A recent article based on the two-day methadone workshop by the National Academies of Science, Engineering, and Medicine distills several of the messages of that workshop: extending take-home flexibilities and allowing physician prescribing are two of the top ones (for more on that workshop, see https://atforum.com/2022/03/nasem-methadone-expand-access-primary-care/).
The report, published in Health Affairs May 27, is by Richard Bonnie and colleagues, and is called “An Expedited Regulatory Strategy for Expanding Access to Methadone Treatment for Opioid Use Disorder.” The report takes issue with the requirement that only federally authorized opioid treatment programs (OTPs) can provide methadone treatment for opioid use disorder (OUD). In what has become a common theme, the report states that most medical providers and pharmacies could just as easily provide methadone treatment, expanding its availability. Requiring patients to go to OTPs just adds to stigma, the authors write.
The report does acknowledge that there is “hard work” involved in changing the requirements, including developing measures “that may be necessary to avoid unanticipated or undesirable consequences of reform.”
OTPs say that they can avoid these consequences by staying involved in which patients are best able to get more take-homes, for example.
The Substance Abuse and Mental Health Services Administration (SAMHSA) allowed more flexible take-homes when COVID-19 started, to reduce the waiting lines outside OTPs and cut back on possible exposure to the virus (see https://atforum.com/2020/03/otp-regulations-loosened-due-to-pandemic/). The change has been shown to be successful – more patients getting take-homes with no negative treatment outcomes. The writers of this report would like to see the flexibility, which means that “less than stable” patients can receive take-homes, extended beyond the public health emergency of COVID-19. The concerns of OTPs, who in general favor fewer regulations, center around their liability in giving more take-homes in cases in which patients may divert medications or take too much themselves. After all, OTPs are private providers and they, not the academic researchers (who are not OTP providers) are liable.
The article is a health Affairs “forefront” piece, an opinion article.