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Methadone Should Get a Home in Primary Care

July 05, 2018

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Tim Viall
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(Boston) - Physicians and public health officials are calling on Congress to update the laws that regulate methadone prescribing to help reduce barriers to a treatment proven to be effective for opioid use disorder. According to a newly published New England Journal of Medicine Perspective, allowing methadone to be prescribed and dispensed in primary care practices would increase access and get the medicine into the hands of an at-risk patient population.

Methadone in Primary Care – One Small Step for Congress, One Giant Leap for Addiction Treatment,” is authored by Jeffrey Samet, MD, MPH, chief of general internal medicine at Boston Medical Center (BMC), Michael Botticelli, executive director of the Grayken Center for Addiction at BMC, and Monica Bharel, MD, MPH, commissioner of the Massachusetts Department of Public Health.

Opioid overdoses claim an average of 115 lives a day. Opioid use disorder, the major driver of overdose deaths, is a complex medical condition that can be successfully treated, but treatments remain inaccessible for many people, particular those in rural and suburban communities. Only roughly 20 percent of Americans who have an OUD take one of the three FDA approved, evidence-based medications – methadone, buprenorphine, and naltrexone – according to a 2015 JAMA study.

The oldest and one of the most effective medications to treat OUD, methadone, is available in primary care settings by prescription in Great Britain, Canada, and Australia. This is standard practice in those countries and seen as non-controversial because it benefits the patient, the care team, and the community. In the U.S., methadone is typically administered daily under supervision to patients in specialty clinics, requiring daily trips to these clinics and making it a difficult treatment to adhere to. Additionally, these clinics can be hours away and are not always accessible by public transportation.

“Allowing more qualified and trained physicians and other advance practice clinicians to prescribe methadone prevents the need to establish new methadone clinics for people living in nonurban areas, which could be cost- or infrastructure-prohibitive, and it diminishes the ‘not in my backyard’ sentiment that is commonly associated with them,” said Samet, who is also a professor of medicine at Boston University School of Medicine and the Perspective’s corresponding author.

Administering methadone in primary care could also reduce the stigma associated with opioid use disorder and align its management more with other medical conditions that are already treated seamlessly in primary care.

The authors suggest that the Controlled Substances Act could be amended to allow clinicians who have the required training to prescribe buprenorphine for opioid use disorder to also engage patients in methadone treatment for the condition in office-based, primary care settings.

“The goal is to increase access to medication for this treatable disease, and it makes sense that we take concrete steps to streamline substance use disorder into standard medical care,’’ Commissioner Bharel said.

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