One of the best tools to manage the opioid crisis already exists


In the years since a member of my family started taking methadone, a drug that helps him avoid the excruciating withdrawal symptoms and intense cravings that come with an opioid use disorder, he attended the funerals of three of his closest friends with whom he used drugs. The number of acquaintances he has lost is in double digits.

Methadone might have saved them, if only they could get it at their local pharmacy.

Like heroin or oxycodone, methadone stimulates opioid receptors in the brain. The difference is that while heroin rapidly floods these receptors leading to an intense high, methadone’s effect is more gradual and long lasting. At the right dose, my family member (whom I won’t name due to the lingering stigma surrounding opioids) and other patients can get full days of relief from pain, withdrawal, and cravings, without intoxication. . But methadone is strictly regulated. Rather than picking it up from the local pharmacy, patients have to visit a specialist clinic – often daily – to get each individual dose.

In March 2020, concerns over Covid-19 led the Substance Abuse and Mental Health Services Administration, or SAMHSA, to relax these restrictions. The agency announced that states could apply for an exception allowing clinics to offer a greater quantity of take-out doses – up to 28 days – for patients believed by the clinical team to be stable and able to handle the drug safely. Some clinics have seized the opportunity. In a multi-state investigation of 170 opioid treatment programs, about half followed SAMHSA’s relaxed guidelines for newly enrolled or less stable patients. And two-thirds of the clinics surveyed offered their stable patients four full weeks of take-home doses.

The pandemic provided the natural experiment to demonstrate that relaxing methadone regulations in the United States was safe for patients and communities. More than two years later, on July 13, researchers from the National Institute on Drug Abuse and the National Center for Injury Prevention and Control published some of the most powerful results of this experience. While fatal overdoses involving opioids reached amazing heights in the United States during the first year of the pandemic, the percentage of overdose deaths involving methadone decreased.

Some were concerned that allowing patients to take more take-home doses would increase the likelihood that they would take multiple doses at once and overdosebut further research found This was not the case. In fact, another 2022 study shows that when two Oregon clinics offered extra take-home doses to patients who had been in treatment for 180 days or more, treatment success actually improved. More people continued treatment and fewer relapsed. Patients said the increased take-home doses gave them a sense of confidence and gave them more time to spend with their careers and family.

We already know that methadone works. Allowing people to pick up a week’s or month’s supply from their local pharmacies will make it more effective and for more people.

In November 2021, SAMHSA announced that it to deploy themselves regulations eased for another year. Meanwhile, lawmakers have introduced a bill it would reform methadone care. But many clinics chose not to increase take-home doses despite the ability to do so. Relaxing state regulations on existing methadone clinics is not enough. If SAMHSA and the federal government hope to save lives, they should free methadone from the siled clinics that make its use incredibly painful for patients.

We already know methadone works. Allowing people to pick up a week’s or month’s supply from their local pharmacies will make it more effective and for more people. And methadone not only helps people stay sober, it saves lives. One February 2020 studyfor example, compared patients prescribed methadone or buprenorphine, a similar but less potent drug used to treat opioid use disorder, with patients who had gone through other treatment pathways, such as residential treatment and behavioral therapies. Only treatment with either drug was associated with a reduced risk of overdose – 76% in 3 months and 59% in one year. A 2015 study in England found similar results: patients who received psychological therapy alone were twice as likely to die of an overdose than those who received methadone or buprenorphine.

Partly because buprenorphine can have a lower risk overdose than methadone, it has fewer restrictions. The drug has long been a controlled substance, but unlike methadone, patients can get buprenorphine from a pharmacy and take it home. Although buprenorphine is as effective as methadone at higher doses, studies show that when patients received the most commonly prescribed lower doses of buprenorphine, they were significantly less likely to continue treatment than methadone-treated patients. This was the case for a member of my family. Before methadone, he tried buprenorphine, partly because it was easier to get, but he never felt stable with it. “I always felt like I was about to fall off a cliff,” he said. One day it would seem perfectly fine. The next day he chattered a bit about his speech. Another day I got a call saying he needed bail.

The pandemic provided the natural experiment to demonstrate that relaxing methadone regulations in the United States was safe for patients and communities.

That’s why he chose methadone, despite the layers of regulations enacted in the 1970s, this meant that instead of getting monthly supplies from his local pharmacy, he had to go to the opioid treatment center day after day, so that a nurse could watch him place the liquid in his mouth and swallow it.

Eventually, after proving their reliability to their advisor, a patient can earn individual doses to take home. That same counselor also has the authority to withhold that patient’s dose for any reason, whether it be a positive drug test, subjectively inappropriate behavior at the clinic, or possession. of one expired bottle cap. This makes processing inconsistent and unpredictable.

In a small qualitative survey published in 2021 in Harm Reduction Journal, patients repeatedly said that daily clinic visits interfered with their ability to maintain steady employment. It’s not just about taking medicine. Patients often attend mandatory counseling sessions and produce urine samples on the spot (under supervision) to prove they are taking the drug and have not relapsed. Some of these services are inconvenient. Some are humiliating. Most also drive up the cost of care (and benefits to the many for-profit facilities). At any time, a family member pointed out, a patient with take-home doses of methadone can be called for a bottle recall, in which case they have a few hours to pick up all used and unused take-home doses and bring them at the clinic before it closed.

Methadone might have saved my family’s friends from an overdose – if they had been able to get it at their local pharmacy.

Health researchers and policy analysts have long deplored these regulationsand often called for their overhaul. Other countries, such as Canada, Australia and the United Kingdom, have authorized the collection of methadone ordinary pharmacies since the 60s and 70s. But stigma, racismand patient distrust prevented the United States from doing the same.

While data from July shows patients were just as safe, if not safer, when offered more take-home doses during the pandemic, the North Carolina survey suggested the community also remained safe. Only six out of 87 the patients interviewed sold or shared their doses in the summer of 2020, often with the stated aim of helping a friend who needed methadone.

There are many ways the United States can improve the treatment of people who use drugs, such as openness safe consumption sites, distributing the drug naloxone, which reverses overdoses, and making it easier for doctors to prescribe buprenorphine. But one of the simplest and most effective is ahead of us: extracting methadone from the clinics that chain those who need it. The United States is currently exploring ways to reform opioid treatment centers, but with overdoses becoming more frequent and more deadly, now is the time to recognize that one of the best tools to prevent overdoses has been around forever, if only we could forget about treatment centers opioids and collect it from the pharmacy.

Emma Yasinski is a science journalist whose work has appeared in The New York Times, National Geographic, The Atlantic and other publications.


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