California assembly member Matt Haney’s home in San Francisco isn’t far from a methadone clinic, where he has watched people line up early each morning in the Tenderloin, a community long considered the epicenter of the city’s substance use epidemic. They wait for the daily dose of methadone that relieves their cravings and minimizes opioid withdrawal symptoms. Despite methadone’s effectiveness, state and federal rules meant to guard against its misuse keep it inaccessible to many people who desperately need it, Haney said, reports Stateline. “What kind of normal person with a job, a life and a family can line up for medication every morning, sometimes far from where they live?” California is one of many states with rules that are stricter than federal regulations on when, where and how people can access opioid treatments like methadone. “It’s almost comical how difficult it is to get this medication and stay on it,” he said.
Addiction treatment is poised for change. This year, the federal Substance Abuse and Mental Health Services Administration (SAMSHA) made permanent a set of pandemic-era rules that loosened several restrictions, including those on take-home doses of methadone. It is a move that academics, advocates and providers say will improve treatment access and success rates. Having the flexibility to take medication at home can mean patients can get to work or get their kids to school on time. In theory, the new federal rules make more take-home methadone doses available to a wider subset of patients. What’s less clear is how the rules will trickle down to states. There’s concern states that didn’t preserve the relaxed regulations they had during the pandemic might be slow to adopt them now. About 1,800 certified opioid treatment programs operate in the U.S., giving methadone treatment to about 400,000 people. That’s just 19% of the estimated 2.1 million people with opioid use disorder.