Some U.S. lawmakers want to change methadone treatment availability, but their plan's success seems unlikely

When it comes to substance abuse disorder, perhaps
there is 'no cure.' (Adobe Stock photo)

Solving the U.S. fentanyl overdose crisis has led to political discussions about decreasing methadone treatment restrictions. A recent proposal by a bipartisan group of U.S. senators seeks to save lives by "allowing addiction specialists to prescribe [methadone] outside of the clinics now permitted to dispense it," reports Carmen Paun of Politico. But the bill faces opposition from methadone clinic directors who maintain "that allowing prescribing outside of clinics is risky without their strict safeguards. Methadone is an addictive opioid that’s deadly if abused."

If passed, the bill "would reshape not only how methadone is prescribed but also dispensed — patients could pick up their prescription at the pharmacy," Paun explains. "Now, most have to go in person every day to a clinic to receive their dose under supervision." The additional time and expense of daily travel to and from treatment clinics can make recovery more difficult.

Conflicts over methadone are like a catch-22: "Proponents of making methadone easier to get say that [fentanly's death] toll is ample reason to rethink treatment rules that are now decades old," Paun reports. "The clinics fear it’s a bad idea that could make the overdose problem worse. Thus far, they’re winning the debate in the only forum that matters: Congress."

As the legislation stands now, it is not likely to become law, but the opioid problem remains. "The clinics have succeeded in convincing enough Republicans that expanded access comes with significant risks," Paun writes. "Advocates of broader prescribing say the clinics are more interested in protecting their turf than in saving lives. . . "

Even if methadone could be dispensed through the pharmacy model, the drug isn't a panacea. "Many of those who start methadone treatment drop out within the first year," Paun reports. "Only 34% of a sample of 39,000 patients at BayMark Health Services, one of the nation’s largest methadone treatment providers, were still in treatment one year after they started . . .The reality of opioid use disorder is that, for many, there is no cure, experts in the condition say. Rather, it’s a chronic condition needing lifelong medication and management."