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and most effective medications to treat this disorder — methadone — is out of reach for many people, largely due to outdated federal laws.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.

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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  • The prejudice towards methadone treatment is wrong and entirely related to physicians not wanting to endanger their license. From personal experience methadone is allowing me to once again become a useful taxpaying member of society. These archaic attitudes have to be eliminated. J. C.

  • I want to know if there is primary physician that provides methadone pills…I cantt keep on going to the clinic to getting the dose because I have a job that I sure don’t wanna lose due to clinic that I have to go every day ….I’m always being late for work I can’t take it anymore I really need a primary physician that prescribes methadone….Please can u provide me with primary that will help me please…I was told that psychiatrist and pain management provide also with methadone…Thanks Nancy

  • I’ve been on Methadone in in the program for several years. It has allowed me to keep a job and a marriage of 16 years. I hate the stigma of Methadone. I’ve had to hide this from my job as I lost one job once they found out I was taking it, even though they told me I was a modal employee right before they found out. I currently get a month take home supply but before that it was extremely hard and risky going to clinic often. 1 if you had to be at work early like myself you were constantly rushing not to be late and 2 always worrying about running into someone else from work that would tell your boss. Its time to make it prescribable by family practitioners or others. There are many of us that don’t abuse it and many of us that need it. Why make something thatbsaves lives so hard to get or make it so unattractive. I would have get oxy so much sooner if it would have been more accessible and less restrictions. Its easier to get anything else then something that’s safer and legal to treat addiction. its backwards

  • I have been a addict for almost 25 years. I am 40 and have been on every type of help medication for opioids /heroin, and the only one that has actually really worked for a long time is methadone. It would be wonderful to actually be free to go anywhere I wanted to go. I haven’t used drugs in over 6 years now, and before that I was clean for 8yrs, both on methadone. I relapsed while I was coming off methadone. I was at 30mgs, when my mother passed,
    and 6 months after my mother died, my father passed away. It was right after that, when I relapsed for a couple months before I got back on the clinic. If I was able to get take homes or methadone prescribed, I would actually be able to live a ” normal life”. I have a lot of information regarding methadone and staying clean. It’s wonderful and hopefully you can break through. If I can be of any help, let me know

  • What can I do as a citizen of the United States to help doctors be able to prescribe Methadone for pain and drug abuse in a family care setting not all of us can go to a methadone clinic at 7 in the morning and sit with a bunch of horrible people that try to sell the drugs to you and pretty much every time I’ve gone to any kind of methadone clinic I’ve lost my job because they’re incoherent they treat everybody the same some of us go for pain some of us are good Christian people good good citizens I just went to a pharmacy and they told me that they will no longer feel my methadone from the doctor that is prescribing it to so many people for pain not for drug abuse what can I do as a citizen of the United States to help doctors be able to prescribe methadone for pain and drug abuse in a Family Care setting not all of us can go to a methadone clinic at 7:00 in the morning and sit with a bunch of horrible people that try to sell the drugs to you and pretty much every time I’ve gone to any kind of methadone clinic I’ve lost my job because they’re incoherent they treat everybody the same some of us go for pain some of us are good Christian people good good citizens I just went to a pharmacy and they told me that they will no longer fill my methadone from the doctor that is prescribed in it too so many people for pain not for drug abuse what do we do I finally have a brand new car wife of 15 years we’re going to adopt a child we’re going to buy house and if this government takes my methadone away I can’t keep working and then I lose shame on you United States government more people are dying from car accidents and all that crap and yes if people are using illegal illicit street drugs don’t help them put them in rehab or put them in methadone clinics with people with no records leave us the f*** alone you horrible people and if any good person is listening to this please send me an email send my wife an email and let me know what to do I will move out of this country just to get the correct help I need but I will not go back to one of those methadone clinics where they treat you like a piece of garbage and they don’t let you keep your job I work 56 hours a week for an Amish company shame on you United States government more people dying from car accidents and all that crap and yes if people are using illegal a listen street drugs don’t help him put them in rehab or put them in methadone clinics but us people with no records leave us the fuk all oh you horrible people and if any good person is listening to this please send me an email send my wife an email and let me know what to do I will move out of this country just to get the correct help I need but I will not go back to one of those methadone clinics where they treat you like a piece of garbage and they don’t let you keep your job I work 56 hours a week for an amish company how much posed to get to a clinic when I got to be there at 4:30 a.m. I got to be at work at 4:30 a.m. what a people like me shame on you people

    • I was on 460 mg of methadone daily.It was becoming too much to go to the clinic everyday and put 100 miles a day on my car.I finally pleaded with my primary doctor to prescribe it for me.I told him it was either that or I had no choice but to go back to pain management.My doctor prescribed me methadone for two years.I was able to wean myself off a bit at a time and on my own schedule.I thought I was stuck on it for life.What freedom I have now.I have been off of methadone for 5 years and plan on staying off.If I hadn’t had the freedom of having my doctor prescrbe it I would either still be driving a hour to the clinic or be on some other opiod.My suggestion is to establish a relationship with your physician.Even if it is pain management.Explain the only way for you to get off of everything is to have the liberty to wean yourself off a bit everyday.It made a world of difference to know I could wean myself off everyday but godforbid I cut back too much in a day I had access to it so I wouldn’t get sick.If I didn’t have it accessible I would have never cut it as much as I did everday.I knew if I cut it too much in a day I had it available in case I got sick.This gave me the confidence to cut it by at least 5 mg everyday until I was off.I thank God for this doctor that understood and was willing to take a chance for me

  • Methadone was made in Germany by the NAZI because of short supply of Med in WW2 don,t get on it the cold turkey is worse than HEROIN and you can get a heart attack and methadone gives you constipation,Vision problems, breathing, and may shut down your thyroids also I have been on almost 15 years I wish Id never got on this terrible drug.Don,t inject it it will destroy your heart fast. and veins.

    • I have been on Methdone for 11 years. I regret having to use it, but THE RISK OF OVERDOSE exists without it. I have not had any of the problems you have outlined. I take colace for the constipation, ( stool softener ) If you are stupid enough to inject it, then that is on you. That’s just idiotic to shoot it since it enhances nothing about the drug. No vision problems, and I am grateful. I was in Chicago overdosing and the kicking the habit, clean, then take dope again, overdose. If I knew I would never use again, I would be fine. A alcoholic takes a drink, slips up, no one says things like ” idiot! No will power” verbally attack or like they attack junkies. They DO NOT know how they would act in identical circumstances. And I love how you used NAZI in large print. Things do not become more or less true, helpful, effective if it comes from shitty origins. To imply that is ridiculous. If you weren’t implying that then why bring it up?! it doesn’t matter who made it. The origin has no bearing on the usefulness. If the Nazis made it, there is no proof it was done to assault us in the western world. Nonsense!

    • Thank You for Your Advice and feedback …im trying to get off if..I have a job n can’t b going everyday to the clinic I’m about to lose my job is it possible that primary physician will provide methadone ?? If you happen to know of a physician that will prescribe it please share the info It would be very helpful…Thank you God bless You n ur family

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