More than 80% of Americans who qualify for life-saving medication treatment for opioid addiction do not actually receive it. Methadone maintenance therapy—which involves the daily use of a liquid or pill—is the oldest, most researched form of medication treatment for opioid addiction, and has been used in the US for fifty years, yet it remains prohibitively difficult to access, especially for those living in rural areas. Many other developed countries have allowed community clinics and pharmacies to dispense methadone, but this is not usually an option in the US. In a recent article, we wrote with a group of addiction medicine providers from Canada and the US, we argue that it is time for the US to follow suit.
Access
Current US regulations allow methadone for addiction to be distributed only through designated facilities called Opioid Treatment Programs (OTPs), often referred to as methadone clinics. These are independent facilities mandated by federal law to provide a host of services for patients with opioid addiction, including access to physicians, counselors, nurses, and on-site dispensing of methadone. Around 1,500 OTPs currently operate within the US, with 96% based in urban areas. With the opioid epidemic decimating rural communities, and few OTPs nearby, patients often drive hours every day to access life-saving methadone. This leaves little time to focus on other important components of addiction recovery, such as keeping a job with regular working hours.
Despite rising numbers of opioid overdose deaths in the US, the number of active OTPs in the country has remained roughly the same over the past 15 years. Of course, methadone is not the only treatment option available; naltrexone, a monthly injection, and buprenorphine, a daily medication that can be taken at home, are also highly effective. But for many individuals with severe opioid addiction, methadone remains the safest and most effective long-term treatment.
The development of innovative treatment strategies is critical to curbing the opioid epidemic.
International perspectives
Our Canadian neighbors have shown that dispensing methadone from pharmacies (rather than restricting access to specialized clinics) is safe and highly effective. Unlike the United States, Canada, Australia and the U.K. have passed legislation that permits a prescription for methadone to be taken to participating pharmacies where methadone can be administered under direct observation by the pharmacy staff. Having the option of receiving methadone in community pharmacies is more convenient for patients. In the US there are approximately 67,000 pharmacies, nearly 50 times more than the number of OTPs, that might be used to widen to provision of methadone during this epidemic.
The costs of dispensing methadone in the community in countries like Canada, Australia and the U.K. are very similar to the costs of dispensing methadone in an OTP like in the US (approximately $10-15 USD per patient per day). This contrasts sharply with the individual and societal costs associated with untreated opioid addiction, and the immeasurable cost of overdose deaths, when individuals are not able to access appropriate and timely treatment.
A call for action
The development of innovative treatment strategies is critical to curbing the opioid epidemic. But we should maximize access to existing treatments like methadone. Pharmacists are widely available, highly trained healthcare professionals whose expertise could be further leveraged in the effort to combat the opioid crisis. This is a lesson that has been learned around the world and it’s time for the US to make this life-saving treatment more available.
Feature image: thierry ehrmann, Défense de prendre des narcotiques (detail), CC BY-NC-ND 2.0
