Why is it still so difficult to get life-saving addiction medications?
About 200 people are dying monthly of opioid overdoses in Massachusetts. There are effective medications to treat opioid addiction, namely methadone and buprenorphine. So why does society, including government and health officials, make it so hard to get them?
A year-long investigation by STAT addiction reporter Lev Facher into access to addiction medication nationally found that “virtually every sector of American society is obstructing the use of medications that could prevent tens of thousands of deaths each year.”
These obstructive policies must change. If we as a society truly believe the science that addiction is a disease, it should be treated as one. Medications to treat addiction should be readily available without stigma and without reticence by health care professionals. While neither methadone nor buprenorphine is harmless, and they need to be taken responsibly, the same is true of a host of other medications, none of which are subject to similar restrictions.
The most obvious example is the operation of methadone clinics, which, Facher reported in the second part of his multipart series, operate with onerous restrictions that often require patients to come to clinics daily to receive their medication. Some patients can receive “takehome” doses but many clinics hand those out sparingly. As Facher points out, there are patients for whom losing take-home doses means losing their job, since they cannot hold a job while traveling daily to a far-away clinic. New federal rules could loosen some restrictions, but only if state regulators and individual clinics adopt the new flexibilities. While the federal shift is a step in the right direction, this board continues to support a more radical change that would let doctors prescribe methadone and pharmacists dispense it, so patients no longer have to go to a specialized clinic. Most of the opposition to these changes is coming from the methadone clinics themselves, which have a financial interest in maintaining their monopoly.
Beyond the indignities of methadone clinics, Facher lays out in his introductory story a host of other policies that inhibit people’s ability to access and use medication to treat opioid addiction.
The problem is that methadone and buprenorphine are themselves opioids, so some people adopt the attitude that using medication is trading one opioid for another. Narcotics Anonymous discourages participants from taking the medication, preferring an abstinence approach, and some sober living houses will not accept people on medication-assisted treatment. Some prisons bar their use, although Massachusetts is unique in mandating that medication-assisted treatment be available in prisons and jails. While there is potential for abuse, these medications are far safer, especially when taken in prescribed doses, than illicit drugs like heroin and fentanyl that many of these people would otherwise use.
The federal government used to require doctors to obtain a special license to prescribe buprenorphine, and even though that requirement was lifted under the Biden administration, many doctors remain unwilling to prescribe it. A recent Globe story found that when young people have substance use disorders, almost no pediatricians are willing to dispense medication, sometimes with tragic results. Even if someone can get a prescription, many pharmacies do not stock buprenorphine. There is a desperate need for better medication
This board continues to support a more radical change that would let doctors prescribe methadone and pharmacists dispense it, so patients no longer have to go to a specialized clinic.
management for opioid use disorder training for doctors, including pediatricians, in medical schools and through continuing education courses.
STAT reported that there are other regulations inhibiting people from seeking treatment, like federal laws that prohibit pilots and truck drivers from taking methadone and buprenorphine. While people in these and similar roles need to avoid impairment, a policy that discourages someone with addiction from seeking treatment can potentially place the public in more danger than if the person were able to sustain recovery.
The United States can look to other countries for models of how to better use these drugs. Countries like Canada and the United Kingdom make it easier to obtain methadone, while France has fewer restrictions on physicians prescribing and pharmacists dispensing buprenorphine.
The United States should look to these policies and work to eliminate any regulations that incentivize drug users to avoid seeking or obtaining help.