Thursday, June 20, 2024 | 2 a.m.
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When you’re sick, you go to the doctor.
When you have a life-threatening disease, you get medical treatments to save your life.
When you have opioid use disorder (OUD), you can hit a brick wall, because America’s health care systems cannot always deliver the care you need.
This is true for several reasons, including stigma and a lack of understanding that addiction is a treatable, chronic medical disease. There are also an array of restrictive policies and practices, including federal legal barriers, that prohibit your state from providing access to one (i.e., methadone) of three OUD medications available through a prescription.
In the era of high-potency synthetic opioids, like fentanyl, expanding access to life-saving medications for OUD, particularly methadone and buprenorphine, is critical. Both medications are associated with reduced mortality in people with OUD. They help doctors treat addiction and save lives at a time when opioid-involved overdose deaths are near historic highs. While the latest statistics show the first nationwide drop in overdose deaths in 5 years, many states are recording increases, and Black and Indigenous Americans are still disproportionately more likely to die from an opioid overdose.
Illicitly manufactured synthetic opioids can be much more powerful and deadly than heroin. Since opioid withdrawal is so excruciating, people with untreated OUD often seek out illicit opioids to prevent pain — both physical and emotional— even when they want to stop using them.
In contrast, methadone and buprenorphine are proven to help people with OUD manage their disease and be part of the recovery process. New research recently published in the Journal of Addiction Medicine, suggests that higher doses of buprenorphine are associated with reduced opioid-involved overdose deaths and death from other causes. Relatedly, methadone may be needed for patients who don’t respond well to buprenorphine. Yet, physicians, even those who are experts in treating addiction, are not always trusted to make appropriate clinical decisions when it comes to these medications.
Unfortunately, despite the recent elimination of a registration requirement for prescribing buprenorphine for OUD, buprenorphine continues to be hindered by burdensome policies, such as nonevidence-based state regulations and unnecessary prior authorization requirements by insurers. All these hurdles impede timely access to buprenorphine for OUD and fuel our overdose crisis.
Similarly, methadone’s potential is limited by a 50-year-old federal law preventing regulators from even trying to increase access to it through prescriptions dispensed from community pharmacies — an approach that has been used successfully in other countries for decades. Consequently, patients who need methadone for OUD must visit an opioid treatment program to get their medicine.
While these programs play an important role in the addiction treatment continuum, it’s past time for Congress to pass federal legislation that would empower federal and state regulators to determine how best to provide access to methadone prescribed by addiction specialist physicians for OUD through local pharmacies, which overwhelmingly outnumber programs.
Tragically, concerns around methadone and buprenorphine diversion tend to slow necessary reforms. While diversion concerns must be considered and appropriately addressed, they should represent only one aspect of our national conversation when it comes to life-saving medications for OUD, not dominate it.
Outdated laws, regulations and policies governing both buprenorphine and methadone for OUD are failing to meet the moment — and worse, are exacerbating the deadliest overdose crisis in American history.
Dr. Michelle Lofwall is board-certified in psychiatry and addiction medicine. She is a professor of behavioral science and psychiatry and the Bell Alcohol and Addictions Chair at the University of Kentucky College of Medicine. She wrote this for the Lexington Herald-Leader.
