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and most effective medications to treat this disorder — methadone — is out of reach for many people, largely due to outdated federal laws.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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  • I have been diagnosed with CRPS, a very painful nerve pain syndrome. I am currently being prescribed 180 10 Mg. Percocet monthly to manage the pain for this condition. I have used methadone in the past for opioid addiction and depression and it is a miracle drug. I cannot find a doctor to prescribe it to me for this pain and I cannot understand the stupidity of the allowance of so much Percocet when methadone in pill form would work much better for me. Are there any pain specialists out there in the Los Angeles area who would be willing to switch me over from Percocet to methadone for this unbearable pain? If anyone knows someone who would be willing to help me, I would be very grateful.

  • I have been on Methadone for 20 years due to a C-4 break in my neck. It was the only drugs that kept my pain at bay. I was getting a script from my PCP but he just retired 2 months ago. So now my new doctor will not write the script and sent me to pain clinic which they won’t either. I think it’s pathetic that something that has worked so well they want me off of and give me other opioids in its place. STUPID. Methadone is a very safe drug, I don’t abuse it, I take it as written. I am furious now because they are giving me other meds to help with the pain that don’t touch the pain. The DEA has gone overboard about the opioid addiction. PISS OFF IN KC.

  • The only thing keeping me from quitting opioids right now is the fact that I cannot go to a clinic to get methadone my work hours will not permit itwhich is a crying shame because I do not have the time to get sick and miss work so I spend lots and lots of money to keep myself from being sick so I can workbut unfortunately I start too early and I get out too late I’d like to go to a regular doctor primary care physician to get methadone I would have been off this s*** years ago the government needs to stay out of the medical field either stop making it so hard to get painkillers or make it easier to get methadone and you would have a lot less people doing heroin with fentanyl I’m just a drug addict and I can see that it’s a shame that our so-called higher educated don’t have a clueand on the flip side of the coin with these new laws with the opioids my 75 year old mother is no longer able to get the medication that she needsthey cut her back so far that two weeks she’s up and about in two weeks she stays in bed waiting for her next script which is a crying shame that someone has to live in that kind of pain

  • I have been on methadone 3 years and it works amazing. You slowly lose your want to use. It literally works great for cravings helps and pretty much gets rid of my anxiety and depression. I tell people it give us our lives back in almost ever way. It is leaps and bounds a better treatment than suboxone imo. Suboxone don’t work if u ask me not long term anyway. Going everyday sometimes waiting 30 min to a hour. And they are all only open from 5 or 6 am till 11 or 12 pm so its very inconvenient to get there before work and clinics at least around Pittsburgh only accept welfare insurance or cash 420$ a month so its very complicated when all I want is to be able to be normal and be like everyone else it basicly saves my life cause without it my life isn’t anything you would consider a life I been planing to write our governor and make 300 copys and send one everyday till they look at how hard it is for addicts and how many people it will save and help if they fix the problems so let hope they take it seriously and fix these broken laws

    • Keep writing every member of your state, and CDC, they are trying to dictate how much to take. AMA is working for us.

  • I used Methadone at the clinic in my town and went without using Heroin or any other opiates for 3 yrs. I became unable to drive after a back surgery so I couldn’t get to the clinic for the past 3yrs. Without Methadone I’ve been in & out of detox for heroin I wish I could get Methadone to take at home!

  • I have been on methadone 10 mg. tablets, 3 times daily since I have been cut down. I was prescribed methadone for chronic pain. Now I don’t know what I am going to do, my Doctor is leaving after August I don’t know what to do or where to go. Someone Please Help Me.

    • Jacqueline, I was in the exact situation as you. My doctor retired in July. I’ve been on Methadone for around 12 years. I was switched to Bupenorphine and it was horrible! I had to get back on Methadone. Unfortunately, the only way to get it is through a clinic. Look into it if you can. I hate having to go, but it’s way better than not having it. These laws need to be changed! After a while of use the clinic allows you to pick up a monthly supply. Hope you get the help you need. Also, a pain clinic may be your answer. Best of luck! Pete.

