Below is an excerpt of the new book Your Body, Your Health Care (Cato Institute 2025) by Jeffrey A. Singer, MD, a senior fellow in Health Policy Studies at the Cato Institute, a practicing surgeon, and a fellow of the American College of Surgeons.

INTRODUCTION

As a general surgeon, when patients consult me for health problems and I determine that an operation would help solve their problem, I explain, in plain English and avoiding medical jargon, what the operation entails. I tell them why the operation is necessary to solve their problem. I tell them the risks and benefits of the procedure and make them aware of the pros and cons of surgical and nonsurgical alternatives to the proposed operation. I don’t proceed to operate without their informed consent. While I do all this out of respect for my patients’ autonomy, my profession’s ethics also require me to do this. Nowadays, civil tort case law requires it as well.

The doctrine of “informed consent”—that individuals have a right to refuse whatever medical or surgical treatment they choose, even if doing so will harm them—is a relatively modern development. A little over 100 years ago, society commonly accepted that doctors could do whatever they perceived was in the best interests of their patients, regardless of a patient’s wishes or priorities.

Things began to change in 1908 when Mary Schloendorff, a patient at New York Hospital, consented to a diagnostic examination under anesthesia for a suspected uterine tumor. She explicitly stated that she did not want to undergo an operation while under anesthesia but instead wanted to discuss the findings with the doctor and later decide about surgery. Despite her instructions, the examining surgeon diagnosed a uterine fibroid tumor and proceeded to remove it. Schloendorff subsequently sustained postoperative complications that ultimately caused gangrene in her left arm, which required surgeons to amputate several of her fingers.

Schloendorff sued the Society of New York Hospital for assault and won on the merits. After the defendants appealed the decision, New York Appeals Court Judge Benjamin Cardozo (later a US Supreme Court Justice), in 1914, wrote for the majority:

“In the case at hand, the wrong complained of is not merely negligence. It is trespass. Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent, commits an assault, for which he is liable in damages. This is true except in cases of emergency where the patient is unconscious and where it is necessary to operate before consent can be obtained.… [Schloendorff] had never consented to become a patient for any purpose other than an examination under ether.… she had forbidden the operation.”

It took decades for informed consent to become a hallmark of medical ethics. Even into the 1970s, many doctors admitted to withholding terminal cancer diagnoses from their patients. Nowadays, the patient-doctor relationship has largely shifted from one of medical paternalism and patient acquiescence to what bioethicist Daniel Sokol calls a “leveled partnership” in which the medical profession respects patient autonomy and the government punishes providers who violate the doctrine of informed consent.

While informed consent and respect for autonomy govern how health care practitioners interact with their patients, this new ethos is absent when it comes to the government asserting authority over adults’ health decisions. The government dictates what kinds of health professionals adults may consult. It determines what medicines adults may purchase and under which circumstances they may consume them. It bans adults from ingesting substances or engaging in activities that the government decides are unhealthful, regardless of individual risk-benefit priorities. It does all this because the government assumes it knows what is in adults’ best interest. In summary, every day the government treats all adults the way that Mary Schloendorff’s doctors treated her.

In the following pages, I want to inform you about how lawmakers and policymakers at all levels of government have failed to heed Judge Cardozo’s pronouncement that “every human being of adult years and sound mind has a right to determine what shall be done with his own body.” I hope to expose the harmful unintended consequences of this paternalism. Finally, I want to point out roads leading to a future where the government respects the autonomy and rights of all adults.

To obtain a copy of Your Body, Your Health Care, click here. 

Today, the Cato Institute is releasing my new book, Your Body, Your Health Care—a defense of your right to make your own health care decisions without government interference.

My book examines health care policy through a lens that presumes liberty and autonomy. As adults, we are sovereign individuals with moral agency who possess our bodies. As a physician, I adhere to an ethical code that values autonomy. I will not perform a test, procedure, or treatment without a patient’s informed consent. And if a patient refuses to follow my advice, I will respect their decision.

Unfortunately, policymakers often ignore the principle of autonomy. They block adults from seeking care from clinicians outside government-approved systems. They restrict access to medications deemed “unsafe” or “ineffective”—even when patients are willing to accept the risks. They penalize nonviolent personal behaviors that they disapprove of and even obstruct harm-reduction strategies that could make people safer.

Your Body, Your Health Care explores the various ways that government undermines adult autonomy and suggests methods to stop this infringement. It calls on members of the medical profession to take the lead in fighting for patients’ right to make their own health care decisions.

