Harm reduction advocates, including myself, have long argued for reforming current federal policy regarding methadone medication assisted treatment (MAT) for opioid use disorder. In the U.K., Canada, and Australia, primary care practitioners have been prescribing take-home methadone to treat opioid addiction or dependence since the 1960s, and numerous pilot programs in the U.S. have found that the same approach can work successfully here.

The Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) regulate methadone outpatient treatment programs (OTPs) in the U.S. and, among the onerous regulations is the requirement that patients present to the clinic each day to receive oral methadone from a clinic staff member and swallow it in front of them. This policy is an outgrowth of the stigma long-attached to people addicted to some drugs—that such people are deceitful and manipulative and might use or sell take-home methadone. (Fortunately, people addicted to nicotine or alcohol do not suffer such distrust.)

It’s not hard to discern a problem with this approach. Methadone clinics can be few and far between and, in many cases, NIMBYism prevents clinics from proliferating. Patients seeking MAT must often travel several miles every day to stay on the program, an often-impossible demand. Yet the DEA has for years allowed primary care practitioners to prescribe take-home buprenorphine (a Schedule III opioid) for MAT.

Because of lockdowns and social distancing requirements during the COVID pandemic, in March 2020 SAMHSA permitted methadone clinics to dispense up to 28 days’ worth of take-home methadone to clinic participants as an emergency measure. In March of this year, citing “sufficient evidence to conclude that this exemption has enhanced and encouraged use of OTP services,” SAMSHA extended the take-home rule, and stated it is “considering mechanisms to make this flexibility permanent.”

Yesterday a National Institutes of Health news release reported on a study published the same day in JAMA Psychiatry by researchers led by the National Institute on Drug Abuse, National Institutes of Health, and the Centers for Disease Control and Prevention. They reported the emergency take-home methadone program “was not associated with harms” and “add[ed] evidence to support take-home treatment for opioid use disorder.”

In a recent blogpost I once again urged lawmakers to enact legislation permitting health care practitioners to prescribe take-home methadone to their patients with opioid use disorder. Such a measure would not only be supported by the evidence, but it would make methadone MAT much more accessible and practical for patients who need and seek help. To that end, Rep. Donald Norcross (D‑NJ) has introduced H.R. 6279, the Opioid Treatment Access Act of 2022, which has bipartisan support. While the measure is a step in the right direction, the bill has flaws.

For example, it only allows board certified addiction specialists to prescribe take-home methadone. In some regions of the country, such specialists are hard to find (there are only two in Wyoming). And primary care practitioners should be able to prescribe methadone—as they have been doing in the U.K., Canada, Australia, and in U.S. pilot programs—if the goal is to meaningfully improve access to MAT. Another drawback of H.R. 6279 is that it adheres to the SAMSHA criteria regarding the amount of take-home methadone that may be prescribed and the benchmarks that patients must meet to receive take-home methadone. Clinicians understand that no two patients are the same—that clinical contexts vary. Lawmakers must not tie their hands when they are treating their patients. Clinicians should be allowed to prescribe take-home methadone according to their best clinical judgment based upon individualized assessments of their patients.

While H.R. 6279 is a welcome step in the right direction, it needs improving. The new evidence showing take-home methadone is safe and effective will hopefully provide the impetus toward that end.