Federal regulations for OTPs (methadone clinics) have been in place, largely unchanged, since 1973. This presentation will review the history of methadone as a treatment for OUD with a specific analysis of the racial bias and health inequities perpetrated by 42CFR, section 8. A small minority of board certified addiction clinicians have deep knowledge of the rules and regulations that govern OTPs at the state and federal level. Access to timely and effective treatment with methadone is one strategy to reduce morbidity and mortality of OUD yet the current regulations create multiple barriers to access and continued successful treatment within an OTP. Methadone remains the one medication where clinical decisions made by a trained and licensed physician has been ceded to the federal government. To over-ride the federal regulations, a complicated application must be submitted by the medical director to the federal and state agency for each patient every year. This includes treatment of patients living at skilled nursing facilities, patients with serious or terminal chronic diseases, and pregnant people. The emergency order issued in April 2020 to increase take home bottles due to COVID-19 was the first shift in the delivery of methadone treatment in the United States and I will review the early literature on this experience in the United States. In addition, the clinical evidence behind mandated group visits, required counseling, daily medication administration, and drug free toxicology will be examined. Nearly seventy percent of the OTP market is delivered by for-profit companies, often backed by investment banks. This presentation will review the role that profit plays in the delivery of methadone and the impact this has on patients, families, and society. The final one-third of the talk will envision a more patient-centered and evidence-based approach to methadone delivery in the United States based on experience in other countries and clinical practices from some OTPs in the United States.
Learning Objectives:
Learners will be able to:
Describe the federal regulations governing Opioid Treatment Programs that may present barriers to sustained treatment with methadone.
Demonstrate knowledge of evidence-based treatments for OUD and critically assess the models of care delivery at OTPs
List three advocacy efforts that they could support to improve patient access and provision of care at the local, state, or federal level
