Methadone clinics spar with addiction doctors over bill to expand services

LOn Tuesday, lawmakers will debate an addiction medicine proposal that would have been considered unthinkable just a few years ago: giving a select group of doctors the power to prescribe methadone directly to patients.

America’s deadly drug overdose crisis claims 110,000 lives each year, but with the crisis not over yet, many advocates see methadone as a potential game-changer. Although this drug is very effective, it is so heavily regulated that many patients find it unavailable.

Now, a growing coalition of lawmakers, patient advocates and addiction doctors believe any strategy to reduce opioid deaths must center on making methadone more accessible.

“Every day, we are losing people to outdated rules that would use methadone to treat opioids,” Sen. Ed Markey, D-Mass., the bill’s author, told STAT in a statement. People with dyslexia are criminalized and stigmatized. The status quo is costing lives, but some companies running opioid treatment programs would rather protect their own bottom lines than the patients they are meant to serve. It’s long past time to abandon the excuse of protecting profits and modernize these outdated rules.

The bill is receiving a formal markup from the Senate Health, Education, Labor and Pensions Committee, chaired by Sen. Bernie Sanders (R-Vt.). If passed, the bill would allow certified addiction physicians to prescribe methadone to patients outside of dedicated methadone clinics, undoubtedly the biggest overhaul of the addiction treatment system since the Nixon administration.

Opponents, however, say the bill would do more harm than good. Methadone itself is an opioid, and in rare cases, abuse can lead to overdose. Historically, law enforcement groups such as methadone clinics and the Drug Enforcement Administration have strongly opposed significantly expanding access to methadone.

While the bill still faces significant hurdles on Capitol Hill, its support from major addiction treatment groups and bipartisan lawmakers highlights a shift in attitudes toward methadone among prominent policymakers and public health experts.

Its original House sponsor, Rep. Don Norcross (D-N.J.), called methadone clinics a cartel. In the Senate, the legislation has the support of an unlikely pair: Markey and Rand Paul (R-Ky.). Major advocacy groups such as the American Society of Addiction Medicine and Recovery Voices also strongly support the legislation.

Other public health leaders and key Biden administration figures have also reversed their stance on methadone treatment. Rahul Gupta, director of the White House Office of National Drug Control Policy, told STAT in May that all options are on the table when it comes to expanding access to methadone. Nora Volkow, director of the National Institute on Drug Abuse, announced support for doctors prescribing methadone at last year’s STAT event.

Brian Hurley, an addiction physician who currently serves as president of the American Society of Addiction Medicine, said in an interview that the need for effective treatments for opioid use disorder has never been greater. This is not just a bill to expand the conversation, we want it to become law.

However, the bill has faced fierce opposition from methadone clinics and the American Opioid Dependence Treatment Association, a powerful trade group that represents them.

In response to growing calls to liberalize methadone access, AATOD and several for-profit methadone clinic chains have launched an aggressive public relations campaign called “Programs, Not Pills,” arguing that simply expanding access to methadone, without in-person Visiting a clinic does not require mandatory psychosocial intervention. Counseling can do more harm than good.

At an October STAT event, AATOD founder and CEO Mark Parrino argued that passage of the bill could destabilize the treatment system and lead to an unexpected increase in overdoses involving methadone. Parrino told STAT in an email that the organization’s position has not changed.

In effect, the debate pits two powerhouses in the small addiction policy world against each other: ASAM, which represents doctors, and AATOD, which represents clinics.

But in an interview, ASAM President Hurley downplayed the divisions surrounding the methadone access bill, formally known as the Modernizing Opioid Treatment Access Act (MOTAA).

ASAM and AATOD have long agreed and worked together on policy measures to expand access to treatment, he said. We don’t see eye to eye on MOTAA.

Still, the groups’ public lobbying of each other, as well as the broad coalition supporting the bill, may be a sign that AATOD’s influence is waning, lobbyists and congressional aides said in interviews.

Last year, the group suffered another legislative defeat after lobbying hard against a measure that would have eliminated the so-called “X exemption,” which requires health care providers to prescribe buprenorphine, another drug used to treat opioid addiction. Receive special training before using commonly used medications). President Biden hosted an event in January to celebrate the bill’s passage.

In early 2022, AATOD retained lobbying firm Van Scoyoc and Associates for $60,000 per year, the first time the company retained an outside lobbying firm, according to disclosure forms. Van Scoyoc cited issues surrounding methadone legislation and the implementation of medication-assisted treatment (MAT) in his revelations.

Supporters say the bill’s bipartisan support is another sign of a shift in Washington’s attitude toward methadone. One Republican lawmaker who co-sponsored the legislation, Rep. Don Bacon (R-Nebraska), called the current system of methadone clinics a source of failure.

“If you want methadone, you have to line up every day, which means you’re not at home, you’re not at work, and I think it just makes it harder for people to stay healthy,” he told STAT in an interview. If a doctor can prescribe it and they can buy it at a pharmacy, then they can buy this month’s methadone and live with their family and maybe get a job. It helps people stand up.

The bill’s path forward remains unclear: While lobbyists say the bill could clear the Senate HELP committee, it’s not guaranteed a vote in the full Senate.

Even so, it will face a tough time in the Republican-controlled House of Representatives.

“I’ll probably have to do a lot of one-on-one persuasion,” Bacon said.Maybe, I have to explain [House Speaker] microphone [Johnson] and [House Majority Leader] Steve Scalise.

He added: Sometimes I think we could have more empathy for people who are going through this.

Statistics coverage of chronic health issues is funded by:Bloomberg Philanthropies.our financial supporterNot involved in any decisions about our journalism.

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