Lawmakers on Tuesday will debate an addiction medicine proposal that would have been considered unthinkable just years ago: giving a select group of doctors the power to prescribe methadone directly to patients.
With no end in sight to the deadly U.S. drug overdose crisis, which claims nearly 110,000 lives a year, many advocates have zeroed in on methadone as a potential game changer. While the medication is highly effective, it is so tightly regulated that many patients see it as impossible to access.
Now, a growing coalition of lawmakers, patient advocates, and addiction doctors is arguing that any strategy to reduce opioid deaths must center on making methadone vastly more accessible.
“Every day, we are losing people to outdated rules that criminalize and stigmatize people using methadone for opioid use disorder,” Sen. Ed Markey (D-Mass.), the bill’s author, told STAT in a statement. “The status quo is costing lives, yet some companies running opioid treatment programs would rather protect their bottom line than the patients they are meant to serve. It is long past time to move past excuses to protect profits and modernize these outdated rules.”
The bill is receiving a formal markup from the Senate Committee on Health, Education, Labor, and Pensions, chaired by Sen. Bernie Sanders (I-Vt.). If passed, the legislation would allow certified addiction doctors to prescribe methadone to patients outside the context of a specialized methadone clinic — representing easily the biggest reform to the addiction treatment system since the Nixon administration.
Opponents, however, say the bill would do more harm than good. Methadone is itself an opioid, and in rare cases it can lead to overdose when misused. Historically, methadone clinics and law enforcement groups like the Drug Enforcement Administration have strongly opposed major expansions in access to methadone.
While the bill still faces significant obstacles on Capitol Hill, its support from major addiction treatment groups and lawmakers from both parties highlights a shifting attitude toward methadone among prominent policymakers and public health experts.
Its original House sponsor, Rep. Don Norcross (D-N.J.), has referred to methadone clinics as “cartels.” In the Senate, the legislation is backed by an unlikely pair: Markey and Rand Paul (R-Ky.). Major advocacy groups like the American Society of Addiction Medicine and Faces and Voices of Recovery also strongly support the legislation.
Other public health leaders and key Biden administration figures have also changed their stance on methadone treatment. Rahul Gupta, the director of the White House Office of National Drug Control Policy, told STAT in May that “all options are on the table” when it comes to expanding methadone access. Nora Volkow, the director of the National Institute on Drug Abuse, announced her support for physician-prescribed methadone at a STAT event last year.
“The need for additional access to effective treatment for opioid use disorder has never been greater,” Brian Hurley, an addiction physician currently serving as the president of the American Society of Addiction Medicine, said in an interview. “This is not a bill that is only intended to expand the conversation — we want this to become law.”
The bill has garnered major opposition, however, from methadone clinics and the powerful trade group that represents them, the American Association for the Treatment of Opioid Dependence.
In response to growing calls for liberalization of methadone access, AATOD and several for-profit methadone clinic chains launched an aggressive public relations campaign titled “Program, Not a Pill” — arguing that simply expanding access to methadone without requiring in-person attendance at clinics and mandating psychosocial counseling would do more harm than good.
At a STAT event in October, AATOD’s founder and CEO, Mark Parrino, argued that the bill’s passage could destabilize the treatment system and cause an unintended rise in overdoses involving methadone. Parrino told STAT in an email that the organization’s position has not changed.
In effect, the debate pits two powerhouses in the small addiction policy world against one another: ASAM, which represents doctors, and AATOD, which represents clinics.
But in an interview, Hurley, ASAM’s president, downplayed the fissure surrounding the methadone access bill, formally known as the Modernizing Opioid Treatment Access Act, or MOTAA.
“ASAM and AATOD have a history of agreeing with one another and working together on policy initiatives that expand access to treatment,” he said. “On MOTAA, we are not aligned.”
Still, lobbyists and congressional aides said in interviews that the groups’ open lobbying against one another, and the broad coalition supporting the bill, may be a sign that AATOD’s influence is waning.
The organization suffered another legislative defeat last year after lobbying hard against a measure that eliminated the so-called “X-waiver,” which required health providers to undergo special training before they could prescribe buprenorphine, another common medication used to treat opioid addiction. President Biden held an event celebrating that bill’s passage in January.
In early 2022, AATOD retained the lobbying firm Van Scoyoc and Associates for $60,000 per year — the first time it has ever retained an outside lobbying firm, according to disclosure forms. In its disclosures, Van Scoyoc cited the methadone legislation, as well as “medication-assisted treatment (MAT) delivery-related issues.”
The bill’s bipartisan backing, advocates say, represents yet another sign that Washington’s attitude toward methadone has shifted. One Republican lawmaker co-sponsoring the legislation, Rep. Don Bacon (R-Neb.), called the current methadone clinic system “a recipe for failure.”
“If you want methadone, you have to stand in line every day, which means you’re not at home, you’re not at your job — I think we’re just making it harder for people to get healthy,” he told STAT in an interview. “If a doctor could prescribe it and they could get it at a pharmacy, then they can get their methadone for the month and stay with their family, maybe go get a job. It’s helping people get on their feet.”
The bill’s path forward remains unclear: While lobbyists said it could receive approval from the Senate HELP Committee, it had no guarantee of receiving a vote before the full Senate.
Even if it did, it would face an uphill climb in the Republican-controlled House.
“I’d have to probably do a lot of one-on-one” convincing, Bacon said. “Probably, I’d have to explain it to [House Speaker] Mike [Johnson] and [House Majority Leader] Steve Scalise.”
He added, separately: “Sometimes I think we could have more empathy on our side of the aisle for people going through this.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.