A recent story in Alcoholism & Drug Abuse Weekly focused on the reasons that more than 90% of opioid treatment programs use methadone, mainly liquid methadone, and how this formulation could not be practical in an office-based or pharmacy setting.
For the story, go to https://onlinelibrary.wiley.com/doi/10.1002/adaw.33873
“For pharmacy dispensing, they would need a safe,” said Dustin Alvanas, chief operating officer of CODAC in Rhode Island. “The safe that is required for methadone is 10,000 pounds. The safe has to be closed and locked when not being used. And when the DEA walks in, it better be. The methadone itself is very inexpensive, but I would be interested to know if the pharmacy is willing to incur the cost of the safe, the security, and the staffing. If the pharmacy were to do liquid, they would have to have this monstrous safe, have an electronic system to inventory the medication. If they’re going to tablet, how are they going to treat someone who gets 100 milligrams? I can’t see pharmacies carrying a large amount of methadone on hand. If you get 28 days of methadone tablets, that’s going to be 500 or 600 tablets.”
“A community pharmacy can already dispense methadone for OUD [opioid use disorder] by becoming a medication unit associated with a licensed OTP,” said Lucas G. Hill, Pharm.D., clinical associate professor, University of Texas at Austin College of Pharmacy.” To do so, they must complete several mountains of paperwork and follow all the same dispensing rules as an OTP (e.g., separate safe for methadone bolted to the floor). They must also maintain a separate entrance and a separate dosing window for OTP patients. These costly structural requirements render community pharmacy dispensing of methadone nonviable in almost all cases.”
And Hill added: “I expect legislation enhancing methadone access to leave many questions related to dispensing regulations in community pharmacies unanswered and subject to later agency rulemaking processes. I assume those rules will be very strict and mostly unchanged from the current rules for OTP dispensing. Thus, methadone liberalization is likely to be far more conservative and gradual than advocates want and opponents fear.”
A current deep dive into buprenorphine as prescribed by OTPs is forthcoming in ADAW.