New research from the University of Pittsburgh finds that legislation that has bipartisan support in Congress would expand access to a medication that many refer to as “liquid handcuffs.”
Methadone can be a game changer for people who are addicted to opioids. The medication prevents painful withdrawal symptoms and blunts cravings, allowing people to slowly wean off drugs such as fentanyl, heroin and oxycodone.
In out-patient settings, methadone is only available at special clinics that dispense limited doses – some require people to come daily for the medication. This ostensibly prevents misuse of methadone, which itself is an opioid: With proper dosing people don’t feel high as methadone has limited euphoric effects when compared to illicit opioids.
The Modernizing Opioid Treatment Access Act would allow patients to circumvent clinics by getting methadone from a pharmacy with a prescription from an addiction medicine physician. MOTA is supported by a host of advocacy organizations, including the American Society of Addiction Medicine.
According to research published in the journal “Health Affairs Scholar” from the University of Pittsburgh’s Dr. Paul Joudrey, an addiction medicine specialist, MOTA would expand methadone access from 49% of US Census tracts to 63% of tracts.
Though MOTA’s impact is relatively modest in growing methadone’s footprint, Joudrey argues it could have a meaningful impact on opioid-involved overdose fatalities – deaths have been climbing for more than two decades.
“It’s kind of a really painful thing to witness as we see overdose deaths continue,” said Joudrey. “We have this proven treatment kind of locked away.”
Liquid Handcuffs vs. Trojan Horse
Though pharmacies dispense methadone tablets for pain management, the liquid or concentrate form is commonly found at clinics where patients consume it under supervision.
The clinic system was set up in the 1970s under the Nixon Administration. Scholars say regulations reflect attitudes of the era which often viewed addiction through the lens of criminal justice, as opposed to public health.
Critics, such as Joudrey, argue these half-century-old regulations impose unfair burdens: The daily, or near daily, visits interfere with patients’ work schedules, parenting and other responsibilities. Before taking an out-of-town trip, people must also get special permission for take-home doses.
Many patients complain that the culture at clinics is paternalistic and unpleasant. For example, an analysis from Pew found that Pennsylvania is 1 of 10 states that require clinic staff to watch patients while they urinate for drug screens. Some patients find this degrading.
The American Association for the Treatment of Opioid Dependence, the industry trade group representing methadone clinics, opposes MOTA. Executive director Mark Parrino calls the legislation a Trojan Horse that would allow methadone to be prescribed without any of the therapeutic support and oversight provided by clinics. Parrino warns MOTA could lead to an increase in methadone-involved overdoses. It’s a concern shared by the Addiction Policy Forum.
A number of law enforcement associations – including the Major County Sheriffs of America, the National Alliance of State Drug Enforcement Agencies and the National Association of Police Organizations – say MOTA might lead to a rise in crime.
Methadone requires special care, agrees Pitt’s Paul Jourdrey. He says this can be achieved through the prescription drug monitoring program, which is an electronic database that tracks controlled substance prescriptions. He points to other countries, such as Australia and Canada where MOTA-like policies already exist.
“The pharmacology of methadone doesn't change upon crossing from Canada into the United States,” said Joudrey. “What those other countries show is that you can achieve many of the same degree of safety checks that exist in a methadone clinic, in a pharmacy.”
