Officials back bill to expand methadone access
In the face of rising fentanyl overdose deaths, San Francisco officials are pushing to change state law to expand the types of clinics that can dispense methadone and make it easier for patients to get take-home doses of the drug.
Assembly Member Matt Haney, D-San Francisco, called the measure his “most important bill of the year.”
Dr. Christy Soran, a deputy medical director at the San Francisco Department of Public Health, said she sees the legislation as a key tactic to address fentanyl overdoses in the city. During the height of the COVID-19 pandemic, when the government made methadone easier to access via telehealth appointments and take-home doses, it became clear methadone regulations could be loosened safely to make it easier for people to access the drug, she said.
Methadone activates the same receptors in the brain that fentanyl and other opioids do but at a lower intensity. It can help a patient reduce their dependence on dangerous street drugs and is a leading treatment for opioid addiction. It is still possible to overdose on methadone, however, and it is highly regulated.
Haney says California’s regulations make methadone too difficult to access. Often, people must travel miles to reach their nearest clinic, where they wait in line every day to get the medication. Drug dealers often congregate around methadone clinics to tempt vulnerable patients with street drugs as an easier way to relieve their withdrawal symptoms. Haney pointed to one clinic near City Hall where he said there’s effectively a gantlet of drug dealers who congregate in the blocks surrounding the building.
“It is the worst possible design for getting people off of fentanyl and into treatment,” Haney told the Chronicle. “We’ve made it incredibly difficult to access a medication that is proven in getting people off of fentanyl and heroin.”
Methadone is the most highly regulated drug in the United States, and California has some of the country’s most onerous regulations, said Dr. Leslie Suen, an addiction medicine doctor at UCSF.
The federal government recently loosened its own methadone rules, including permanently adopting a pandemic rule that made take-home doses of methadone available to more people and letting patients to continue methadone treatment via telehealth appointments. The Haney bill is intended to align California’s law with the new federal guidelines so patients in the Golden State can take advantage of the new rules.
California Opioid Maintenance Providers, a group that represents methadone clinics, has raised concerns about the legislation and is pushing for changes that would narrow it. Among the issues it’s raising is the possibility that the legislation could open the door to doctor shopping, in which people seek out doctors who will improperly prescribe the medication.
San Francisco is sponsoring the bill, which also has support from Santa Clara and San Mateo counties, various clinics and treatment advocacy organizations, the California Society of Addiction Medicine and the California State Board of Pharmacy.
The bill, SB2115, cleared its first hurdle on Tuesday, when lawmakers on the Assembly Business and
Professions Committee voted to advance the measure. It must clear several more committees, pass out of both houses of the Legislature and earn a signature from Gov. Gavin Newsom to become law.
Last month, 61 people in San Francisco alone died of drug overdoses, according to the Chronicle’s overdose tracker. Of those, 45 involved fentanyl.
“We have tens of thousands of people just in San Francisco who are addicted to opioids,” Haney said. “Even if we lock up the drug dealers, we have to help these people.”