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and most effective medications to treat this disorder — methadone — is out of reach for many people, largely due to outdated federal laws.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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  • Hi my name is Randy
    I have been doing some research on being proscribed methadone.. Reason being is because I’ve had injurys in the past that led me to be opid depend.. I sought out help at a methadone clinic and was treated for 6 years.. I had a hardship in the family and could no longer afford the clinic so I dropped out at 30 MIL and by the second day I was in detox and could not handle seames how I did not wake till I was at a lower dose.. So I had a choice to make.. Buy drugs of the street.. Our buy subtext of the street or see a doctor.. I did not have Heath insurance at the time and did not wanna go back to drugs so I’ve been taking subtext.. But the subtext has been causing sever issues with my health as far. As anxiety and heart populations. Muscle contractions and more.. Ive been taking it for 5 months and in the mean time I switched jobs and water 90 days to e health insurance so I can see a doctor about being prescribed methadone.. Resin is to gET away from subtext and because I can’t afford the clinic because it’s 340 a month their Plus’s their opining time does. Not work with my work schedule.. So I’ve done made it this far to be able to see a doctor and I was just about to scedual a appointment and I did sum research and came across this.. This is very unfortunate and now I’m stuck and don’t know what to do

  • To Dgolden 1023 you are 1000% wrong and it’s people like you that make people not get the help they need . 12 steps can’t fix a chemical imbalance. Your body stops making the chemical and the drug replaces it and some people never can get their body to start making it again others maybe able to but it’s not being addicted !! Are you addicted to air ? Food? Water? Without the medication people will suffer . Addiction is something that affects you negatively someone taking a medication to function normal so they can work and live happy isn’t addiction . They are dependent on it just like you depend on food and water or a medication you take for any other disease. Bottom line is people who make a mistake and use shouldn’t be made to suffer and beg and jump through hoops to get a medication that works better than anything out there . It saves lives and I bet there are people around you that you have no idea are on it . Doctors , lawyers all walks of life . Time for government to get out of healthcare and let doctors treat the mess that the government and pharmaceutical companies and doctors made

  • For those complaining of the conditions around their clinics about you start calling the police and reporting these people….

  • I am on a methadone clinic in Mass. The setting here is not exactly ideal for sobriety. Is there a PCP or private Dr.offices That is able to prescribe methadone with out going to a clinic?

    • Couldn’t agree more. I’m on a clinic in mass as well and While the methadone has helped stop using the enviorments around the clinics mine add well be street pharmacies. I developed addictions to other drugs such as benzos….something that prob wouldn’t of happened if I could go get my methadone like I used to be able to go get my suboxone…..in a nice drs office and a week or 2 eventually month script instead of having to go to a clinic every day walking down street pharmacies where I’m offered every other drug. And full disclosure…….I’m an addict so I have trouble saying no….done of uppity may say I wouldjust abuse my script but I didn’t w subs. Just got unlucky lost my job and insurance. In short you’re 100%right about the setting.

  • I agree wholeheartedly with this article about this terrible opiate epidemic, and the use of methadone, or lack of use I should say. I’ve worked, more than full time, sometimes up to 3 different jobs at a time, since 1986, almost none provided medical insurance. I have custody of my children, and have worked extremely hard to provide for them, until that fateful day, almost 10 years ago, when my spine basically fell apart, after running pnumatic jackhammers for 3 days straight (not to mention, pretty much my entire life) and collapsing in the yard of my employer. MRI’s and other tests showed I had several herniated discs, fusion, straightening of the neck & spine, carpel tunnel, tendinitis, and severe nerve damage in both hands & arms. With no access to affordable health care, single parent, no child support, and making that magical salary amount that’s not enough to aquire health insurance, but makes me “overqualified” to get any government assistance. Next move to keep our lives moving forward, I started buying painkillers off the street. Long story short, I’m now a full blown addict, still working myself to death to keep going, and the only medication that helps me beat this, is Methadone. Suboxone only works if you plan on spending the next several months in bed, and not working, because it basically just “scratches the surface” of an addiction problem. Methadone, on the other hand, makes me feel almost 100% I go from being a full blown addict, in massive acute withdrawals, and within 30 minutes, if not less, after being administered a dose of Methadone, to feeling almost as if the whole thing was a horrible nightmare, and I just woke up! Only problem, no one will perscribe it for me. Hopefully, if someone reading this can help me, please? I’m well on the road to becoming another sad statistic, in this horrible nightmare.

  • What’s the point of a methadone treatment if a person is on it for life, I would think that the purpose of the clinic is to eventually get you off it. My brother has been on it for years and it hasn’t done much for him, I feel that these clinics don’t want patients to come off it for money gain.

    • Opiate dependency/addiction is a life long disease just like diabetes or any other chemical imbalance in your body . Taking methadone is helping keep your brother alive because it blocks cravings and if he uses helps prevents overdoses . It’s a tool and if used correctly and on the right dose you can live a normal life but some people have other problems and for some reason methadone is to blame when it’s not . No one gets high off it , it’s not trading dope for methadone. How scientists and doctors can tell people methadone is safe and works but still people are to ignorant to understand, much like climate change ,i think people just need a class of people to shit on to make themselves feel better but I got news for you no one is perfect and just because your on methadone ,most people drink or smoke or drink coffee or need something to cope like antidepressants . I get it , it was a choice to use for some but most had a doctor start them , but it’s a disease and we don’t make cancer patients stand in line and beg for medication even though they smoked ! They chose to ! Or a diabetic who lived a unhealthy life should they be treated like criminals forever to get the medication they need ? This isn’t 1970 anymore . Other countries are realizing addicts are humans and should be treated like everyone else. Let doctors help get the government out of out healthcare just like trump and republicans say less government involved in healthcare

    • You obviously never have been addicted to opiates and dont understand the hold opiate addiction has on the body and brain. Its hard thing to understand unless you youve been through it. Methadone saved my life. Period. Best program hands down.

