Across the United States, about 1.6 million people struggle with opioid use disorder (OUD), a chronic disease that includes addiction to heroin and prescription painkillers such as oxycodone. Methadone is a lifesaving medication for treating OUD; expanding access to the drug is critical to addressing the opioid crisis.
Decades of research demonstrate that methadone and two other Food and Drug Administration-approved medications reduce overdose deaths, illicit opioid use, and the transmission of infectious diseases such as hepatitis C and HIV. However, methadone can be dispensed only by opioid treatment programs (OTPs), which must also provide counseling and can offer a range of other services and additional medications for OUD. As of March 2019, about 409,000 patients were receiving methadone treatment and, as of July 2021, 1,836 OTPs were operating across the U.S.
But OUD—and even the medications proven to help manage the disease—is highly stigmatized. Some policymakers, health care providers, and even patients themselves still view addiction as a moral failing and not a chronic medical condition. As a result, many barriers to treatment exist. A new issue brief from The Pew Charitable Trusts offers the following recommendations for federal and state policymakers so they can reduce these barriers.
Federal and state rules tightly control where OTPs can be established, when and how they can dispense medications, what services they must offer, and which professionals they must employ to oversee treatment. These regulations are intended to protect patients and communities, but they can be overly burdensome. To strike a better balance between safety and access:
In many cases, patients must wait weeks to be enrolled in an OTP, during which time medication is not yet available. And even after that lengthy process, they then must visit the clinic in person, typically daily, to receive their medication. This can be prohibitively difficult, especially when people live far away or have conflicting responsibilities such as work or child care. To enable more patients to benefit from methadone:
OUD disproportionately affects people eligible for Medicare (older adults and individuals with disabilities) and Medicaid (individuals earning lower incomes). Although both programs currently cover treatments for OUD, the requirement that all Medicaid programs do so is temporary. Further, many OTPs do not accept reimbursement from these programs. To reduce the financial burden of treatment on patients:
OTPs—and the medications they dispense—work. Federal and state policymakers have several opportunities to increase access to both and help thousands more Americans recover from OUD.
Ian Reynolds is a senior manager and Vanessa Baaklini is an associate with The Pew Charitable Trusts’ substance use prevention and treatment initiative. Josh Wenderoff is an officer with Pew’s health programs.