In response to the recent piece by Mike Incze and A. Taylor Kelley, “It’s time to change the outdated laws governing methadone treatment”:
As a provider at an opioid treatment program (OTP) in Ogden, I agree that reforms are needed to increase access to methadone for patients with opioid use disorder. However, the authors’ proposed solution, the Modernizing Opioid Treatment Access Act (M-OTTA) would take us in the wrong direction.
The authors correctly assert that methadone is the one of the most effective medications for addiction, yet fail to acknowledge its effectiveness is due to it being administered in the evidence-based OTP model that prioritizes behavioral services and patient oversight to prevent misuse and diversion. M-OTTA would undo that and allow private practice physicians to prescribe 30-day supplies of the Schedule II narcotic for patients to pick up at local pharmacies without any oversight.
Recent policy changes have allowed OTPs to provide stable patients take-home supplies of methadone, a change broadly supported by the OTP community. But we are only just beginning to understand the implications and recent studies are conflicting as to whether it results in increased overdose risk.
Methadone induction for patients addicted to fentanyl and xylazine can take weeks until the withdrawal symptoms subside. Allowing a new patient suffering through painful withdrawal unsupervised access to a 30-day supply of this narcotic will likely result in some patients self-administering deadly doses to ease symptoms.
I share Drs. Incze and Kelley’s goal of getting more Utahns in treatment, but respectfully, as a physician who treats patients with methadone every day, unsupervised use would be catastrophic. Policymakers should instead provide increased funding for OTP mobile clinics and fund partnerships between OTPs and Federally Qualified Health Centers to reach patients in rural areas. As such, I urge Sen. Mitt Romney to withhold his support of M-OTTA and instead support evidence-based policies to safely expand access to methadone.
Scott Carleton, Ogden
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