New federal regulations take effect Tuesday that aim to make treatment for opioid use disorder more patient-centered. How much Pennsylvanians benefit from these reforms depends on state regulators.
Methadone is an extremely effective medication that people who are in recovery for opioid use disorder take to reduce cravings and withdrawal symptoms.
Methadone is also highly regulated. For example, patients can’t get the medication from a pharmacy, but instead must go to special clinics that often have limited hours and strict rules.
Researchers, clinicians and advocates have long argued that the current system creates barriers to care, which is why the American Medical Association and other leading health care organizations are praising the new federal rules that make it easier to start methadone treatment and reduce the number of in-person visits required of patients.
But Dr. Paul Joudrey, a board-certified addiction medicine physician and assistant professor at the University of Pittsburgh’s School of Medicine, said there’s some confusion among Pennsylvania methadone clinics as to how state policy aligns with the new federal regulations.
“I think providing clarity to the medical directors and opioid treatment programs would be a big first step to help adopting these flexibilities where we can,” said Joudrey, who added that if providers are uncertain about the new rules, they’re unlikely to change.
In February, Pennsylvania’s Department of Drug and Alcohol Programs alerted clinicians that the federal government had finalized new methadone rules. The department says it is reviewing the updates and will have more in the near future.
“DDAP believes all Pennsylvanians living with substance use disorder should have access to drug and alcohol treatment by removing restrictive barriers and is working to destigmatize treatment such as medications for opioid use disorder,” said a department spokesperson.
Joudrey says the federal changes for methadone are a good start, but ultimately don’t go far enough to expand access. For example, while patients are now permitted to take home more doses of methadone, the rules still dictate that they must still go to a clinic as frequently as every other day when starting treatment.
“If you're someone who lives in a community that's far away in Pennsylvania from a methadone clinic, this doesn't do much for you,” said Joudrey.
The clinic-based system is ostensibly designed to prevent misuse of methadone, which can cause overdose. (Though the National Institute on Drug Abuse notes that most of these fatalities involve methadone that’s prescribed for pain management, not addiction treatment.)
Today’s methadone regulations are also reflective of Nixon Administration-era attitudes: When it was approved by the Food and Drug Administration in 1972, policy makers tended to view addiction as a criminal justice issue, as opposed to a matter of public health.
Joudrey wants clinicians who are already registered with the U.S. Drug Enforcement Agency and prescribing controlled substances to be able to write prescriptions for methadone as a treatment for opioid use disorder. Then patients can get the medication from their local pharmacy and not be burdened with frequent visits to a clinic. Until that happens, Joudrey said Pennsylvanians living in many rural and suburban communities will be cut off from treatment.
