Methadone treatment was too restrictive to help my son

Legal and regulatory restrictions create barriers to accessing lifesaving methadone treatment

By Lynda McDonald

Fatherhood inspired my son to seek treatment at a methadone clinic. But, repeatedly, he was denied access to this lifesaving treatment.

Once he committed to addressing his opioid use, the clinic rules and regulatory environment made it almost impossible for him to work or see his son.

As patients are required to go daily to take the medication, he would have to go early in the morning to keep his job. However, he would find out that his medication was withheld once he arrived because his counselor needed to see him. He’d often have to choose between going to work or waiting for the counselor to come in and release the hold.

Clinic staff was limited, unlicensed and overworked; many were interns who had no clue what to do. There were few people to help him or help resolve treatment roadblocks.

For instance, he would be penalized for not joining a weekly 5:00pm meeting. It was on Zoom with limited capacity, so when he tried to get on, it was filled by 4:45pm. Furthermore, the clinic dispensed doses from 6:00am to noon. With only one nurse working at 6:00am, the line was so long he couldn’t wait. There was no consideration for him as a person or that he was proactively seeking treatment. He couldn’t meet their demands. He was passing all his urine tests, but they wouldn’t let him take any doses home because he never made a meeting.

These pre-dawn mornings, hours spent in line instead of with his son, and penalties for missed meetings went on for over a year. Ultimately, he decided to just come off of it, as it was more of a burden than a help.

This went on for over a year at which time he decided to just come off of it as it was more of a burden than a help.

The Problem

Despite decades of research demonstrating that methadone is one of the most effective treatments for opioid use disorder, access to the medication remains limited due to outdated federal requirements that are rooted in stigma and unnecessarily restrict access to this lifesaving medication.

Federal law limits its availability to specific clinics – known as opioid treatment programs (OTPs) – rather than allowing it to be provided at a doctor’s office or pharmacy like other medications. Notably, when methadone is used to treat pain, such restrictions do not apply. Patients are required to go to OTPs daily to take the medication, which can present problems regarding employment, education, child care, transportation, etc. These barriers, as well as the stigma around methadone stemming from the strict regulations that differentiate it from other medications, can often prevent people from seeking needed treatment.

The Solution

The federal requirements around methadone are outdated and rooted in stigma and need to be permanently changed. Prescribers should be allowed to prescribe methadone to patients to be dispensed at pharmacies and taken at home.

During the COVID-19 pandemic, the federal government authorized flexibilities that allow patients to take home up to 14- or 28-day-supplies of methadone. Preliminary studies have shown that these larger take-home quantities have increased engagement with treatment, improved patient satisfaction, and resulted in very few incidents of misuse or diversion of the medication.

Take Action

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Tell your members of Congress to support improved access to medications for addiction treatment

Tell your members of Congress to cosponsor the Opioid Treatment Access Act, which would remove barriers to care, including allowing increased access to take-home doses to be dispensed at pharmacies.