You can order my book here and from all major booksellers.

I will be at the Cato Institute on April 10 to discuss the book with Michael F. Cannon, the Cato Director of Health Policy Studies, and Nita A. Farahany, a Duke University Law Professor and bioethicist. You can register to attend in person or online here.

I hope this book encourages more people—especially those of us in medicine—to stand up for patients’ right to make their own choices. I’d love to hear your thoughts.

In 2019, Colorado lawmakers reduced possession of up to four grams of most controlled substances to a misdemeanor. Distribution or sale of controlled substances remained felonies. The law took effect as the fentanyl wave was making its way across the country, from east to west, and shortly before the COVID-19 pandemic caused a spike in alcohol and illicit drug use and fentanyl-related overdose deaths.

The increase in overdose deaths, some of which were featured in local and national news reports, caused lawmakers to pass and the governor to sign a bill in 2022 refelonizing drug possession. It reclassified drug possession as a Class 4 felony, forced people convicted of possession to undergo a clinical assessment for substance use disorder, and authorized courts to mandate treatment at their discretion. The bill also authorized increased funding to distribute naloxone and fentanyl test strips and to expand mental health services in the state. Some lawmakers pushed, unsuccessfully, to classify fentanyl as a “weapon of mass destruction” and to impose harsh mandatory minimum sentences.

The Colorado story closely resembles what happened in Oregon. There, voters approved a ballot initiative decriminalizing possession of small amounts of controlled substances and provided increased funding for harm reduction programs. The bill took effect in February 2021—as the state locked down in response to the raging COVID-19 pandemic—and as the fentanyl wave crested in the Pacific Northwest. That reform died in the crib as lawmakers reversed course and recriminalized drug possession in 2024.

Colorado’s refelonization law commissioned a team of researchers from the University of Colorado School of Medicine and the Kaiser Permanente Colorado Institute for Health Research to study its effects. They reported their findings earlier this year.

The report found no correlation between refelonization or mandatory drug rehab, and overdose rates. Cole Jurecka, one of the co-authors, told Filter Magazine, “I was not surprised by the fact that overdoses did not decrease and stayed the same or increased for certain populations.” Jurecka continued:

The most surprising finding for me was that retention on certain medications for opioid use disorder did not increase—in fact, [it] decreased for methadone—given the fact there were some small provisions in the law that would in theory help people access these drugs more easily. That was not the case.

The report found a slight decrease in overdose deaths in Colorado in 2024—a trend seen across the country. I speculate about why overdose rates have been dropping here and here.

Thus, increasing criminal penalties and mandating treatment did not improve outcomes. This should surprise no one. Researchers have long known that increased penalties and mandatory minimum sentences do not curtail drug use and overdose deaths. Mandating treatment fares no better and might make matters worse.

In my book Your Body, Your Health Care (Chapter 11), I write:

Addiction is a compulsive behavioral disorder characterized by continually using a substance or engaging in an activity despite the negative consequences. Jail is a negative consequence. Neither jail nor the less negative alternative of a forced stay in a rehab facility are likely to make anyone overcome their addiction unless they are deeply motivated to do so at the outset. Research shows that involuntary treatment usually doesn’t work. In fact, research suggests that coercing drug treatment might increase the risk of subsequent overdose. A 2016 systematic review of research on compulsory rehab found no evidence of improved outcomes, with some studies suggesting that compulsory rehab did more harm than good. A 2017 report by the Massachusetts Department of Public Health found that fatal overdoses were twice as high among people who were subjected to compulsory treatment compared to those who entered treatment voluntarily. This is because patients complete mandatory treatment but still retain their underlying compulsive disorder. After release from the treatment program, they have a high relapse rate. Because they had abstained from drug use while in treatment, their tolerance level has dropped, and they are more prone to overdose when they resume taking their usual dose of the drug.

To be sure, there are some examples of people who respond well to compulsory treatment, but such patients are highly motivated when treatment begins. People who might fit that description include commercial airline pilots or medical doctors, who face losing their license—and their careers—unless they enter drug rehab. But they are exceptions to the rule.

However, the most important reason why coercive treatment is wrong is that it is an affront to personal autonomy. Treatment versus jail time does not equal informed consent.

The evidence is clear: criminalizing drug possession and mandating treatment don’t save lives—they may even cost them. 

