Open Letter to Congress From Persons in Recovery: What Opponents Get Wrong About Methadone.

by Patty McCarthy and Zac Talbott

As people living in recovery from addiction and as leaders in the recovery movement, we know that methadone saves lives. We’ve seen it help friends survive the lowest points of their substance use disorders – helping them enter remission and create productive and fulfilling lives.With his long-term recovery aided by methadone, Zac is living proof that the medication works.

As a record number of Americans die from drug overdoses, this crisis requires immediate action. Unfortunately, the current public policy approach to addiction is not comprehensive or multi-faceted enough to stem the tide of deaths. We must agree as a nation – culturally and legally – to end the stigma of addiction and accept evidence-based treatments that work.

To Congress’ credit, in December, the Senate Health, Education, Labor, and Pensions (HELP) Committee gave hope to patients nationwide. By advancing a vital piece of legislation called the Modernizing Opioid Treatment Access Act (MOTAA), the committee endorsed efforts to permit board-certified addiction specialist physicians who separately register with the Drug Enforcement Administration to prescribe methadone to patients with opioid use disorder (OUD)that can be dispensed at pharmacies—like other medications. Perhaps the Senate HELP Committee realized that, contrary to opponents’ misconceptions, MOTAA is careful in its approach. In fact, MOTAA includes more specific guardrails for patient safety and quality of care in federal law than currently exist.

Why is this critical for people with OUD? Because MOTAA safely expands access to an evidence-based treatment proven to reduce overdose deaths. This would be a major step forward because federal regulations developed 50 years ago effectively limit methadone for OUD to clinics called opioid treatment programs (OTPs). In addition to being a patient at one for roughly ten years, Zac owns and operates OTPs today. We are both familiar with the lifesaving work that many OTPs do to help patients manage their withdrawal, avoid preventable overdose deaths on the street, and enter recovery. However, OTPs are inaccessible to far too many Americans, and patients deserve the ability to move beyond the structure of an OTP when they are ready.MOTAA rightly espouses a “both-and” approach where methadone will be accessible through OTPs as well as physicians who have the highest level of addiction training and competency in the country.

A whopping 80% of counties in the U.S. don’t have an OTP that can dispense methadone, and there are only about 2,000 OTPs nationwide, compared to over 60,000 pharmacies. The logistical burdens associated with attending OTPs today can be destabilizing for some people, and cumbersome for most, especially those who come from lesser means. These burdens can make it extraordinarily difficult for patients to hold a job, secure housing, take care of a family, or visit doctors that can address their other healthcare needs. In addition, some OTPs take a cookie-cutter approach to OUD treatment, which can result in more stable patients frequently lining up for dosing with unstable patients – creating an environment that can trigger reoccurrences in drug use even among patients who were previously in remission.

Some MOTAA opponents say they are worried about increased methadone diversion – patients sharing or selling their methadone to others. While diversion risks must be managed with any controlled medication, opposing MOTAA on this ground obscures three crucial facts:

1. Methadone diversion is already illegal. Just as a person could be arrested and prosecuted for selling prescribed opioids for pain after picking them up from a pharmacy, the same would be true if a person shared or sold their prescribed methadone for OUD. If MOTAA naysayers were as concerned about other powerful pharmaceutical opioids ending up in the wrong hands, then they should call for all opioids to be dispensed at special clinics and not at pharmacies. No one, however, is calling for this, because it would be illogical to ban appropriate access to medications at pharmacies when safeguards are in place.

2. While methadone diversion does occur today, it’s usually to help people with OUD manage excruciating withdrawal symptoms, not for recreation. This suggests there needs to be more medical access to methadone for OUD and touchpoints within healthcare systems to promote recovery. While it is true that improper use of methadone carries risks, like other prescribed medications, choosing to tie the hands of addiction specialist physicians from appropriately prescribing methadone to more patients who need it is a deadly decision. Safely expanding access to methadone will help reduce diversion of treatment medications to those who need but cannot currently access them.

3. MOTAA prescriptions will be subject to federal time-in-treatment restrictions as are take-home methadone doses dispensed from OTPs. Some MOTAA opponents claim that new patients will receive 30-day methadone supplies in their first days of treatment. This is false. While there is a 30-day cap on methadone prescriptions under MOTAA, those prescriptions are explicitly subjected to federal quantity limitations on unsupervised use, too.

In short, there are thousands of doctors who specialize in addiction treatment and tens of thousands of pharmacies that can safely dispense methadone to patients. Expanding access to methadone for OUD isn’t about fighting a medical turf war; it’s about doing what’s right for millions of people – people like us – who have suffered from addiction. As persons in recovery, we urge Congress to acknowledge the lifesaving benefits of methadone and swiftly pass MOTAA so that addiction specialists can work alongside OTPs and safely prescribe methadone, saving more lives like ours.

Patty McCarthy is a person in long-term recovery and the Chief Executive Officer of Faces & Voices of Recovery. Zac Talbott is a person in long-term recovery and the President of Talbott Legacy Centers, which operates opioid treatment programs.