Methadone Care still Hard to Get after Act Passed

Opioid drug use disorder is killing over 115 users a day in the U.S. alone. The United States is ranked highest for overdose deaths with Kentucky, New Hampshire, Ohio, West Virginia, and Pennsylvania as the top 5 states. In 1974, FDA approved Methadone, a synthetic opioid, that has been effective and successful in treating patients with opioid use disorder. However, Federal Law regulates that separate clinics dispense the synthetic opioid and not in general health care facilities.

That was the case until Congress passed the Drug Addiction Treatment Act of 2000 to include primary Care facilities, but regulations for the opioid stayed intact. Unfortunately, not many primary Care facilities jumped on the wagon. Accessing treatment at a Methadone clinic makes it difficult for most opioid drug users because most Methadone clinics are few and far between. Public transportation routes usually are not close by and getting transportation to and from can become difficult. Methadone, which helps break the addiction, especially for heavy opioid users, has to administer daily, this also makes it difficult if one is not close to a clinic.

Top Opioid Addictive Drugs:
Heroin- (illegal)
Fentanyl –Used as a pain reliever and together with other medications for anesthesia.
Oxycodone (Oxycontin)-prescribed for pain.
Hydrocodone (Vicodin)-prescribed for pain.
Codeine- prescribed for pain.
Morphine-prescribed for pain.

Methadone and Primary Care Physicians

So why is it that Primary Care Physicians are less than willing to provide Methadone in general health facilities? Buprenorphine, Methadone, and Naltrexone were among the treatment drugs allowed to administer at primary care facilities. Many doctors choose not to offer opioid treatment. They understood the Act passed as more of an option. Buprenorphine and Naltrexone are partial agonists versus Methadone which is a full agonist. With a partial agonist, you reach a plateau, so it is harder to overdose. A partial agonist drug is more appealing to a physician to prescribe. A full agonist (Methadone) is on the same level as Heroine, and some physicians feel they are just swapping out one addiction for another.

According to Dr.Stefan Kertesz of UAB School of Medicine and many physicians, they do not see addiction as a brain disorder and more of a personal failing. The regulations for administering Methadone include specialized, structured care, with periodic drug testing and counseling. These regulations create a barrier to setting up administering this drug along with other general responsibility for their patients. In other words, it’s probably easier to not manage than to dispense with all the rules and regulations. Let the clinics already in place handle the opioid crisis.