If policymakers are serious about addressing addiction and overdose, they must abandon punitive reflexes and start trusting people to make their own health decisions. Autonomy, compassion, and evidence—not fear—should guide policy.

As the United States government barrels toward a debt crisis, both House and Senate Republicans seem content to keep forcing taxpayers to overpay for low-quality health care. Senate Republicans especially are blindfolding the passengers while slamming on the gas. 

Former President Biden went on a health care spending spree. He created Obamacare premium subsidies for households earning up to $600,000 per year. He opened the floodgates to improper enrollment in Obamacare. He increased Medicare spending by 14 percent and Medicaid spending by 20 percent over the pre-Biden baseline—that is, new spending above and beyond the typical year-to-year increases. The House Republicans’ budget might at least reduce annual growth in Medicaid spending from 6 percent to 3 percent; by the 10th year of the budget window, it might just barely eliminate the Medicaid portion of the Biden Bump. 

The Senate GOP budget is an effort to rescue Biden’s spending spree. Obamacare subsidies for those earning up to $600,000 would stay. Biden‘s Medicaid and Medicare spending increases would stay. And Senate Republicans would accomplish all this through what is perhaps the largest, most dishonest, and most shameful budget gimmick in US history.

Decades ago, Congress enacted budget rules to prevent runaway deficits. But no Congress can bind future Congresses. Profligate legislators have rewritten those rules, including by subterfuge. The result is a record federal debt equal in size to the entire US economy, which Congress increases by another 6 percent of GDP each year. 

The Senate GOP budget would rescue Joe Biden’s spending spree. But Senate Republicans don’t want to face accountability for that decision. So they devised a novel and massive subterfuge that would enable them to pass their irresponsible budget with fewer votes and would effectively throw all congressional budget rules out the window.

Their subterfuge is literally to pretend that tax and spending laws that Congress has already passed aren’t real. Senate Republicans want to pretend that Congress has already renewed Biden’s spending spree, that Congress has already cut taxes, and that the federal debt is already heading as high as Senate Republicans want to raise it. None of those things are true, of course. But if the Senate passes a resolution that pretends they are, Republicans can enact those policies without facing accountability from voters. After all, if those things have already happened, there’s no need to cast unpleasant votes for the tax increases and spending cuts necessary to pay for them. Senate Republicans’ phony “policy baseline” is perhaps the largest, most dishonest, and most shameful budget gimmick in US history.

The United States government is heading toward a debt crisis. The House Republican budget would keep barreling down that road. Senate Republicans are blindfolding the passengers while slamming on the gas.

When a debt crisis arrives, it will bring drastic cuts to federal health programs. Not reductions in the rate of growth. Actual, deep cuts. Mostly to Medicaid. Democrats who continually expand government health programs and Republicans who continually expand federal debt are putting the health care of low-income patients in a precarious situation.

Secretary Robert F. Kennedy, Jr., has announced and begun implementing the elimination of 10,000 positions at the Department of Health and Human Services. He is also reorganizing the department. He estimates savings of $1.8 billion per year. A further 10,000 HHS employees have taken buyout offers or retired early since President Trump resumed office. Altogether, these moves will reduce HHS staffing levels by some 24 percent.

To the extent Congress authorizes the secretary to do so, reducing HHS staffing levels is the right thing to do. Congress should go further by eliminating the regulations and spending programs those HHS employees implemented. Doing so would prevent the risk that cutting some HHS jobs could paradoxically increase the size of government.

Many HHS Employees Deserve to Lose Their Jobs

Let’s be honest. Many HHS employees deserve to lose their jobs. To take just one example, when COVID-19 came to the United States, HHS employees crippled the public health response.

While other nations were removing regulatory barriers to COVID-19 diagnostic tests, Food and Drug Administration officials increased regulatory barriers to those tests. Scientists called the FDA’s actions “insane.” Private companies and government labs developed dozens of effective tests. FDA officials blocked them all. They did not loosen their grip until President Trump ordered them to stop blocking tests and to let states approve tests themselves.

It gets worse. For many months, the only test the FDA approved was the one that the Centers for Disease Control developed. Yet the CDC (also part of HHS) contaminated its tests with the COVID-19 virus, rendering them “useless.” An FDA inspector warned CDC employees that if the CDC were a private company, he would “shut you down.” Spoiler alert: the FDA did not shut the lab down.

A federal court has just ruled that Congress never even gave the FDA authority to regulate the laboratory-developed tests it banned during COVID-19.

