By Allison Lu
People who are struggling with addiction need access to treatment, not barriers. This includes medication that can help with addiction, such as methadone. Methadone is an FDA-approved medication that helps people reduce or quit their use of heroin or other opioids. Although there are messages all over for people who are struggling to get help, the reality is that stigma against people who use drugs makes it difficult to access treatment. This started to change during the COVID-19 public health emergency when the government relaxed rules requiring people to visit specific sites to receive their medication.
Dispensing methadone in person through specific sites is stigmatizing and inconvenient for many people who use drugs. For one, community members can identify a patient who comes in as a person who uses drugs. The practice of dispensing medication stigmatizes people who are on methadone treatment. It is also a major inconvenience or simply inaccessible for people who have to travel to the methadone clinic daily.
More than 400,000 Americans received methadone before the start of the pandemic. These individuals needed to travel to their methadone clinic daily, even if it was very far away. Daily travel to the methadone clinic is a major chunk of one’s day. This affects a person’s ability to work and can exacerbate any difficulties they face. For example, in eastern Washington state, there is only one methadone clinic. This forced patients in that state to travel long distances to access a methadone clinic. One individual even compared the strict methadone take-home policies to “liquid handcuffs.”
During the COVID-19 public health emergency, the Substance Abuse and Mental Health Services Administration (SAMHSA) relaxed rules on methadone to stop the spread of COVID-19 by improving methadone maintenance treatment (MMT) access. This allowed opioid treatment programs to request take-home methadone exceptions for stable patients. Patients considered “clinically stable” could receive a month’s supply of methadone. And people who were less stable could get two weeks’ worth of take-home doses. This reduced the number of patients coming into the clinic and decreased the risk of COVID-19.
Flexible rules on take-home dosing are vital to improving methadone access. Even though the COVID-19 pandemic has been awful, it has been a blessing in disguise for people receiving MMT. It magnified how the rules for dispensing methadone were too strict and unnecessary.
Research on the impact of the methadone take-home policy shows how it benefits people on MMT. States and opioid treatment programs also report that this policy is helpful. It allowed more people to engage with treatment and improved patient satisfaction. Research shows that people with access to take-home MMT feel more independent and are more willing to follow their treatment regimen.
Yet, despite the clear benefits of the take-home policy, SAMHSA has not decided whether it will make this policy permanent. As such, people worry about how this policy change will impact their daily lives. They should not have to worry about when or if SAMHSA will overturn this policy.
Methadone take-home flexibilities should be permanent.
Misconceptions about methadone and people on MMT led to restrictive policies such as on-site dosing in the first place. Policymakers must not let stigma dictate sensible policy. For example, many people oppose allowing methadone take-home flexibilities due to the mistaken idea that people will sell their methadone doses. Yet, research has shown that diversion of take-home doses because of this new policy is rare. This misconception is incorrect and can perpetuate stigmas against people using methadone. Moreover, it further pushes people who use methadone away from obtaining health services.
The research is clear that the methadone take-home policy allows more people to engage with treatment. It also allows opioid treatment program providers to have a stronger relationship with their patients. Patients trust providers to manage their methadone without unnecessary daily visits, which helps improve the provider-patient relationship. Further, emergency room visits and the number of people experiencing an overdose did not change with this policy.
While SAMHSA has considered making this policy permanent, it has not confirmed anything yet. Making it permanent would allow more than 476,000 patients the privacy to take methadone in their own homes. As such, it would be a mistake to end methadone take-home flexibilities.
If we’re serious about supporting people living with addiction, then we should make access to treatment as easy as possible. Methadone take-home flexibilities should be permanent.
Alison Lu is a junior at Brown University pursuing a concentration in Public Health and a certificate in Engaged Scholarship. She was also a Drug Policy Alliance intern in Fall 2022 where she learned about and participated in many of DPA’s efforts to improve the health and well-being of people who use drugs. In the future, she plans on attending medical school to become a physician dedicated to helping underserved populations.