As of July 28, licensed opioid treatment programs (OTPs) can operate vans which dispense methadone. The final rule, issued June 28 by the Office of National Drug Control Policy (ONDCP), Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA), follows the March 9, 2020 Notice of Proposed Rulemaking, making it clear that the vans could only be operated by brick-and-mortar OTPs.
The DEA’s concerns about diversion are alleviated by its trust of OTPs and their longterm commitment to quality treatment of opioid use disorders. These aren’t just any vans bringing methadone to communities.
Allegra Schorr, president of the Coalition of Medication Assisted Treatment Providers and Advocates (COMPA) and owner, principal and vice president of West Midtown Medical Group in New York City, as well as Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, are thrilled with the final rule.
The vans have to be retrofitted to DEA specifications, as methadone will be dispensed inside them, but OTPs and the State Opioid Treatment Authorities may ask the Substance Abuse and Mental Health Services Administration (SAMHSA) to use SAPT block grant funds to buy the vans.
Methadone vans are not new. Eight vans, connected to OTPs, were grandfathered in. But in 2007, the DEA imposed a moratorium on vans. It is now lifted. During the past 6 years 19 OTPs have operated vans (not with methadone, but with other services). More than 20 years ago, vans were used to bring methadone to outlying rural areas by Evergreen Treatment Center in Washington State.
An important streamlining initiative also now exists. Under the final rule, the separate registration requirement for vans is eliminated.
“Although DEA is a law enforcement agency, we know we can’t arrest our way out of this problem,” said Thomas Prevoznik, deputy assistant administrator of the DEA’s Diversion Control Division, in the press briefing June 28. “We’re squarely focused on efforts to increase the use of medication-assisted treatment to reduce OD deaths and help opioid-addicted people.” Noting that “not every opioid-addicted American has access to the 1,900 brick-and-mortar locations,” Prevoznik said the vans will make it easier for patients, especially in rural areas, to get methadone. “We are using all the tools at our disposal to make treatment options available,” he said.
The increase in opioid OD deaths during the pandemic “underscores the need for medications that support long-term recovery from OUD,” said Rachel Levine, secretary of the Department of Health and Human Services (HHS), SAMHSA’s parent agency. “The DEA’s new rule will streamline the process” of getting methadone. In addition, Levine noted that under the Centers for Medicare & Medicaid Services (CMS) marketplace, insurance is available for people to get coverage, including for substance use disorder. Recently, the CMS issued new policies making it easier to receive treatment through telehealth, including for buprenorphine, she said, adding that she is confident that with the mobile methadone vans, “these changes will reduce overdoses.”
Vans which are registered in one state may go through another state if necessary, as long as they don’t provide services in the state they aren’t registered in (many OTPs are on borders of states). “There is no issue for a van to transverse another state as long as they’re not providing service in the state they’re not registered in,” said a senior policy official from the DEA.
“No American should have to ride a bus for two hours every day to receive the medication they need,” said SAMHSA Acting Director Tom Coderre, adding that treatment should “meet people where they are.” And, he added, “in case you’re wondering who these people are, they’re our mothers, fathers, daughters, sons, people like you and me, who deserve the best chance to recover and survive.” Coderre, himself in long-term recovery, added that to find treatment, people can go to findtreatment.gov or call 800-662-HELP.