HHS employees exceeded their authority. They admitted that they treat their fellow bureaucrats better than lowly private citizens. Their mistakes likely cost lives. But when those abuses came to light, did any of them lose their jobs?

Institutional Incompetence

Such institutional incompetence is pervasive at HHS. The department implements countless regulations and spending programs that do more harm than good.

HHS enforces regulations that deny patients the right to make their own health decisions. It denies patients with life-threatening illnesses the right to choose their treatments, including treatments available in other countries. It forces women seeking birth control and diabetics seeking insulin to get permission from government-appointed gatekeepers. It prevents many beneficial treatments from ever reaching patients. All evidence indicates these regulations have a net negative impact on health. They’re just not worth having.

Kennedy fired the entire FDA office whose job is to restrict access to safer alternatives to cigarettes. The only people who should mourn their departure is Big Tobacco.

HHS implements regulations that increase health insurance premiums, create unnecessary gaps in coverage, and force insurance companies to compete to avoid and mistreat the sickest patients. The purpose of those regulations, naturally, is to protect the sick. Yet one of President Biden’s economic advisors found those regulations produce “backdoor discrimination” against the sick that is both “beyond any insurance carrier’s ability to control” and so pervasive that even “currently healthy consumers cannot be adequately insured.”

HHS implements spending programs that increase the burden of government, health care prices, and health insurance premiums. It reduces health care quality and encourages medical errors. It pays low-quality providers more than high-quality providers. It gives quality bonuses to low-quality hospitals and mediocre health insurance plans. An arm of Congress—the Medicare Payment Advisory Commission—has complained for decades that HHS doesn’t even bother to measure the quality of medical care on which HHS spends trillions of taxpayer dollars.

Those spending programs are the main force driving the federal government toward a debt crisis. Enrollees and taxpayers would be better off if Congress fired upward of 90 percent of Medicare and Medicaid bureaucrats, cut Medicare spending by a third, gave what remains to enrollees as cash, and converted Medicaid into a system of zero-growth block grants.

“Authoritatively stating that these drastic changes will improve the health of Americans without any explanation insults the American public and defies logic,” three members of Congress wrote to Kennedy. One could say the same of Congress’ creation of HHS’s authorities in the first place.

Surging HHS Staffing

Nonetheless, HHS staffing levels have grown along with both the overall federal workforce and the harmful regulations and spending the department implements. Over the past two decades, the federal workforce added 452,000 net jobs, including 132,000 in the past five years. Federal jobs are surging even as trust in the federal government is falling.

From 1996 to 2023, full-time equivalent positions at HHS grew from 57,200 to 81,300, a 42 percent increase. Most of that increase came under Presidents Obama, Trump, and Biden. President Clinton initially cut 8,900 full-time equivalent positions (13 percent of HHS’s workforce) but then added back 3,300, for a net reduction of 5,600 (8 percent). President George W. Bush eliminated a net 700 full-time equivalent positions (a 1 percent decrease). HHS’s workforce grew by 12,800 full-time equivalent positions (a 21 percent increase) under Obama, 2,500 (3 percent) under Trump, and 6,200 (8 percent) in Biden’s first three years.

In context, Kennedy’s cuts are substantial but reasonable. The layoffs he announced (10,000; 12 percent of workforce) are comparable to Clinton’s reductions at HHS (8,900; 13 percent) from 1993 to 1996. They are comparable to recent private-sector layoffs at Intel (15,000; 15 percent), Tesla (14,000; 10 percent), Dell (12,500; 10 percent), Boeing (17,000; 10 percent), and Cisco (9,600; 11 percent). Other companies recently announcing substantial layoffs include Meta (3,600; 5 percent), UKG (2,200; 14 percent), Intuit (1,800; 10 percent), Expedia (1,500; 8 percent), and Indeed (1,000; 8 percent). 

After Kennedy’s layoffs, HHS would still employ more people than it did when George W. Bush left office.

To read about private-sector job losses is to watch a wondrous market process of constant correction and adjustment, one that constantly moves resources from low- to high-value uses. 

That process does not touch government jobs. Even if HHS’s activities were net beneficial, its staffing levels would be long overdue for correction and adjustment following a 15-year surge.

