The battle to control methadone, the miracle molecule that treats addiction

ONE doctor, a patient advocate and the most powerful figure in the methadone treatment industry presented competing visions for the future of American addiction medicine this week. A conversation that touches on stigma, patient rights, and the apparent divide in healthcare providers’ attitudes toward patients with addiction.

The debate centers on a single question: whether U.S. doctors should be allowed to prescribe methadone, a drug used to treat addiction to drugs such as fentanyl and heroin, directly to patients.

Although methadone is easily the most effective drug currently approved for treating opioid addiction, it can only be accessed in specialized clinics that require patients to participate in counseling, undergo drug testing, and undergo drug testing. regularly and come in person every day to receive a single dose.

One of the main reasons why so many people are dying today is because methadone use is terrible and for many people, says Aaron Ferguson, community outreach director for the Urban Survivors Association. That’s worse than continuing to use drugs. , a national organization dedicated to supporting the rights and well-being of people who use drugs. Those who oppose this will say things like: Methadone is too dangerous and doctors cannot administer it. Patients cannot be trusted with it. To me, all of this pales in comparison to the number of lives that could be saved if we only made this miracle molecule available to those who could benefit from it.

The comments were made during a panel at the 2023 STAT Summit in Boston. The future of methadone treatment is hotly debated in the medical community and in Washington, where Sens. Ed Markey (D-Mass.) and Rand Paul (R-Ky.) have introduced a bill for Allows addiction specialists to prescribe methadone directly. While that proposal won the endorsement of the American Society of Addiction Medicine, it was strongly opposed by the American Opioid Dependence Treatment Association, the trade group that represents methadone clinics.

Amid the opioid overdose crisis that is now claiming the lives of more than 80,000 Americans each year, a growing coalition of patient advocates, medical providers and lawmakers has allege that the current methadone treatment model is costing thousands of lives. They argue that allowing doctors to prescribe methadone directly to patients is long overdue and that medical providers nationwide are ready and willing to do more to prevent deaths from overdosing. Furthermore, they argue, Canada, Australia and many European countries are much more liberal when it comes to methadone distribution, and drug users there have much lower rates of overdose, infectious disease transmission and death.

“I believe I am part of a new generation of doctors who are being trained to prescribe these drugs, regardless of preference,” said Zoe Adams, a medical historian and resident physician at Massachusetts General Hospital. Mine is addiction.” It is still a work in progress. There’s still a lot of stigma. But the longer methadone exists in the shadows, in the silos of methadone clinics, the stigma will continue to exist.

However, Methadone clinics have strongly opposed efforts to significantly liberalize methadone treatment and have launched an advocacy campaign called Programs, Not Pills, in opposition to the law. of the Senate and emphasized their belief that patients at methadone clinics need more than the drug itself.

Mark Parrino, founder and president of AATOD, warned during the panel that achieving sweeping change may not be so easy. He argues that the health system is unprepared and not even ready to make methadone part of primary health care. Potential obstacles, he said, include a lack of physician enthusiasm for prescribing methadone; pharmacists are unwilling to stock and dispense it; and drugmakers are reluctant to produce and distribute it more widely, especially after the lawsuits and criticism that many have experienced in the wake of the opioid crisis and the oversupply of prescription opioids that has accelerated It.

Parrino also warned that a sudden increase in methadone access could lead to a spike in methadone overdose deaths. Methadone itself is an opioid and works by stimulating opioid receptors in the brain, thereby helping people looking to reduce their illicit opioid use avoid withdrawal symptoms without experiencing withdrawal symptoms. euphoria or depression similar to heroin or fentanyl. Although methadone-related overdoses have occurred in a small number, the drug is much safer than opioids sold on the illegal market, which increasingly contain dangerous mixtures of fentanyl and xylazine.

“Honestly, my concern after more than 40 years of being involved in this issue is backlash or unintended consequences,” Parrino said. This does not mean that we can be driven solely by those fears. That is not the problem. But that means we have to be mindful and we have to think carefully about how we implement any policy.

Ferguson countered that arguments focusing on the potential increase in methadone-related deaths are focusing on the wrong thing and that any valuable medical intervention carries corresponding risks.

When it comes to a potentially life-saving treatment, he says, you’re willing to take all kinds of risks. When you look at things like brain surgery, heart surgery, I mean, antibiotics 30,000 Americans die every year from antibiotic-resistant bacteria, but no one keeps antibiotics in a safe on the wall. If this were any other group of Americans dying next to a stadium, we wouldn’t quibble about the relatively low number of unintended consequences.

Adams agrees, citing evidence from the emergency measures the federal government took during Covid-19. In particular, policies around take-home methadone that allow patients to take extra doses home so they don’t have to go to the clinic every day have become much more relaxed. Despite some initial concerns, subsequent data showed that unintended consequences such as greater methadone abuse or increased methadone-related overdoses never materialized.

That data only makes Markey and Paul’s legislation in Washington stronger, Adams said.

“We have this forward momentum recently because of what happened during Covid, when methadone became more available to people and how people actually reported that they felt like they had more rights,” she said. more control over your life. People were not diverting methadone, people were not dying at the rate of methadone overdose deaths. And I think we took that momentum from those positive results and tried to advance the legislation as much as possible.

STAT’s coverage of chronic health problems is supported by a grant fromBloomberg Philanthropies. Ours financial backeris not involved in any decisions about our journalism.