Imagine your doctor diagnoses you or one of your family members with a significant health condition that if left untreated results in a sixfold higher risk of death and results in debilitating mental and physical health symptoms. Fortunately, there is a well-established, inexpensive medication that is guaranteed to alleviate the symptoms and reduce the risk of death by 50%.
Surely you or your family member can access this medication readily, yes? If the diagnosis is opioid addiction, and that lifesaving medicine is methadone, the answer is unfortunately no.
This is the situation people with opioid use disorder (i.e. opioid addiction) who struggle with heroin, fentanyl or prescription pain medications and happen to live in many suburban and rural communities in Colorado face as they seek lifesaving treatment. Methadone, a medication developed in the 1940s, is the most effective medication for opioid use disorder.
Patients who have struggled for years with opioid use say that methadone helps them feel normal and provides the stability needed to improve their lives. Despite the ongoing surge of preventable overdose deaths, access to this medication remains restricted due to outdated regulations that prohibit the use of methadone outside of specific clinics.
Methadone’s restrictive regulations date back to the 1970s and the “War on Drugs.” People who want access to treatment are typically required to show up several times a week to federally licensed opioid treatment programs (“methadone clinics”) to be directly observed while taking methadone. There is little a patient can do if they miss doses because of family obligations, snow or illness except prepare for the inevitable and debilitating withdrawal symptoms.
Furthermore, these programs are geographically concentrated in urban areas. Of Colorado’s 34 opioid-treatment programs, only five are located outside of the Front Range, creating a situation where patients would be required to drive hundreds of miles over a single week to access methadone treatment, according to a 2020 study. For many rural and suburban Coloradans, it is simply not feasible to engage in treatment while maintaining a job or caring for children or family members.
Fortunately, there is an opportunity to change the outdated laws governing methadone treatment currently in the U.S. Congress. The Modernizing Opioid Treatment Access Act, or M-OTAA, is bipartisan legislation that proposes to safely increase access to methadone treatment.
While increasing flexibility for opioid treatment programs, M-OTAA will also allow addiction medicine specialists to prescribe methadone for patients to pick up at their local pharmacy, just as they do for most medications. The bill has been endorsed by all major addiction medicine societies including the American Society of Addiction Medicine and specifically empowers addiction medicine specialists to treat patients who may have limited access to methadone because of where they live.
Colorado Sen. John Hickenlooper serves on the Health, Education, Labor, and Pensions Committee and has supported the legislation. Now is the time for our other representatives to support this important legislation.
Despite broad support for this legislation by national addiction medicine experts and 20-plus years of evidence showing that methadone is effective when given outside of regulated clinics, there remain vocal critics of this legislation. Some believe that the chemical properties of methadone and the intensive services offered in opioid treatment clinics are reasons to keep methadone limited. There is also concern for over-prescribing and repeating the prescription opioid overdose crisis of the early 2000s.
While methadone, like many medications, can be dangerous if used inappropriately, highly trained addiction medicine specialists are well-suited to prescribe methadone in a safe and individualized manner. By removing outdated regulations, M-OTAA would help ensure that all Coloradans have access to safe and comprehensive addiction care from doctors, like us, who are experts in treating opioid use disorder.
People could receive a prescription from an addiction medicine specialist in a regular office, just like other complex illnesses, and pick up their methadone from their local pharmacy, increasing privacy, reducing stigma, and eliminating the geographic disparities in access to high-quality, effective opioid use disorder treatment.
By supporting M-OTAA, our elected representatives can help expand access to lifesaving treatment for all Coloradans, regardless of where they live. As the overdose crisis continues to devastate communities throughout our state, maintaining the status quo for methadone treatment is untenable. We urge our elected representatives to support M-OTAA and increase access to high-quality addiction treatment.
Paul Christine, MD, PhD, lives in Denver and is a primary care and addiction medicine physician and researcher. His focus is on increasing access to high-quality, low-barrier substance use disorder treatment and medical care for people who use drugs.
Christine Neeb, MD, lives in Denver and is a primary care and addiction medicine physician. Her focus is on integrating addiction medicine into primary care, particularly exploring novel ways to increase access to methadone for vulnerable populations.
Jarratt Pytell, MD, MHS, lives in Denver and is a primary care and addiction medicine physician and researcher. His focus is on improving the care of people who use drugs in primary care.
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