Cutting Some HHS Jobs Would Expand Government

Paradoxically, absent further action, terminating some HHS employees would expand government. HHS implements regulations that bar market entry for foods, drugs, and medical devices. Until food inspectors and drug/​device reviewers set those barriers aside for specific items, HHS continues to deprive consumers and producers of their rights to buy and sell those items. Firing those employees (or employees who support them) effectively raises those barriers higher. (Firing FDA drug reviewers’ communications team, which numbered “about 50 people,” is a different matter.) Inspectors general and other administrative staff identify and stop improper payments in Medicare and Medicaid. All else equal, eliminating those positions would increase government spending.

Kennedy claims his plans to cut 3,500 FDA jobs will not “affect drug, medical device, or food reviewers, nor will it impact inspectors.” As the Zen master says, we’ll see. Media reports claim device reviews have slowed despite HHS rehiring some reviewers. 

To the extent any of these cuts would expand government, the solution is to eliminate the underlying regulations and spending. Kennedy and Trump should immediately call on Congress to do so.

What’s the Endgame?

If these cuts are happening because Kennedy is the rare government official who voluntarily limits his own power, he deserves tremendous praise. His behavior suggests he isn’t.

Other than firing people, he has given scant indication that he wants to shrink government or restore people’s right to make their own health decisions. He has not called on Congress to eliminate harmful regulations and spending programs. Past rounds of firings at HHS, which occurred while Kennedy was secretary, did terminate FDA device reviewers. 

Indeed, these cuts may be a prelude to expanding government and further curtailing freedom. Kennedy’s actions and rhetoric suggest he wants to use HHS’s powers to erect even greater barriers to entry for food additives, infant formula, vaccines, and other medicines. He has launched new studies on vaccines and autism. He has demanded that FDA employees hand over data on device safety. He promises to deliver absolute safety—something that does not exist but is typically code for more regulation. He uses rhetoric like “gold standard” science to hide the reality that the safety standards HHS enforces—that he now imposes on consumers and producers—are inherently unscientific value judgments.

These factors suggest that Kennedy is not looking to lay down HHS’s powers so much as prepare the ground to use them more vigorously than his predecessors. Let the patient beware.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), over 6.1 million people over age 12 have opioid use disorder (OUD). Increasing access to OUD treatment would reduce the number of people who seek drugs in the dangerous black market and, in turn, reduce the risk and incidence of overdose deaths. 

In the United States before 1972, primary care physicians would prescribe methadone to people with OUD. Since 1972, however, only government-approved opioid treatment programs (OTPs) have been allowed to dispense methadone to treat OUD. SAMHSA places regulations and restrictions on organizations that seek to operate OTPs. OTPs must obtain certification from the Drug Enforcement Administration (DEA) to operate a narcotics treatment program. States must also license OTPs, imposing additional regulations, costs, and restrictions. 

The various layers of regulations hinder the proliferation of OTPs. These and other government obstacles explain why only about 400,000 individuals with OUD received methadone in 2019, while 1.6 million US residents reported developing OUD that year. Recognizing these barriers, Congress has attempted incremental reforms. For the past few sessions of Congress, the bipartisan Modernizing Opioid Treatment Access Act (MOTAA) has failed to pass. If enacted, MOTAA would expand access to methadone treatment by allowing board-certified addiction medicine physicians to prescribe methadone in their offices and clinics. 

However, President Donald Trump’s February 19 executive order implementing his “Department of Government Efficiency” Deregulatory Initiative provides an opportunity to expand access to methadone treatment for people with opioid use disorder (OUD). Seizing on this deregulatory momentum, the American Society of Addiction Medicine (ASAM) has spearheaded a letter to Attorney General Pam Bondi and Acting DEA Administrator Derek Maltz, calling for a review of methadone treatment regulations. The letter argues that these regulations are “not based on the best reading” of the underlying law and “constitute a significant regulatory action that materially harms competition in health care delivery.” The American Society of Health-System Pharmacists, the National Commission on Correctional Health Care, the National Community Pharmacists Association, and the R Street Institute endorsed the letter. 

Many policymakers have long believed that the current methadone treatment regime is mandated by federal statute. In reality, much of it was created by federal regulatory agencies— specifically the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS)—pursuant to authority delegated by Congress. 

The direct legislative sources are the Narcotic Addict Treatment Act (NATA) of 1974 and 21 U.S.C. § 823(h). NATA authorized the use of narcotic drugs like methadone to treat addiction but required practitioners dispensing such drugs to be registered with the DEA and that SAMHSA and the DEA approve treatment programs. 21 U.S.C. § 823(h) states that the attorney general, through the DEA, “shall register an applicant to dispense narcotic drugs to individuals for maintenance treatment or detoxification treatment” in compliance with standards set and certified by the Secretary of HHS.

