America’s leading addiction researcher calls for widespread methadone phase-out

BOSTON — The U.S. government’s top drug scientist is calling for a sweeping deregulation of methadone, a key drug used to treat opioid use disorder.

American doctors should “absolutely” be allowed to prescribe methadone directly to patients, Nora Volkow, director of the National Institute on Drug Abuse, said Wednesday.

“There is absolutely no reason for that,” Volkow said. “There are countries where doctors give methadone and the results are really as good as they get.” [at] methadone clinics.”

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Volkow’s comments, which came at the annual STAT summit, represent perhaps the strongest call yet from a high-ranking official in favor of allowing much wider access to methadone.

Currently, however, methadone can only be prescribed at specialized methadone clinics known as opioid treatment centers, or OTPs. Patients often have to attend clinics each morning to receive a single dose of methadone and participate in counseling.

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“Methadone is underutilized in part because it requires such strict conditions to be prescribed,” Volkow said. “We have a pretty strong health care system in the United States, and we should streamline it to maximize access to treatment for people with substance abuse or other illnesses. And that includes methadone.

Advocates for increased access to methadone have become more vocal in recent years as America’s addiction epidemic has worsened: Currently, 107,000 Americans die of drug overdoses each year. More than 80,000 of these deaths are related to opioids.

Additionally, as the powerful synthetic opioid fentanyl has permeated the US drug supply, doctors have reported difficulty using buprenorphineanother drug used to treat opioid addiction, making methadone’s role even more important.

Volkow went further and also lobbied for pharmacists to be allowed to dispense methadone to patients in consultation with a doctor.

Despite calls to increase access, however, methadone clinics have shown strong resistance to making the drug available outside of the context of OTP. Such a move could lead to poor treatment outcomes, they have warned, and even lead to methadone overdoses — methadone, itself, is an opioid sometimes used to treat pain.

“There were 5,500 to 6,000 methadone-specific deaths from 1999 to 2015,” Mark Parrino, director of the American Association for the Treatment of Opioid Dependence, the trade group that represents methadone clinics, said earlier this month at the group’s annual conference. “We don’t want to add to the problem we already have.

About 3% of opioid overdoses involve methadone, according to a recent NIDA estimate, although it’s unclear how many of those involved other opioids — and whether, in those cases, methadone was prescribed for pain or addiction, or obtained illegally.

At the STAT summit, Volkow also provided real support for implementation supervised injection — essentially, specialized facilities that allow people who use drugs to do so in the presence of trained medical personnel who are ready to intervene and reverse potential overdoses.

“I’m a scientist and I’m always dealing with data,” Volkow said. But some data is available, she said, from facilities that have opened in other countries, including Canada and Australia.

“Those who have done the research have shown that it has saved significantly [percentage of] patients from overdose,” she said. “These circumstances document that in these circumstances it can save lives.”

Volkow’s comments come as the Justice Department, at President Biden’s direction, evaluates whether to drop a 2019 lawsuit filed by Trump administration lawyers that would prevent a controlled injection facility in Philadelphia from legally opening.

Some harm reduction advocates have also called for the federal government to support supervised injection sites, but they remain a political issue — usually among Republican politicians, but in some progressive strongholds as well. In August, Govt. Gavin Newsom (D) of California vetoed a bill that would have allowed the state to start a pilot network of supervised injection sites, citing potential “unintended consequences.”

Amid a broader call to rethink the language Americans use when discussing addiction and drug use, Volkow also reiterated her years-long push to rename the agency she has run since 2003. “Abuse,” she has said, implies that people with addictions is being activated. , consider choices every time they use drugs.

The acronym should stay the same, she argued — but its full title should change to National Institute of Drugs and Addiction. Upon taking power, the Biden administration also called for the agency’s name to be changed, but such a move requires congressional approval.

“I’m very optimistic that they will change that,” Volkow said.

STAT’s coverage of chronic health issues is supported by funding from Bloomberg Philanthropies. Ours financial backers do not participate in any decisions about our journalism.

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