Krystal Parker, a former heroin user, spent years making long daily bus trips with other patients to a methadone clinic in southwest Florida. For over a decade, the medication has kept at bay her crippling anxiety and the agonizing nausea of withdrawals. Parker’s experiences underscore what critics say are draconian methadone regulations that erect barriers to one of the few effective treatments for opioid use disorder, a life-or-death hurdle that may finally be overcome if Congress acts this year to expand access to the drug, reports the Washington Post. Bipartisan bills were reintroduced in both chambers of Congress last week that would allow patients seeking treatment to get methadone at local pharmacies with a prescription from a doctor specializing in addiction, as well as from federally regulated clinics. Proponents of the measures say methadone is proved to help wean people off more dangerous street drugs, yet remains frustratingly difficult to get, even amid an opioid crisis. A rigid clinic system imposed 50 years ago often requires daily visits to clinics that critics say stigmatize patients, disrupt lives and make it difficult to work. For advocates of widening access to methadone, the relaxed rules during the pandemic offered a real-world experiment that they say proved the benefits of giving patients greater control over their lives.
Methadone, developed as a painkiller for wartime casualties, remains much safer than the illegal street drugs killing tens of thousands of people each year. It blocks the roller-coaster effect of opioids, quashing the cravings that course through the body. At least one group is not on board with proposals to expand access to methadone beyond the clinic system -- the clinics themselves, many of which are for-profit. Mark Parrino of the American Association for the Treatment of Opioid Dependence, the industry trade group, cites a worrisome recent uptick in methadone-related overdose deaths as a warning signal about why it may be dangerous to broadly deregulate methadone. He believes the legislation, if passed, would probably lead to the diversion of methadone to the streets, with grim consequences. “If that happens, I assure you there will be media accounts of methadone designed to treat opioid use disorder now killing people,” Parrino said. That prediction is dismissed by many addiction specialists, who note that methadone can already be prescribed by physicians and dispensed by pharmacies for chronic pain. Amid a raging fentanyl crisis, they argue, board-certified specialists should be able to write prescriptions to treat addiction. For patients involved with methadone clinics, the daily routine can feel like being on probation. Counseling sessions are mandated. Urine tests are regular. Missing an appointment can lead to a reduction in a dosage of methadone, patients say.