Opioid use disorder, which claims 115 lives a day by overdose in the United States, is a complex, chronic medical condition, but one that can be successfully treated with proven medications. And yet, one of the oldest and most effective medications to treat this disorder — methadone — is out of reach for many people, largely due to outdated federal laws.

Of the three medications approved by the Food and Drug Administration to treat opioid use disorder, federal law relegates only methadone to be dispensed in separate clinics apart from the general health care system. It’s not unusual for methadone clinics to be in out-of-the-way locations and often inaccessible by public transportation, especially in rural and suburban communities. When individuals trying to break an addiction to opioids can’t get to a methadone clinic on a daily basis, they can’t get treatment.

The other two federally approved medications, buprenorphine and naltrexone, can be prescribed and administered in primary care settings, where treatment can take place as part of an overall clinical care plan.

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Methadone is typically taken daily in a highly structured setting, an approach that benefits many patients. But methadone should be treated no differently than other FDA-approved medications for opioid use disorder. As we write in the New England Journal of Medicine, it’s time for Congress to remove this barrier to treatment and allow methadone to be prescribed in primary care settings, as well as in existing standalone clinics.

Only about 20 percent of Americans who have an opioid use disorder are being treated with buprenorphine, naltrexone, or methadone, a woefully small percentage that shows the extent of the barriers to treatment that we need to remove to stop this public health crisis. Restricting the availability of methadone to designated clinics has contributed to this treatment gap.

Methadone has been available by prescription in primary care clinics in Canada since 1963, in Great Britain since 1968, and in Australia since 1970. In these places, methadone is the most commonly prescribed treatment for opioid use disorder, and it isn’t controversial because it has been shown to benefit the patient, the care team, and the community.

Methadone works. In a 2017 review of all causes of death among people with opioid use disorder, those receiving this medication were one-third less likely to have died during the study period than those not treated with methadone.

Methadone is a synthetic opioid that reduces cravings and withdrawal symptoms for heroin and other opioids. Developed in 1937 as a pain medication, it was first studied as a treatment for heroin addiction in New York City in the 1960s.

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By the 1970s, the system for delivering methadone that we know today had been fully developed. Patients visit a designated clinic, typically every day, take methadone under observation, and get specialized, highly structured care, including counseling and periodic drug tests.

The methadone clinic model was carved into law in the United States in 1974, when Congress passed the Narcotic Addiction Treatment Act. The regulations around methadone, driven by fears of accidental overdose and diversion, evolved in such a way that primary care physicians almost never delivered methadone treatment. Stigma and a not-in-my-backyard mentality resulted in the placement of a sizable number of methadone clinics in locations that were hard for many to reach.

The last time Congress expanded access to medication for opioid use disorder in primary care was when it passed the Drug Addiction Treatment Act of 2000. It allowed physicians to prescribe and administer buprenorphine in their offices, making this medication more available to thousands of patients. But the barriers to the delivery of methadone remain intact.

Methadone has saved many lives and could save many more. Several studies have shown that methadone treatment in a primary care setting is both feasible and successful. In rare cases, it has been allowed in primary care offices. Our experience in Boston over a 10-year period with a limited number of patients who received methadone treatment in a primary care setting after being stable in a methadone clinic was excellent, with no adverse incidents.

We call on Congress to allow methadone treatment to be delivered in primary care settings, as well as through special methadone clinics. That would be just the beginning. We also need to enhance physician training about opioid use disorder, create incentives for prescribing medications to treat it, and integrate treatment into existing models of care.

From the federal government down to community partners, we are all desperately searching for solutions to stem the opioid epidemic. Increasing the availability of medications that can effectively treat opioid use disorder — including methadone — will be essential if we are to succeed in saving lives.

Jeffrey Samet, M.D., is the chief of general internal medicine at Boston Medical Center and a professor of medicine at Boston University School of Medicine. Michael Botticelli is the executive director of the Grayken Center for Addiction at Boston Medical Center. Monica Bharel, M.D., is the commissioner of the Massachusetts Department of Public Health.

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  • Iv been in pain managent fr many years & im still in pain mangement & im on methadone but now my doctor lowered me dwn where its unbearable iv been looking for a new doctor to get methadone i dont drive so clinic is very hard fr me to commit to or id be there.They are million sub doctors around but im having a very hard time nj needs to change the laws.I have a life & have to get up n funtion everyday & im scared to death in 3days when in out of my methadone tablets im in need of a doctor asap im doin the right thing…..

  • i have been on every pain medicationfor twenty years. I got my life and self respect when my pcp suggested methadone for pain. i was prescribed 80 mgs day and never ran out or carried the pills with me again. some days i even forgot to take them. never with the short acting oxys. the cost was 83 $ a month full cost. my insurance would not pay unless i went back to oxys or morphine that cost upwards of 2 thousand per month. i said no and three months later i got 7 days worth and a good riddance from my pcp as his hands were tied. I wanted to die! im currently trying to get a specialist while having to go to a clinic everyday. i have gained 20lbs fallen asleep driving 3 times and no longer am physically active.
    thanks ignorant jerks.

  • Only had a chance to read 3 comments so far. Ive been in treatment over 12 yrs.now in the same clinic, been there Longer then counselors ( I’ve had many ) the director and most of The patient’s I pay $119 a week now.i have asked my Dr. to prescribe methadone for treatment /or back pain. There’s no way my family can move very far away from the clinic until things change and i can get a Dr.to prescribe it even if it was a 2 week scrip at a time,let alone cheaper.. Now i remember when big farma was giving Dr’s new BMW’s & vacations and other insentives for pushing oxytocin. Why don’t they do the same for methadone ? Or pay 50%- 75% of the cost for those of us lucky enough to be in treatment and not in the ground . the problem could be that half the folks talking over 150mg prolonged, are sleeping their day away or not working the program. ( I’ve had a kid on 240mg) And sleep 21-22 hrs a day, I have 2 adult kids one gets saboxone from a dr. there are many Good and bad things i can say about it but Dr’s should be able to prescribe it even if they put a ? 50mg or ?125mg cap on it.I’m sure this will get picked apart. It’s one view on this topic

  • I know that many of us that have gotten our lives together on methadone programs should at least be allowed to have this option. Maybe when we have been on a program and can prove the length of time with no illegal drugs could get a prescription from our primary doctors or our even the doctor at the OTP. I mean really, a lot of us have no reason to use since we have been able to stay clean on methadone. We should not be punished all our lives and be made to go through hoops with clinic rules based mostly on the beginning of ones recovery. Now the only time I hear about drugs or talk about them is at the methadone clinic. We are older now and having health problems to deal with too.

    • I have been stable for 10 years.I have been treated as a junkie and a liar by a so called counselor and I haven’t used in 10years…I am desperate to locate a compassionate and a person who has a love for humanity,I am in Ct.and can’t believe that the staff at this clinical setting 😁is allowed to abuse hippa etc.the rules are archaic …I ask if anyone in Ct has good clinic experience ?

  • I am pleased to say I am a methadone pt of 17 years and it has been a life saver for me.I got hurt on the job and began using opioids and before I knew it was addicted.My primary care DR .told me he didn’t know how to treat addiction but he told me about this drug called methadone,I would never trade my life now for mp previous life,however it really becomes tiresome getting looked at as a useless drug addict.I would love for my primary care dr could write methadone not would it be better but also cheaper .I really want DR ‘s to study the use of it and then the public .

  • I believe methadone should be prescribed by any doctor a doctor can treat cancer or any other disease why not addiction. It’s better to be prescribed methadone than to be out on the street using God knows what.

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