Mike Incze and A. Taylor Kelley: It’s time to change the outdated laws governing methadone treatment

Our current system is an especially poor fit for largely rural states like Utah.

(Trent Nelson | The Salt Lake Tribune) A dose of methadone is dispensed at Operation Recovery's clinic in Price on Wednesday, March 22, 2023.

If you were to receive a diagnosis of diabetes, you’d probably waste little time finding treatment. After all, diabetes is a leading cause of death in the United States, and treatment is critical and often life-saving. But imagine that your only option is to visit a doctor who lives more than 100 miles away, has limited hours and will only dispense medication to you at the clinic — one day at a time.

That may sound absurd, but for many patients in Utah and across the country, that’s what treatment for opioid use disorder (i.e., opioid addiction) looks like. Methadone — the primary medication used to treat opioid use disorder — reduces the risk of death and disability by more than 50% and is recognized as the one of the most effective medications for addiction ever developed. Yet access to methadone in the U.S. is remarkably restricted, creating a paradoxical challenge for individuals seeking life-saving treatment. But by passing the Modernizing Opioid Treatment Access Act (M-OTAA), Congress can change that.

We write this letter as physicians, researchers, addiction experts and Utahns who are committed to stemming the tide of preventable overdose deaths in our state and beyond. In these unprecedented times, where illicit fentanyl and toxic adulterants like xylazine have overtaken the illegal drug market, it is incumbent to ensure effective treatment is accessible to everyone.

Unfortunately, less than half of individuals with opioid use disorder are currently able to access any treatment. While new laws enacted over the past year have made it easier for healthcare providers to prescribe buprenorphine (i.e., Suboxone), methadone remains fettered by antiquated policies from the War on Drugs of the 1970s. These longstanding federal barriers effectively deny treatment to millions of Americans.

Why is methadone so difficult for patients to access? One major reason is that doctors, including addiction specialists like us, cannot prescribe it to treat addiction. Any patient seeking methadone for addiction treatment must receive it at a federally-licensed opioid treatment program (i.e., “methadone clinic”). While these programs can be therapeutic for their participants, the bar for participation is exceedingly high. Patients must go in person six days per week for observed dosing for months when starting treatment. Patients who miss a dose because of snow, illness or emergency family or work obligations have no option but to suffer destabilizing symptoms of withdrawal, which increases the risk of returning to drug use.

Our current system of methadone regulation is an especially poor fit for largely rural states like Utah. There are only five opioid treatment programs in Utah outside of the Wasatch Front. For Utahns living in rural areas, commuting to and from a treatment program can take hours each day, making things that many of us take for granted like childcare and employment nearly impossible. The situation is even more dire in our neighboring states — Idaho has a total of six opioid treatment programs, and Wyoming has none.

Fortunately, right now we have a rare opportunity to change the outdated laws governing methadone treatment. M-OTAA is a bipartisan, bicameral piece of legislation that could bring methadone treatment into the 21st century. The bill allows for increased support for and flexibilities within opioid treatment programs, but more critically it would allow addiction medicine specialists to prescribe methadone for patients to pick up at their local pharmacy under the oversight of the same federal organization that currently regulates methadone clinics. The bill has been endorsed by all major addiction medicine societies in our state and the country, including the American Society of Addiction Medicine and the Utah Society of Addiction Medicine.

Despite this overwhelming endorsement by addiction experts, M-OTAA needs more support, especially among Republicans, to advance the bill out of the Health, Education, Labor and Pensions (HELP) committee. Sen. Mitt Romney, because you serve on this committee, your co-sponsorship and championing of the bill would provide critical support for this legislation and extend a new lifeline to countless Americans and Utahns who are currently unable to access this life-saving treatment.

Critics of M-OTAA say that the relatively complex properties of methadone and the wrap-around services provided by opioid treatment programs are reasons to keep the medication confined to specialized centers. While methadone can be dangerous if used inappropriately, addiction specialists like us are well-trained to safely prescribe the medication. Services like behavioral health counseling and social work are increasingly available in settings like primary care, where we work, in addition to comprehensive, whole-person healthcare that cannot be found at most opioid treatment programs.

Sen. Romney: You have a unique opportunity to continue your longstanding commitment to making high quality healthcare available to all people. We urge you to co-sponsor and champion M-OTAA to increase access to opioid use disorder treatment. The lives of some of your most vulnerable constituents depend on it.

Mike Incze

Mike Incze, MD, MSEd, is a primary care and addiction medicine physician, advocate and researcher who is dedicated to increasing access to high quality, stigma-free medical care and substance use disorder treatment for anyone who needs it. His work primarily focuses on integrating substance use disorder treatment into primary care clinics and improving care transitions from hospital and emergency room settings to long-term follow up treatment.

A. Taylor Kelley

A. Taylor Kelley, MD, MPH, MSc, is a primary care physician who provides addiction treatment to vulnerable Veterans living in and around Utah. He is a federally funded researcher and advocate committed to improving patient-centered care for all individuals affected by substance use disorders.

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