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and most effective medications to treat this disorder — methadone — is out of reach for many people, largely due to outdated federal laws.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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  • To Miss Ann who says no one should be on methadone for 25 years….. You do not know the circumstances behind anyone’s reason for 25 years on methadone. I will let you know that I also have a spinal disability that causes me chronic pain. Do you actually think that an opioid addict can take pain medicine safely? Methadone has allowed me a safe alternative to be able to live a productive way of life at 65 years old.

    • I have been clean for almost 2 years. I have a reconstructed leg. I have chronic pain. I need methadone through a family physician and not through a clinic I drive to daily wearing out 2 cars I couldn’t afford to properly care for. This is ridiculous. Jackson Mississippi needs reform.
      Pass a law to help us instead of hurt us. There js an idea. I intend on being on methadone for the rest of my life. Much better than the morphine I thought I would take forever. Why make it impossible to get help. Natural selection if you ask the rich.

  • We desperately need a methadone clinic for the Kenai Soldotna area and not just suboxone that doesn’t help ever everyone. I’ve written to the governor, senator etc. And it’s always put on the back burner. This would tremendously help stop crime and help turn addicts into law abiding working citizens. I’ve personally seen it happen with 100’s of addicts in Seattle, Anchorage etc.. Pleaselets get one opened.

  • I’m on methadone 5mg for restless legs. I have no side effects, no high, just complete relief. The pharmacy made a mistake with my prescription first, because they failed to order it on time and 2, because they didn’t tell me until it was too late! Because of the strict laws involving methadone, I could not get my prescription transferred to another pharmacy that had what I needed and no one could help me, including my primary care physician, because apparently a doctor has to have a special license to even prescribe it! 😤. It was the weekend and I went without, tortured by my condition, no sleep. It’s so unfair. Nothing has ever worked so well for my condition like low dose methadone! Yet I have to jump through all kinds of hope it I won’t get my prescription at all!

  • Hello I have been on methadone clinic twenty one years. I go to the clinic once a week which is good but, I feel like I’m in jail sometimes , can’t go on vacation , Let me take that back , you have to get all the paperwork were your going ,were your staying howlong you will be there, its just very hard make me not want to go at all. I wish I could go to my primary doctor and get my med, it would be so much better , but i feel now its all about the money , that’s all the program cares about , in twenty one years they never talked about me geting off methadone all they say is it would be hard for me, so i stay on. Don’t get me wrong I am grateful that there is a program to help people, but after all this time I wish they would help me get off methadone.

  • Are there any doctors that prescribe methadone so I can get it filled at my pharmacy. ive been on suboxone 14 years and do absolutely nothing. I am more productive and methadone also takes away my back pain. are there any pain management doctors that will prescribe methadone.

    The treatment centers are so expensive it will leave me homeless again

    • It only costs me $3.30 for a months script at 50miligrams a day. It now coes me $97dollars a week. And Im on socicial security. Ive been on methadone for over 30yrs

    • I’m on methadone 5mg for restless legs. I have no side effects, no high, just complete relief. The pharmacy made a mistake with my prescription first, because they failed to order it on time and 2, because they didn’t tell me until it was too late! Because of the strict laws involving methadone, I could not get my prescription transferred to another pharmacy that had what I needed and no one could help me, including my primary care physician, because apparently a doctor has to have a special license to even prescribe it! 😤. It was the weekend and I went without, tortured by my condition, no sleep. It’s so unfair. Nothing has ever worked so well for my condition like low dose methadone! Yet I have to jump through all kinds of hope it I won’t get my prescription at all!

  • I so agree with you Robert. I also live 45 minutes from my clinic. Though I just go once a week, it is a hour and half to get there and back, I have to attend a 2 hour group for counseling every weekly visit. I have around 25 years clean on all urinalysis. Go Figure. That is a half a day gone weekly. Also I am 65 years old and disabled. The only time I even hear about drugs is there at the clinic! I transferred from another state so I have no old using friends or triggers in this state. Please understand we do not all have the same stories for anyone reading this that are not familiar with the clinics rules. This is why there is no handle on the opioid epidemic. It is too hard sometimes to adhere to clinic rules and obtain help to get the medicine that keeps us on the right path!

    • A monthly Dr. Visit without insurance and script filled for methadone- 145.$ methadone clinic-15$ per day and gas. Do the math. Thats why we feel trapped in our addiction when we should only see dr. 1 time a month you can live outside of a daily reminder at the clinic, that is a ball and chain itself. Btw 105$ a week at clinic not including gas everyday, 30 miles 1 way. 420 dollars a month. Thats a car payment . 840$ a month for myself and my mom for 1 household

    • That’s right no one should have to go to a Methadone clinic for 25 years. I think after so many years of participating and doing it right, no dirty drug screens etc you should be able to get it from a local physician. To me it’s a money racket, they get you in there and then they’ve got you and it’s harder to get off of than anyone may think

  • I can say that methadone treatment really does work and works very well to stop using opioids. As stated in this article it is a huge challenge to get to the clinic on a daily basis. I have had to turn down a few great job opportunities due to not being able to make it to the clinic and to work in time, the clinic does service from 5am-11am but it’s about 40 minutes from my home and waiting times varying from 10 minutes to 45 minutes to receive your daily dose and this is the problem. We really need help to make the treatment more accessible to people struggling with opioid addiction and extend treatment to the normal clinic and hospitals . I truly believe that this would drastically reduce the people using opioids and save many lives. We know methadone treatment works but is far from being assessable to so many.

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