnership with people with lived and living expertise of methadone treatment.

3. All entities should individualize methadone treatment, framing care around goals defined by the patient. These goals may not necessarily include abstinence or eventually terminating methadone treatment but instead be focused on reducing overdose risk and improving quality of life. The federal government should play a leading role by establishing a “patient’s bill of rights” and creating patient-centered outcome measures, such as improvement in quality of life. Providers and programs should redefine safety, which is currently focused on avoiding diversion—when a patient’s medication is given or sold to another person—to prioritize evidence-based care retention practices such as providing take-home medication.

4. States should improve their OTP practices by reducing burdensome barriers and requirements. For example, they can allow longer-term take-home medication and more flexible counseling schedules, expand telehealth, provide comprehensive care, and increase transparency around clinic rules and patient outcomes. States can encourage changes in clinical practices by developing oversight and financing structures to incentivize person-centered care, such as take-home medication and counseling schedules based on individual client needs and desires.

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

6. All entities should work to address public misinformation and stigma about methadone treatment by targeting impacted groups. Specifically, anti-stigma campaigns and local discussions on specific concerns should engage people of color and underserved rural communities. People working in the criminal legal system, especially judges, should also be trained on the benefits of methadone treatment for people on probation and parole as well as for those who are incarcerated.

Conclusion

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

Frances McGaffey works on Pew’s substance use prevention and treatment initiative.