    • Yes it is a life long disease but you are only meant to be on medically assisted treatment for 3 or 4 years not for a lifetime it’s kind of funny how you don’t realize that the medication you’re addicted to is the same as the medication you’re taking same thing no devrait nothing changed your just getting your supply on a regular basis now you are supposed to be starting at a joest that is acceptable and stepping down not waiting 20 years and then dropping 10 mg

  • Ive been on methadone for 15 years..came off a severe addcition to pain meds for a pain related issue but it turned into addiction when the pain was more than the medication would fix..so i went to iv drugs to try to stop it..it was awdul and methadone gave me back a fuctional , lower pain life. Not pain free..thats not happening but it works better than all the drugs i ever used prioe and no high , no bs..just life on a normal plane. I have often thought about trying to find a doc to leave the clinic but typically u find one and then they will either stop prescribing due to fearmongering or they retire and youre back to the clinci. So ive stayed at my clinic..im on 130 mg. i AM A RAPID METABOLIZER ..sadly due to hep c messing with my liver and im diabetic. My liver dr told me this is why by 7 at night im not feling too hot and i should come up a bit or have 40 mg to add as a split dose at nite..but they dont do that at my clinic and wont go over my current dose which is called dose capping..its supposed to be not allowed but they do what they want. At a dr Id have the benefit of discussing this with my dr and possibly making it happen. I dont fail drug tests, havent in all the time ive been on methadone. I never have any issues and i am considered very compliant. I think patients like us are perfect canidates for seeing a pcp for this medicine. Why not? I dont understand the feeling of being on probation after 15 yrs..wha more can i prove at this point????

  • There is so many monsters behind the scenes keeping methadone prescriptions out of the hands of people who need it. Why? Because they want doctors to prescribe Morphine, Oxycodone, Oxymorphone, Percocet, and vicodin. I have been prescribed ALL of those. I have a junk yard of parts in my spine. Methadone makes me able to get out of bed every morning and not be in miserable pain. My pain factor is a hard 4 every day. Sometimes it hits a 6. But the last time I was on Oxymorphone (yea, that stuff is a super street drug as well) the Oxymorphone was not killing the pain and what little it did, it was not for long. I was so freaking miserable. Instead of increasing my 3 times a day dose along with my percocets for break through pain. I went to a Methadone clinic, hads to lie to them. And got on Methadone.
    The Methadone blows Oxymorphone away! It last way longer and does a better job. It is better in every single way. Methadone, is what they promised “oxy” to be, but wasn’t. There is ZERO high to Methadone. So you can get the dose you need, to get your pain decreased and have a functioning life.
    People who are addicted to Smack, have a chance to get off of it. People who are pumped to the moon on opiate drugs for pain, have a better alternative. A MUCH better alternative.
    Pain clinics all over America would be helping so many more people if they could prescribe Methadone. And they would keep from building so many future addicts. You can NOT, take Oxy every single day, and not be addicted to it. That is impossible. And you have to keep raising the dose over time. And raising the dose. Add another painkiller in to the cocktail, ect. With Methadone, when you find your sweet spot. You can stay at that amount for years. And it will continue to work.
    We can save so many people and put a big dent in the painkiller problem in America, and around the world. It cost so much less to make Methadone vs Oxy as well. Methadone is one of the cheapest things for them to make. That right there tells you why they dont want all the patients taking it.

  • Great article. A friend of mine has been treated with methadone for 4 years for a drug addiction. She is also type 2 diabetic. She injects her insulin 3 times a day. Recently she feels that the methadone is wearing off to fast. Could the insulin be causing the methadone to be metabolized faster?

    Thank you

    Sam

    • Anything is possible. There is a synergy with methadone and our bodys. Methadone works with the Liver and is designed to work slowly. That’s why folks can take it once a day and it works for over 24 hours. So adding insulin could very well speed up her metabolism, I am guessing of course. But I am sure it is possible. The great thing about Methadone, it has no “high” to it. So if she thinks it is wearing off, she just has to tell her doctor and they will raise it. Try doing that with Oxy, Morphone, ect.

  • Clinics are a joke. Anachronistic. Go back to 1970’s. Crime school. Methadone works. I go to the clinic for medicine that works. I don’t go for the joke groups that try to convince you that you are in recovery. I’m not clean. I’m on legal, very potent, opiates. It works. 3 people die a day in my city. Philadelphia. People hate clinics because they suck. I want a life. Almost impossible when you spend 5 to 6 hrs a day dealing with a fd up clinic to get your medicine. If u can get bupe at a doctors. Why not methadone. Suboxone was formulated for upper class pill poppers. I’m a long term heroin addict I can’t take partial agonists without going into horrible withdraw. Uk, aus, can all doing fine without stupid clinics. Please leave us alone. Give us our meds and stop treating us like criminal cattle. Jesus God. If I want to hear a bunch of watered down psychobabble quasi spiritual bs I will go to a aa meeting.
    Also let me smoke pot. It’s saving my life.

    • My clinic doesn’t make me go to any groups at all. I must have a good one. I do, by choice, go to the art group. But people don’t talk about that stuff at art. We all just listen to classic rock, water color, make clay figures, ect.