In the past year, the administration has taken a more negative approach to medications for addiction treatment, STAT reports.

Reminder: When Department of Health and Human Services (HHS) Secretary Kennedy took office last year, he broke ground as the first health secretary openly in recovery from substance use disorder. And he quickly said that medications for opioid use disorder (MOUD) would remain an essential part of the overdose crisis response.

• But: Since then, the administration and some members of Congress have taken actions suggesting less support for the approach.

The details:

• Last year, the administration appointed Michael Stuart, a former West Virginia state lawmaker who introduced legislation to ban methadone treatment in the state, as the top HHS lawyer (though he was recently reassigned to an unknown role within HHS).
• In September, Rep. Houchin introduced legislation to roll back flexibilities enacted by the Substance Abuse and Mental Health Services Administration (SAMHSA) to make methadone treatment more accessible (e.g., expanded take-home doses, telehealth, eliminating the requirement that someone have opioid use disorder for a year before receiving methadone treatment).
• In April, SAMHSA issued a “Dear Colleague” letter cautioning against the long-term use of methadone or buprenorphine.
• Cuts to SAMHSA could impede provision of MOUD.

The main point: Taken together, the actions represent a resurgence of hostility toward MOUD, which in recent years had become a largely settled issue.

• Many have historically derided MOUD as “just substituting one drug for another.” But in the past decade, as overdose deaths reached record highs, MOUD had appeared to gain consensus across the political spectrum.
• The winds now seem to have shifted away from evidence-based health approaches toward a more punitive response.

The bigger picture: Though the administration has not directly opposed the use of MOUD, the moves come amid a broader push from Kennedy and other officials to reduce use of psychiatric medications and as the administration has expressed interest psychedelics as addiction medications.

Why it’s important: Methadone, buprenorphine, and naltrexone remain the only drugs approved by the Food and Drug Administration (FDA) to treat opioid use disorder. Decades of research has proven their effectiveness, but they remain widely underutilized.

• Experts are worried that the SAMHSA letter could lead some providers to quickly discontinue buprenorphine treatment for patients or discourage them from seeking methadone.