Congress didn’t specifically require the DEA to set up OTPs. It authorized the DEA to set up some sort of registration and regulatory system. The DEA decided to implement 21 USC Sec 823 (h) by requiring OTPs. 

In its letter to Bondi and Maltz, ASAM argues that because 21 U.S.C. § 823(h) does not explicitly mandate the use of OTPs — but instead grants the Attorney General (through the DEA) the authority to register practitioners “in accordance with” HHS standards — the requirement that methadone be dispensed only through OTPs is a regulatory choice, not a statutory mandate.

Before discussing how the regulatory change can help, it’s worth clarifying a key distinction: addiction and dependency are not the same. Opioid addiction and opioid dependency are two distinct subsets of OUD. Dependency refers to the physiological adaptation to the drug such that abrupt cessation can cause a physical withdrawal reaction. Addiction is a behavioral disorder characterized by compulsive use despite negative consequences. People with addiction still feel compelled to use opioids even when they are no longer physically dependent. 

Methadone and buprenorphine are time-tested, evidence-based medications used to treat OUD. Clinicians have been using methadone to treat OUD since the 1960s. They’ve been using buprenorphine since the 1990s. Some patients respond better to methadone; others do well with buprenorphine. 

If the ASAM-inspired initiative is successful, the Trump administration will implement regulatory reforms that could remove obstacles preventing people with OUD from accessing methadone treatment. These reforms can go even further than MOTAA’s modest, incremental reform. The administration can permit all licensed clinicians who are interested in treating OUD to register with the DEA to provide methadone treatment. The administration could remove regulatory barriers to patients with OUD accessing methadone through primary care clinicians, including nurse practitioners, in their community offices and clinics. The DEA and SAMHSA have already implemented this policy for buprenorphine prescribing. 

Critics of treating methadone prescribing like buprenorphine prescribing worry that patients might “divert” the methadone to the black market. But the evidence suggests otherwise. 

In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) temporarily loosened methadone take-home restrictions for opioid treatment programs (OTPs), permitting “stable” patients to receive up to a 28-day supply. The policy proved so effective that SAMHSA made it permanent. Researchers from the Centers for Disease Control and Prevention and the National Institute on Drug Abuse analyzed the effects of this change and reported in JAMA Psychiatry in July 2022 that “monthly methadone-involved overdose deaths remained stable after March 2020.” The National Institutes of Health reported that same month that “the percentage of overdose deaths involving methadone declined between January 2019 and August 2021.” 

It often surprises people that the DEA allows any clinician with a standard narcotics license to prescribe methadone for pain yet prohibits them from prescribing it for addiction treatment. According to the National Institute on Drug Abuse, “Methadone diversion is primarily associated with methadone prescribed for the treatment of pain and not for the treatment of opioid use disorders. In one survey, giving methadone away was identified as the most common form of methadone diversion, which aligns with other findings that 80 percent of people who report diverting methadone did so to help others who misused substances.” 

Of course, no reform is secure unless Congress codifies it. One drawback of relying on executive actions and regulatory reassessments is that they can change in subsequent administrations. While the Trump Administration can move quickly to improve access to methadone treatment, a subsequent administration could revert to the old approach. Ideally, Congress should codify any regulatory reforms in statute.

In a Cato Policy Brief, Sofia Hamilton and I point out that clinicians in Australia, Canada, and the UK have been prescribing methadone to patients with OUD in their offices and clinics for nearly 60 years. They coordinate with community pharmacists who are part of the treatment team. Regulators in those countries defer to clinicians to exercise their medical judgment in deciding the timing and amount of take-home methadone. We argue that clinicians and patients in the United States deserve the same freedom.

We call on lawmakers to enable patients with OUD to receive methadone treatment from sources other than government-approved OTPs. Providers should include office-based addiction specialists, primary care physicians, nurse practitioners, and physician assistants. These treatment options can coexist with more traditional inpatient or outpatient treatment programs.

Ideally, lawmakers should end drug prohibition. As a result of the failed war on drugs, federal bureaucrats, police, SAMHSA, and the DEA regulate how clinicians practice medicine. Prohibition lets lawmakers, policymakers, and law enforcement agents intrude into clinical decision-making and the patient-doctor relationship.