  • I have the dubious distinction of 44 years’ experience in and around methadone clinics, as patient and family member. I now work freelance as opioid sufferers advocate. You are absolutely right about mainstreaming methadone–I could write a compelling BOOK on the subject, but these changes are so long overdue…demographics are changing right beneath our feey, as disabled and elderly experience great hardship and fears that they wont have transport, medicaid cuts may jepordize Tx, etc. WE can change now or pay the price in lives. Let’s organize and cut to the chase!

  • I live in a small town in South Mississippi where the closest/only clinic within a hundred miles is an hour drive. I unfortunately wasn’t able to make the drive for over a week due to transportation issues and was removed from the program. I’ve been trying to get back in the program for over a month now and Everytime I think that I have addressed all of their concerns and jumped through every hoop they had, they find some other reason for not being able to dose me. My reason for this rant is because of they allowed private Drs to prescribe methadone like they do Suboxone, then situations like this wouldn’t happen. It’s not as if I have the option to go up the street to a different clinic, because there isnt one, and guess what, the next closest clinic is a New Seasons clinic also.

    • The ”Clinic” situation in USA seems very short sighted.
      why on earth don’t they do as UK does and allow GP’s to prescribe?../it keeps people working, pharmacies that dispense are close to where the person lives, {usually a a few minute’s walk away if you live in a City} might be harder for village inhabitants, as that will entail a drive to nearest town..
      But how do they expect people top work if they have to drive miles to some horrid methadone clinic, which sounds like a beastly club for drug talk.
      As for counselling, does it actually do any good?
      We all know what the triggers are, and quite frankly, being in a group with other users is a big trigger. {have done groups voluntarily in UK, and there is always someone touching out, or with ‘something to sell’ in the break.
      Far better to have a nearby chemist, with no contact with other users.
      Rushing to get to the chemist in time is bad enough {if one works a longer day}…stuck in traffic and the time ’til closing ticking down..megastress.

  • I know of another reason that methadone should be prescribed in a primary care setting. Unfortunately there is still a stigma against addiction treatment and a lot of people wanting recovery are afraid to be affiliated with an opioid treatment center. They want to be discreet because they may be in a family that is in the public eye, and even have a public persona themselves, they should be allowed to seek treatment as soon as possible. It would be more of a private way to obtain the help they so desperately need. Addiction to opioids affects so many types of lifestyles. It is not just a junkie in an abandoned house now. Please people if you are affected (or afflicted) raise this much needed treatment for privacy concerns as well as mental and physical well being.

    • Agreed not to mention let’s look at the logistical problem. I would like see the statistics on how many people and Especially innocent children have been killed by putting millions of motorists needlessly on the road often many of them are still high and co abusing. This is sooo archaic, as my dad said it shouldn’t be harder to get clean than to get high and this system, I will disagree again with author as he may not have personal experience euth these clinics but I have been clinics in 4 different states and never where they structured nor did they seem care about creating a gameplan to get me better. They are run as for profit so they have no incentive to help you get off. But I been saying this for years I am a molecular biologist and highly educated and having go clinics also creates all sorts possible HIPPA issues as people that might know you could see you in the clinic and immediately know at minimum your addicted opioids of some kind. This NEEDS END NOW.. I believe if even 1 innocent child died because of neglecting us people treating us like children thst need constant supervision. They could took the money Trump admin invested and kept it and got rid every clinic thst would essentially free up tons capital im Grants they recieve that could be better used to actually help patients not help line the pockets of these clinics. I Wish Thanos would literally come snap fingers and disintegrate every clinic (no deaths obvi) and then we get meds 1 /mo or idc even 1/ 2week be better than this archaic system.

  • Janelle, hang in there. Many of us have paid our dues with clinics that did not have our concerns first. Sometimes unfortunately we are all treated the same and we have different stories and responsibilities that along with our recovery we have to handle daily as well. I have been on clinics many years and I am so glad I stayed in that environment. I was in jail and prisons several times before methadone and it has been an amazing help to stop cravings and give me back a conscience to realize better choices and do the right thing. Please do what you have too to survive and be a better person spiritually and physically! The more people that get our stories out about opioid addiction and our recovery with methadone will make it easier to get to office based treatment with a physicians care.

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