Survey finds OTPs are implementing flexibilities

Reminder: In 2024, the federal government issued an overhaul of methadone regulations.

• The changes included greater flexibility in take-home medications. They also stressed that counseling should be offered but not required as a condition of receiving medication, and that drug testing should not be used to punish patients. The rules also eliminated the requirements for patients to have been addicted to opioids for over a year and to have tried and failed other forms of treatment twice before seeking treatment at an opioid treatment program (OTP).
• Why it’s important: Methadone for opioid use disorder is tightly regulated, creating significant barriers to treatment. The 2024 rules codified some flexibilities provided during COVID and aimed to loosen some of the restrictions to increase access to care.

But: There was a question of whether clinics and the state agencies that oversee them would make the shift.

The details: According to data collected by industry groups and the federal government, a significant share of OTPs have implemented major changes.

• The American Association for the Treatment of Opioid Dependence and the National Association of Addiction Treatment Providers conducted a survey that showed promising results. But the data are limited, with responses coming from 241 clinics, representing just over 10% of OTPs nationwide.
• The share of patients still in treatment after three months increased an average of 17% following implementation of the changes.
• More than 70% of responding clinics had adopted at least half of the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) recommended practice changes, including offering greater access to take-home medication and higher doses upon beginning treatment.
• Roughly two-thirds of state opioid treatment authorities, which oversee OTPs, adopted changes to offer and encourage counseling without threatening to withhold medication from patients who decline.

The bigger picture: Some experts noted that the survey could be clouded by selection bias – the possibility that the sample mainly included clinics that had embraced the changes and were eager to report their results.

• They said that most larger providers have not been proactive in implementing the changes and pointed to geographic disparities in the results.
• Clinics’ efforts to solicit patient feedback has also focused on “compliant” patients who follow clinic policy and have achieved stability, who are the least likely to benefit from the more flexible policies.

Read more: Two years after rules overhaul, have methadone clinics really changed?