People Deserve Easy, Dignified, Methadone Access

What You Need To Know

• While methadone is the most effective treatment legally available for those diagnosed with opioid use disorder (OUD) it is the most stigmatized and the most heavily regulated. 

• Methadone access improves quality of life among patients.

• Barriers, like supervised urine screenings, denial of treatment due to use of other medications, and limited clinic hours and locations, make methadone difficult to access.

• White patients are more likely to be referred to a medical professional and receive medication as part of their treatment plan, and less likely to be terminated by the facility than are racially minoritized patients (Entress, 2021)

• Regions with large Black and Hispanic populations have also been shown to have reduced access to hospitals that offer medication-based treatment (Chang et al., 2022).

• In the United Kingdom, Canada, and Australia, clinicians have been using methadone to treat OUD in primary care settings and have prescribed take‐​home methadone since the late 1960s*. 

• Take home doses have been shown to improve outcomes. Specifically, increased access to take-home medication helps patients maintain employment without having to worry about budgeting time for long lines, unscheduled meetings with prescribing doctors, and random urine screens*.

• There should be no forced individual or group counseling, as the evidence simply does not demonstrate that counseling contributes to positive outcomes.

Common Barriers to Methadone

(from Urban Survivors Union : Methadone Manifesto)

• Punitive responses to urine drug screenings

• Overly interventionist, time-consuming, mandated counseling

• High barriers to take-home dose provision

• Stringent admission criteria and arduous intake processes

• Dose capping

• Rising clinic costs and exploitative charging practices

• Transportation difficulties

• Lockbox requirements

• Limited dosing hours

• Accelerated tapering schedules for administrative discharge

• Lack of patient autonomy in determining treatment plans.

Examples

• Ideally, programs would integrate harm reduction practices and person-centered care, even within the current regulatory environment. Some existing programs are already moving toward this ideal, such as the Community Medical Services clinics in Arizona, Ohio, and Wisconsin, which offer 24-hour induction and expanded dosing hours. 

Research

• “Low threshold OST compared to usual care is associated with better treatment outcomes.” Opioid substitution therapy: Lowering the treatment thresholds

• Integrating Opioid Use Disorder Treatment Into Primary Care Settings

• Barriers to Broader Use of Medications to Treat Opioid Use Disorder

• Permanent Methadone Treatment Reform Needed to Combat the Opioid Crisis and Structural Racism

Additional Resources

• The History of Methadone and Barriers to Access for Different Populations - Methadone Treatment for Opioid Use Disorder - NCBI Bookshelf (nih.gov)

• Pitt study endorses removing ‘liquid handcuffs’ for methadone prescribing

• Remove Barriers to Primary Care Practitioners Prescribing Methadone

• The Factors That Make Patients Quit Methadone - Penn LDI (upenn.edu)