The rhetoric against methadone has reached stunning levels. When Representative Donald Norcross (D-New Jersey) joined the other congressional sponsors of the Modernizing Opioid Treatment Access Act this month, his press statement referred to the opioid treatment program (OTP) model as a “cartel.” The proposed legislation would, like the OTAA proposed last year (see https://atforum.com/2022/11/otp-pressure-) make it legal for addiction-certified office-based physicians to prescribe methadone for patients with opioid use disorder (OUD), essentially removing the OTPs from any need to exist.
Here is Rep. Norcross’ press statement:
“This legislation lowers barriers to care at a time when we are still suffering staggering losses due to the ongoing opioid epidemic. We must end the monopoly on this life-saving medicine that only serves to enrich a cartel of for-profit clinics and stigmatize patients.”
Here is what Mark W. Parrino, M.P.A., president of the American Association of Opioid Treatment Programs (AATOD), told AT Forum about Congressman Norcross’ use of the word “cartel.”
It is both unfortunate and offensive that Congressman Norcross has stated that opioid treatment providers are like drug trafficking cartels. There are over 2,000 OTPs in the United States treating 600,000 patients on any given day. OTPs have been operating in the United States since the mid-1960s and have been responsible for treating millions of patients, both in the United States and thirty other countries. Our Association, in cooperation in with the American Society of Addiction Medication, developed the First Treatment Improvement Protocol for SAMHSA, which was published in 1993. This would be the first compendium published, providing clinical guidance in improving patient care in OTPs.
It is understood that elected officials will be critical of organizations that do not support their legislative agenda. There is no need for disparaging name calling in these debates. We are working to preserve the integrity of patient care during a continuing opioid use crisis driven by fentanyl.
I wonder where Congressman Norcross was from 1999 to 2010 when physicians where prescribing opioids to treat pain, which would be the lynchpin for the current opioid epidemic? We did send the Congressman the five published methadone mortality reports from 2003 to 2010. The conclusion of all five reports was remarkably consistent. Methadone mortality increased during that period of time when doctors were prescribing methadone to treat pain and methadone was distributed through pharmacy channels.
It is certainly our hope that we will find a path forward with such legislators since our interest is to expand access to quality treatment for the patients entering our system of care. In our judgment, Congressman Norcross and his cosponsors do not understand the implications of what they are proposing.
And here’s what Zachary C. Talbott, president of the National Alliance for Medication Assisted Recovery (NAMA Recovery), asked about the use of the word “cartel,” told AT Forum:
The MOUD patients who comprise a majority of the NAMA Recovery Board of Directors, as well as many NAMA Recovery members and stakeholders across the country who are MOUD patients enrolled in opioid treatment programs (OTPs), have a variety of OTP patient experiences that range from positive to negative. As may be found among other types of healthcare facilities, there are good, mediocre, and bad OTPs. Focusing only on the bad OTPs, however, paints an inaccurate picture of a field that includes many compassionate, patient-centered medical providers, counselors, nurses, and facility administrators who daily strive to provide quality, individualized care. It is also important to remember that the core evidence base which unequivocally demonstrates methadone’s efficacy was largely conducted within or adjacent to the OTP system. NAMA Recovery’s position since 1988 that stabilized methadone patients deserve options beyond an OTP should not be conflated with current methadone patients dismissing the critically important role OTPs have played historically, play currently, and must continue to play in the future. Many NAMA Recovery stakeholders proudly credit their OTPs and the comprehensive care they receive(d) from them with saving their lives.
AATOD does not support the proposed bill. NAMA Recovery does.
We contacted Representative Norcross and the American Society of Addiction Medicine, which supports and promotes the bill, for comments. Neither responded by press time.
Even if office-based physicians were allowed to prescribe methadone for OUD, whether they will or not remains to be seen. Many obtained the x-waiver to prescribe buprenorphine, but didn’t, or did only to a select few patients. Now that the x-waiver is gone, it remains to be seen whether buprenorphine prescribing will go up.
What would be a really good research topic now would involve proof that office-based methadone, with no other kind of support for the patients, for OUD in the United States would actually be beneficial and not have unintended consequences such as diversion. Methadone is not nearly as safe as buprenorphine, it builds up in the body and can cause overdoses on its own. Yes, for half a century methadone treatment by OTPs has been a success story in the United States. Now, riding on the back of that success, lawmakers are trying to say that removing methadone from the OTP model would work. And they are using rhetoric that is unscientific and unsavory to do so. It’s alarming that so many health organizations are agreeing with them.
For the press release, go to https://www.markey.senate.gov/news/press-releases/sens-markey-paul-and-reps-norcross-bacon-introduce-modernizing-opioid-treatment-access-act-to-reach-more-americans-suffering-from-opioid-use-disorder-as-annual-overdoses-surpass-100000-across-us