Methadone is a proven treatment for people with opioid use disorder, and policymakers should be guided by patients, to create policies for patients, that promote access to this “lifegiving care,” Pew Trusts outlines in a new bulletin about substance-prevention and treatment.
Methadone can help prevent overdose deaths; it is highly effective in reducing opioid cravings and withdrawal symptoms, research shows. But because it is so highly restricted, it doesn’t get to the people who need it. As a result, since 2021, more than 100,000 people in the U.S. have died annually from drug overdoses, according to the Centers for Disease Control and Prevention. But methadone also remains tightly restricted, available mostly through treatment providers, and people can find it difficult to access, especially if they live in rural areas or rely on public transportation.
Pew has written in the past about the state and federal rules regarding methadone and how those rules create barriers to accessing care. In February 2024, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) addressed some of these barriers by updating federal rules governing opioid treatment programs, known as OTPs, currently the only sites that can provide methadone for treating opioid use disorder. The changes were intended to make methadone treatment more flexible by allowing for increased use of telehealth and lowering restrictions on take-home dosing—the practice of allowing patients to take doses of methadone home rather than requiring that every dose be observed at the OTP.
Despite these changes, policy barriers to accessing methadone treatment still exist. Pew’s recommendations for reform are informed by a national conference held last fall called Liberating Methadone: Building a Roadmap and Community for Change, where stakeholders with lived expertise along with healthcare providers and researchers proposed reforms to create a methadone treatment system that embraces a “holistic, person-first approach.”
To create a broader treatment system, Pew recommends, healthcare providers such as hospitals and nursing homes, which currently dispense methadone in very limited circumstances, should train their providers to provide a short supply to start treatment for hospital patients, for instance, or to help patients continue methadone treatment during nursing home stays or providing longer-term take-home medication for patients upon discharge with expanded telehealth options, new methadone providers and dispensing pharmacies – all of which are trained to deliver individualized care, not fixed dosages and not dosages only dispensed from OTPs.
Pew also emphasizes that anti-stigma campaigns are important, to boost care. “People working in the criminal legal system, especially judges, should also be trained on the benefits of methadone treatment for people on probation and parole as well as for those who are incarcerated.”