The Opioid Treatment Access Act (OTAA) would allow non-opioid-treatment-provider (OTP) physicians with training in addiction to prescribe methadone for opioid use disorder (OUD). This is from Section 4, the highly contested OTAA provision, which the big proprietary OTPs oppose (see the recently launched https://programnotapill.com/) but which some of the smaller ones are in favor of.
Leave aside the question of whether addiction physicians want to treat methadone patients, and the additional question of whether pharmacies would stock the medication for dispensation. There are enough problems with buprenorphine on both fronts already. But the issue is how simple this could make life for patients.
There is a juggernaut of support for this legislation, and the concept behind it – getting methadone treatment out of the OTP, despite the fact that this is the only place it has been in the United States. Below are some of the most recent policy statements supporting non-OTP physician prescribing of methadone for OUD.
WHO: Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. WHO Press, World Health Organization, Geneva, Switzerland. 2009, World Health Organization
( “Psychosocial services should be made available to all patients, although those who do not take up the offer should not be denied effective pharmacological treatment.”)
ASAM: The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder, updated 2020. free: www.asam.org/Quality-Science/quality/2020-national-practice-guideline.
(“[B]ecause of the potential harm associated with untreated opioid use disorder, a patient’s decision to decline psychosocial treatment or the absence of available psychosocial treatment should not preclude or delay pharmacological treatment of opioid use disorder, with appropriate medication management.”)
NASEM: Medications for opioid use disorder save lives. National Academies of Sciences, Engineering, and Medicine. 2019. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25310.
(“Lack of availability or utilization of behavioral interventions is not a sufficient justification to withhold medications to treat opioid use disorder”).
These are just a few. Despite this, the American Association for the Treatment of Opioid Dependence, and many non-proprietary OTP experts, including Ken Stoller, M.D. of Johns Hopkins, do not support non-OTP prescribing, based on what they think patients should be offered – comprehensive care. Counseling doesn’t mean exploring one’s childhood, it means helping patients find jobs, housing, secure relationships, and stability in their lives. Simply getting a prescription for methadone may work for patients who already have these things. For others, it might not. According to OTPs, they are the ones best able to judge which patients have such stability.
Some of the best and brightest OTP and methadone experts are part of these proprietary OTPs. So it’s not up to legislators to act without their input. Yet accusations of nest-feathering don’t stop.
Stay tuned for what happens next. AT Forum will keep you informed.