This week, the Modernizing Opioid Treatment Access Act (MOTAA), which would allow certified physicians (by the American Society of Addiction Medicine [ASAM] or the American Academy of Addiction Psychiatry [AAAP]) who are registered with the federal Drug Enforcement Administration (DEA) to prescribe methadone for opioid use disorder (OUD). Patients could then pick up these medications at a pharmacy.
The provision has been long in the making (see: Everything You Need To Know About MOTAA), and there is no certainty that it will pass the full Congress, but it is getting closer. It means that opioid treatment programs (OTPs) would no longer be the sole providers of methadone for OUD in the United States.
Practical considerations have not been addressed by politicians, such as the fact that most methadone patients get liquid methadone, problems with titrating and storing liquid methadone, how induction of new patients would be handled, whether pharmacies (which have not shown much interest in stocking even buprenorphine) would want to stock methadone for OUD, and more. The goal — stopping or staunching the tide of opioid overdose deaths — is a laudable one, and indeed one that expanding access to treatment would address. Eliminating the X-waiver for buprenorphine, which was supposed to accomplish the same thing, has not – at least, not yet.
Edward J. Markey (D-Mass.) who has been an enthusiastic supporter of limiting regulations on buprenorphine and, now methadone, as a sponsor of MOTAA has had much to celebrate with the Dec. 12 passage of MOTAA out of the Senate Health, Education, Labor, and Pensions (HELP) Committee, which he chairs. To say that Sen. Markey is gloating would not be an exaggeration, as even he called the current treatment system one that makes people in recovery criminals, laying the blame for it at the feet of OTPs (presumably, even his constituents, those in Massachusetts). “Methadone for opioid use disorder is locked behind arcane laws that criminalize and stigmatize people in recovery,” he said after the bill passed out of the HELP Committee. “The experts and evidence are clear: This outdated system is costing lives, and we should no longer stand by as outdated federal law keeps people from treatment that they need no matter where they live. We are pleased that my colleagues are joining with me in passing the Modernizing Opioid Treatment Access Act. Together, we took an essential step toward reducing stigma, expanding access, and saving lives in communities all across the country. We will keep fighting until the Modernizing Opioid Treatment Access Act is signed into law.”
Note: As a reporter who has closely covered substance use disorders and OTPs and methadone in particular for almost four decades, I am watching this debate closely. Like many political debates, it is supported by high minded rhetoric, but the reality on the ground is much different. Physicians certified by ASAM and AAAP, no matter what organizations they belong to, have never treated a patient with methadone for OUD unless they have worked in an OTP. Physicians are loathe to prescribe opioids even for pain now, as are hospitals, and pharmacies question prescribers, with everyone worried about the DEA. There is a reason opioid prescribing went down drastically in this country.