Ever since the deadly synthetic opioid fentanyl began showing up in the illicit drug supply in 2014, the number of U.S. overdose deaths has skyrocketed — exceeding all other accidental deaths, including car crashes and gun violence.
In response, the federal government and some states are redoubling efforts to curb the epidemic of overdoses from opioid painkillers, heroin and fentanyl by making medication-assisted treatment more accessible to the estimated 9.5 million people with an opioid use disorder.
The federal Substance Abuse and Mental Health Services Administration has proposed to make permanent pandemic-era rule changes that have allowed certain patients to take home up to a 28-day supply of the addiction medication methadone, instead of showing up for a daily dose at a crowded clinic.
But state drug and alcohol agencies and clinic operators will decide whether to adopt the new baseline rules or retain stricter state regulations. And those that opt for a more flexible approach will have to overcome the stigma, fear and misinformation about methadone that, for decades, has dogged patients who rely on the addiction medication and clinics that dispense it.
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Unlike buprenorphine and naltrexone, the other two drugs approved by the U.S. Food and Drug Administration for the treatment of addiction, methadone has been required under federal law to be administered in person at clinics where long lines and full parking lots have caused resentment among neighbors and passersby. The new rules would allow patients who meet certain qualifications to take it at home for up to 28 days.
Advocates for people with addiction and the methadone industry have long sought the permanent rule changes, which would allow more of the nation’s 476,000 methadone patients to take their daily dose in the privacy of their own homes.
In addition, a bipartisan bill in Congress, the Opioid Treatment Access Act, would take the administration’s liberalization of methadone rules a step further, allowing doctors to prescribe the powerful medication and pharmacies to dispense it.
Mark Parrino, who heads the methadone industry group the American Association for the Treatment of Opioid Dependence, applauded the new federal proposal. If states align their policies with the new recommendations, he said, it will “advance the work of our field in admitting patients to treatment and keeping them in treatment.”
