Amid a national demand for more science-based treatment for people addicted to prescription painkillers, heroin and other illicit opioids, the expansion of methadone clinics has gone mostly unheralded, the Washington Post reports. Unlike buprenorphine, which can be prescribed by licensed practitioners and taken orally at home, or injectable Vivitrol, which can be administered by any doctor, methadone must be given out daily at highly regulated and often very visible clinics. Crowded parking lots, long lines and the potential for diversion of the medication have led many states to limit the number of clinics they license. Some politicians and many other critics have likened methadone treatment to trading one addiction for another. Former New York City Mayor Rudolph Giuliani and former Vermont governor and Democratic presidential candidate Howard Dean are among them. That’s starting to change.
“There has been an underlying stigma against methadone for so many years that the industry naturally maintains a low profile,” said Yngvild Olsen, an addiction doctor in Baltimore on the board of the American Society of Addiction Medicine. “Even now,” she said, “access to methadone is highly geographic. It depends on where you live.” In an opioid epidemic that is killing more than 130 Americans daily, more states, including some that previously limited expansion of methadone treatment, are calling on the industry to set up new programs in opioid-plagued rural and suburban areas that lack adequate medication-assisted treatment options. Opioid treatment companies are responding, with most new clinics offering all three opioid addiction medications, which have been approved by the Food and Drug Administration. A major driver of the expansion is millions in newly available Medicaid reimbursement dollars for methadone treatment in at least 37 states and the District of of Columbia.