Methadone, one of three medications approved by the Food and Drug Administration (FDA) to treat opioid use disorder (OUD), is effective in reducing illicit opioid use and mortality. Despite extensive evidence of its effectiveness, methadone remains one of the most heavily regulated drugs in the United States. At a time when additional methadone treatment capacity is desperately needed, federal, state, and local governments have imposed significant restrictions on how and where patients can receive the medication.
Recommendations For Increasing Access to Methadone
First, the DEA could facilitate expanded access to methadone by regulating mobile methadone vans. Methadone programs in six states and Puerto Rico have used these vans to reach patients who are unable to travel to an OTP. In one notable example, an Atlantic County, NJ, jail warden and judge worked with state officials to bring a mobile methadone van onsite at the jail in order to continue treatment for persons who entered jail on methadone and offer the medication to incarcerated individuals newly seeking treatment. Just as mobile health care clinics have successfully reached underserved populations, establishing methadone vans in rural areas would eliminate the need for patients to drive long distances to obtain treatment.
Unfortunately, the DEA has not approved any new mobile methadone vans since 2007. In 2018, the DEA director said the agency was in the process of issuing new mobile methadone regulations. However, as of July 2019, the DEA had not issued new mobile methadone van licensing guidance. Given the potential for mobile methadone vans to increase access to treatment, the federal government should prioritize the release of these regulations.
Due to the lengthy delay in issuing guidance regarding medication units, it may be helpful for Congress to direct the DEA to take swift action in this area. units in rural counties, jails, prisons and other settings that would benefit from methadone availability, such as residential treatment facilities and Federally Qualified Health Centers (FQHCs). Placing medication units at locations where patients are already receiving medical or behavioral health care would have the added benefit of breaking down silos between methadone providers and the rest of the health care system.
Finally, state lawmakers and officials should revise policies that unnecessarily restrict the number of OTPs and the services that OTPs offer. These policies contribute to considerable state-by-state variation in the availability of OTPs.
Source: Health Affairs, Pew