Tuesday, March 27, 2018

Ban on methadone vans seen as barrier to treatment

A patient talks to a nurse and the driver of a methadone
van parked in Baltimore. (Pew Charitable Trusts photo)
Mobile methadone vans have served people with opioid addiction in rural areas and inner-city neighborhoods for nearly 30 years, but federal reluctance to approve new vans is hampering agencies' ability to fight the current opioid epidemic.

"The U.S. Drug Enforcement Administration, which regulates dispensing of the FDA-approved addiction medicine, has refused to license any new methadone vans since 2007 over concerns about potential diversion of the medication," Christine Vestal reports for Stateline, the news service of the Pew Charitable Trusts.

The federal Substance Abuse and Mental Health Services Administration and some state and local addiction agencies are asking the DEA to lift the moratorium. Mark Parrino, head of the methadone industry's professional organization, the American Association for the Treatment of Opioid Dependence, questioned the ban, saying that no security breach of a methadone van licensed before the moratorium was ever reported. Regulations that would allow methadone vans to be licensed is months away from completion, DEA official James Arnold said at a recent AATOD meeting.

Of the three medications used to treat opioid addiction, methadone is the oldest, most researched, most widely used, and the most tightly regulated. Unlike buprenorphine and naltrexone, which can be prescribed and taken at home, methadone must be taken at one of about 1,500 dispensing locations. Seattle area behavioral health official Brad Finegood told Vestal, "Mobile treatment vans are critical to addressing the opioid epidemic . . . As this epidemic grows and changes, concentrations of people who are affected by it can be found in shifting locations within the city and county. If we’re going to be effective, we need to be nimble and bring the medication to them instead of asking everybody to trudge across town to get their daily dose at a fixed facility." Many opioid addicts seeking treatment say they can't find a treatment program within commuting distance, according to Pew research.

Officials in Connecticut, Maryland, New Jersey, New York and Washington state want new methadone vans but have been blocked by the moratorium. Parrino said Puerto Rico needs vans badly, since Hurricane Maria destroyed most of the island's transportation infrastructure and medical facilities.

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