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and most effective medications to treat this disorder — methadone — is out of reach for many people, largely due to outdated federal laws.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

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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.

  • I use methadone daily & ive been clean for 11 years i got a home, my kids back & a full time job my life has inproved. The only problem is no insurance will pay so it all comes out of my pocket & $70.00 a week adds up fast….

  • I agree that methadone should be made more available but should be kept in a controlled environment. My husband went to his primary care doctor, after searching for a Suboxone Dr. for weeks with no success, and asked if he could recommend one. This “man” told him instead that he could not prescribe him Suboxone but he could give him methadone. My husband was dead 3 days later!!!!!! You cannot give a different opioid, synthetic or not, to a junkie and expect them to do the right thing. They need some sort of structure. This doctor killed my husband, my 11 year old daughter and 2 of her friends found her daddy dead on the kitchen floor, and there is nothing I can do about it. He just gets away with it. That’s [email protected]

  • Ive been on methadone for over a yr now an I can say IT WORKS I HAVE NOT USED ANY OTHER DRUGS once your on a dose tht works for you it works 100x better then subs they are GARBAGE I wish I could go to my regular dr an get a script an speak with 1 person not a bunch of diff people nurses who could careless an act like we are just GARBAGE they need to change the law on tht im from New Jersey thank you for letting me speak on this matter again METHADONE DOES WORK WHEN ON THE CORRECT DOES

  • First off let me say that I almost never comment on stories, I just dont really have the time, but when I read this in my feed I had to voice my opinion.
    I was on methadone for over 5 years and many years of opioids before that.
    I can say that methadone absolutely saves lives, I have seen it myself. It is so hard for addicts trying to get treatment already and there is no reason why someone trying to better themselves should be forced to go to a clinic everyday, it makes it almost impossible to hold a job. Some people have to bus over an hour just to get to the clinic, and then wait in line for up to an hour, there are so many restrictions on traveling etc, clinic hours etc.. that it feels like an uphill battle. All the restrictions on prescribed opiates is absolutely insane and very dangerous in my opinion. Elderly people who are in severe pain are being forced to go to their doctors for meds that they need to live let alone walk , all these restrictions are just making pain patients feel like criminals. So many people require pain meds, I have several issues including Lupus and RA and I am only 39, it was debilitating and I could not live without pain meds, I tried everything. I was able to get off methadone because I have a strong support system which the typical addict does not have access to. I have so much empathy for these people which the average person reading the news does not have or care to have. I personally would never go on methadone again. I have had success with an herb “kratom” that the FDA and DEA are fighting to make illegal because it is a threat to the big Pharma industry. Big pharm runs the DEA and pays them off ..
    Kratom has been used for centuries in Thailand and other countries. It is NOT an opioid or opiate, It does NOT make you high, it does NOT kill, it does NOT slow your breathing down like traditional opioids. The DEA is running a false smear campaign with their propoganda and claims to scare the general public into thinking kratom is dangerous, which it is NOT. I have been using kratom safely for over 5 years and I am only saying this because I have been there…. I do believe methadone should be easier for people to get , I also think people should try kratom before methadone if possible. It gave me my life back and I have started a successful business since being off the methadone.

  • Of course! All “useful” tools in medicine have potential benefit and potential for harm. There is always RISK. Where there is great benefit and opportunity for effective use there is always significant potential for inappropriate use i.e. misuse and the possibility for harm and abuse. Nothing ventured nothing gained! Methadone is a perfect example of this medical principle …life principle!

  • Was in the military and law enforcement and before retiring from both I was prescribed opioids for my chronic severe pain for ten years. Now the VA will no longer prescribe them so I will use cannabis. Not for the THC because I do not like to get high but prefer to use the high CBD strain instead. But I would have to leave Texas in order for me to not break the law. Just paid off my house too, so sad to have to leave.

    • I have been on Methadone for pain for ten years! Yes it sure does work for pain without feeling druged!
      I now am on hospice and they want to take me off! This claim of “the new law” is bull-picky!

  • Hi my name is brandi I am from Biloxi Mississippi I have been morbidly obese all my life I was 700 pouds when I was 18 I am 400 now I am 37 now and. Since 2002 I was in and out of our local hospital for 2 years I lived there I was a gunnine pig I let the ry everything underthe sun the have had me on all the heavy pain meds like oxycotain demorl duliud u name it i did not want tobe a strug out junkie on all that heavy drugs so I ask my Dr if I an the weeker nacotic after I have tried everything so he said that narco and Percocet were the 2 lower ones I have been on nacotic since 2002 my drs keep leaving or there not take my Medicaid every time u try to go to the Dr a try to find a new one they your just another drug seeker i need new hips knees ankels and I have 2 slip dics and a pinch never in my back the drs say with my weight that even if the do the surgery it won’t work till I am 200 pound they won’t operate so ever day I leave in so bad pain I can’t stand it in the past 3 years I have been to 2 different pain management clincls never had a problem like this till I started go to physicans care plaza in Gulfport been there for almost a year and all of a sudden they tell me I tested positive for cocaine I new that was wrong so I went and payed 65 for. A hair test that goes back 3 months there were no signs of any drug what I was percibed took it to them proved them wrong and they still won’t take me
    Back I finally found another Dr brian tsang went
    In was there 6 month I take GI coctail for my stomach persibed by a GI specialist been on all these same meds since 2003 the last month I want to Dr tsang they tryed to tell me I tested positive for alcohol trying to how I tested positive for for alcohol I went to the pharmacy they said my GI coctail contained alcohol took a picture of the pharmacy bottle took it
    Back to my Dr and of
    Course I get discharged again for proving them wrong again I don’t know who to turn to to help me there are other people in my situation who didn’t do anything wrong either but there having to suffer for it what are we supposed to do

  • Nothing like stupid and not knowing what you talk about.ninty percent of methadone overdose is due to miss use.show me someone who condemns it and I’ll show you someone has never really needed it or have never used it properly.
    Ever heard of cervagenic headaches, I had not until after receiving two neck surgies which five years later left me with this suicidle type headache that I would not wish on anyone. My life saver and only answer was methadone which I also had never heard of. Now due to the current stupidity and misuse of the drug my pain doctor has stoped prescribing it do to people’s mis useand the government trying to play doctor. Before you condem things you better watch out you may just step on your own toes

  • I have been on methadone to treat my injuries suffered in a high speed wreck. My truck flipped on the freeway due to ice and my back was broken as well as suffering spinal chord trauma and head trauma. I tried all kinds of pain treatment and methadone has been my saving grace…I have since gone to a 4 year college and have earned with honors a degree in Human Services so I can give back to my community. Without methadone I would not have finished… As a pain patient I deal with being stigmatized as an addict in some people’s eyes but I am not that. I know many of my brothers and sisters who suffer from debilitating conditions also feel this stigma and all I can say to those who are opposed to spend a day in the shoes of those you are judging. All the majority of us are trying to do is be able to give ourselves a better quality of life. I know for a fact it can help and it didn’t damage my mind. I would not have a degree with honors without it. There needs to be easier access to methadone… It simply works. Don’t punish the many for the actions of the few… Save lives…it’s time to give those the treatment they need so badly..

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