In response to the ongoing investigative series by STAT News called The War on Recovery, Advocates for Opioid Addiction Treatment (AOAT) members have released the following statement:
We commend STAT News for digging deeper into the opioid epidemic and where it stands today. Although this crisis has been a hot topic in the news for years, there is still a heavy focus on the problem and not enough meaningful conversation around solutions. The series highlights the scientific evidence around medication-assisted treatment (MAT) as the gold standard for addiction treatment and takes a strong position around how abstinence-only approaches to substance use disorder are driven by stigma and remain a major barrier to overcoming the overdose crisis. We wholeheartedly agree.
As leaders and providers of Opioid Treatment Programs (OTPs) across the U.S., who have been serving and fighting for this community for over 50 years, we have seen firsthand how MAT has saved millions from succumbing to this disease. And while our goal is to expand access to MAT to reach more Americans with opioid use disorder (OUD), we believe efforts must be evidence-based, safe and effective.
Some well-intentioned leaders want to simplify the solution by liberalizing methadone, a schedule II narcotic. The Modernizing Opioid Treatment Access Act (MOTAA) would allow methadone to be prescribed by office-based addiction-certified physicians and dispensed at pharmacies. However, the real-world implications of this policy are concerning and dangerous—and have not been thoroughly discussed in STAT’s reporting.
Our opposition to dispensing methadone without any oversight from a multidisciplinary care team or support services that help address the psychosocial aspects of addiction is solely due to concerns around safety and efficacy. The legislation is not supported by evidence and places patients and communities at risk. The dangers of prescribing methadone without supervision have been corroborated in five federal reports and other federal agencies, all finding that methadone prescriptions obtained in a physician’s office led to more overdose deaths[1],[2],[3].
We agree that the structure of OTPs can be limiting for some patients and disruptive to their daily lives, and we have been working with regulators for years to modify the rules to allow our providers additional flexibilities. For example, state level regulations governing OTPs can be more restrictive, and we are eager to address these constraints to allow more versatility and autonomy in the delivery of OUD care. In the same vein,we applaud the recent SAMHSA modernization rule that will go into effect in April 2024, which provides more flexibility in treatment. Some highlights include giving providers more discretion to determine when someone is clinically ready to receive take-home doses, allowing for telehealth inductions into treatment, and encouraging the expansion of mobile clinics to provide full access to treatment in rural areas. We are confident these sweeping changes to methadone regulation will improve access without compromising requirements for diversion prevention, which keep patients and communities safe.
We must now focus on a more significant barrier to getting people in treatment—funding and insurance coverage—a priority that MOTAA actively fails to address.
Nearly 80% of non-elderly adults with opioid use disorder (OUD) rely on Medicaid or are uninsured. Medicaid serves as the primary payer for many opioid treatment programs (OTPs). However, only 36% of addiction medicine physicians currently accept Medicaid. According to an independent analysis, only 85 addiction specialists accept Medicaid outside the geographic reach of OTPs [4]. Passing MOTAA would risk increased overdoses and methadone diversion in communities, only to slightly extend access with an unproven approach to a prescription of methadone that may or may not be able to be filled. This also comes without certainty that these patients would ever get access to counseling, laboratory services, participation in anti-diversion protocols, and treatment planning by a multidisciplinary care team of nurses, counselors, and providers. Trading the gold standard of care for an unproven experimental approach seems reckless and dangerous under these circumstances.
We will continue working towards evidence-based solutions to the opioid epidemic that safely expand access to treatment to all who need it.
[1] https://www.justice.gov/archive/ndic/pubs25/25930/index.htm
[2]https://atforum.com/documents/CSAT-MAM_Final_rept.pdf
[3]https://www.gao.gov/assets/gao-09-341.pdf
[4] https://programnotapill.com/wp-content/uploads/2024/03/OTP-and-Addiction-Medicine-Physician-Maps-and-Analysis-1.pdf