Health care practitioners who treat addiction have recognized the value of methadone for medication assisted treatment (MAT) since the mid-1960s. It is a critical tool in the harm reduction tool chest. Harvard addiction specialist and researcher Sarah Wakeman et al. published comparative effectiveness research in early 2020 that found MAT with either methadone or buprenorphine were the only treatment approaches “associated with reductions in overdose and serious opioid-related acute care use compared with other treatments”– including naltrexone, inpatient detoxification and residential treatment, and intensive outpatient behavioral health services. With nearly 108,000 overdose deaths occurring in 2021 (87 percent involving illicit fentanyl), one would expect policymakers to place a renewed focus on expanding the availability of methadone treatment to people with substance use disorder.

As I discussed here, the Drug Enforcement Administration imposes very strict regulation on methadone MAT. Patients must travel daily—sometimes long distances—to methadone clinics and take the methadone in the presence of clinic staff. As an emergency measure because of the COVID-19 pandemic, the DEA relaxed some of these onerous restrictions by allowing clinics to dispense small amounts of take-home methadone and permit them to operate mobile vans. But this is temporary and not good enough.

The DEA already permits primary care and other practitioners to prescribe buprenorphine to their patients with substance use disorder. As I have pointed out before, primary care practitioners who want to treat their patients with substance use disorder have been allowed to prescribe methadone on an ambulatory basis to their patients, and follow them in their clinics, in the U.K., Canada, and Australia since the 1960s. Pilot programs in the U.S. have shown this approach can be safe and effective in American communities. A 2018 article in the New England Journal of Medicine pointed to the success of this and other pilot programs and called on Congress to pass legislation allowing health care practitioners to prescribe methadone as MAT to their patients with substance use disorder. In January 2020 the National Academy of Science, Engineering, and Medicine (NASEM) made a similar plea. I have made this argument as well.

In today’s Health Affairs, Zoe Adams, MD et al. make a compelling argument for allowing health care providers to prescribe take-home methadone to their patients with substance use disorder, stating “Take-home methadone dosing should be decided by science, clinicians, and patients.” They point to legislation introduced by Rep. Donald Norcross (D‑NJ), called the Opioid Treatment Access Act of 2022 (H.R.6279) as flawed, but a step in the right direction. I agree.

I commend the authors of this article and hope policymakers give it serious consideration.