Biden administration officials and a bipartisan group of senators believe that if users were treated with another opioid, the alarmingly high rate of fatal fentanyl deaths in America could be cut in half.
They and others in favor of increased availability of methadone say that hundreds of lives may be saved if addiction specialists could prescribe it outside of the current network of clinics that are allowed to dole it out.
Noa Krawczyk, a professor at NYU Grossman School of Medicine who studies barriers to addiction treatment and supports the administration’s drive, described the current situation as “desperate” and said that the benefits of having more individuals on methadone outweighed the hazards.
The directors of methadone clinics, however, are opposed to the idea because they have the most direct experience with methadone treatment. Permitting prescriptions outside of clinics, they warn AWN, is dangerous since it lacks their stringent protections. Methadone is a highly addictive opiate that, when misused, can be fatal.
The president of the American Association for the Treatment of Opioid Dependence, Mark Parrino, stated that “the idea that a physician in private practice without support staff… that they’re going to be able to treat a complex medical problem like the use of fentanyl, is just not substantiated.” This organization represents methadone clinics.
There is a lack of consensus on how to move forward because fatal overdoses increased by over 50% during the epidemic and then decreased somewhat to 103,451 in the year ending in March. Clinics are concerned that it could exacerbate the overdose problem, despite the fact that methadone accessibility advocates cite that number as sufficient justification to reconsider treatment regulations that are already decades old. At least in the one place that really matters—Congress—they are now on top of the argument.
In spite of a bipartisan vote in a crucial committee and a strong push from National Institute on Drug Abuse Director Nora Volkow, a bill to extend methadone availability, introduced by the unusual Senate duo of Ed Markey (D-Mass.) and Rand Paul (R-Ky.), continues to stagnate. According to Volkow, if methadone and equivalent medications were widely available, the number of fatalities caused by fentanyl could be cut in half.
Patients would be able to pick up their prescriptions at the pharmacy under the new law, which would change both the prescription and dispensing processes for methadone. These days, getting your dose now requires daily visits to a clinic, where you’ll be monitored. Clinics are generally located far from patients’ homes, which makes it difficult for them to adhere to therapy, according to patients and bill proponents.
Nonetheless, enough Republicans have been swayed by the clinics’ arguments that expanding access is not without serious dangers. Those in favor of the shift, according to Parrino, are relying too heavily on methadone without also taking into account the other services offered by the clinics.
Legislators sympathetic to the clinics’ positions, like North Carolina Senator Ted Budd (R), frequently bring up the grim past of the opioid crisis, which was stoked by unscrupulous medical professionals and pharmaceutical companies that distributed OxyContin like sweets. They argue that easing access to methadone could lead to a recurrence.
Budd stated that the opioid epidemic would be worsened rather than resolved if diversion-control measures and wrap-around services were eliminated because it would lead to increased methadone usage and trafficking.
Proponents of expanded prescribing argue that legislators who are against the reform are overly risk-averse at a time when the present system is ineffective, and that clinics care more about preserving their turf than about saving lives. Studies showing that methadone or comparable medications aren’t being administered to three out of four patients who could benefit from them are cited by them.
Markey warned that “more people are going to die than is necessary” if the task was not completed.
He added that his bill is a part of a larger movement to reframe drug abuse in the United States as a public health concern rather than a criminal offense.
The Republican president’s harsh stance, which Markey claimed stigmatized drug users and fostered a negative view of treatment, was referred to as the “Nixon years,” and the legacy of that policy is still with us, he added.
Methadone: the argument
There was some optimism that fatal overdoses may have peaked last year; preliminary data from the CDC showed a 7.5% decline in the year ending in March, although this is still significantly higher than the 70,000 or so deaths that occurred at the start of the pandemic.
The move would not entail giving up on holistic care, according to the proponents of methadone distribution through pharmacies, which include the American Society of Addiction Medicine. More patients would remain in treatment if methadone was more widely available, they say, which would improve the chances of long-term recovery.
The reason we’re still facing an overdose crisis, according to Dr. Brian Hurley, president of ASAM and an addiction physician at the Los Angeles County Department of Public Health, is that there isn’t a system in place to prevent patients from dropping out of treatment too soon.
Buprenorphine, in conjunction with naloxone and naltrexone, is another medication option for opioid use disorder, in addition to methadone. They are easily available at pharmacies and prescribed by numerous doctors due to the low or nonexistent risk of addiction.