Thu, November 17, 2022
The top addiction researcher in the U.S. government is calling for the broad deregulation of methadone — a medication that can reduce dependency on opioids — in a major departure from how it is currently made available.
Nina Volkow, director of the National Institute on Drug Abuse (NIDA), made the comments Wednesday during the annual STAT Summit, a two-day event that gathers experts in various health and medical fields. Volkow addressed the summit Wednesday afternoon about “facing the addiction epidemic” in the U.S.
In her comments, as reported by STAT News, Volkow was clear about her desire for methadone to be available by prescription. Currently, people who use methadone are required to go to clinics daily to get the medication, and the specialized clinics are few and far between in some areas.
“There’s absolutely no reason why not [to allow prescription of methadone],” Volkow told the summit, according to Stat News. “There are countries where physicians are providing methadone and the outcomes are actually as good as those they get [at] methadone clinics.”
Daniel Patrick Garrett, a methadone user and the director and founder of Tennessee Harm Reduction, told CBS News that Volkow’s comments represent a positive step.
“It’s great. It’s great,” he said. “I wish this would have happened sooner … These comments, I think, are a step in the right direction.”
Jeffrey Bratberg, a clinical professor at the University of Rhode Island College of Pharmacy, said he read Volkow’s comments with “great enthusiasm,” though he warned that physicians would likely need education and training on how to best treat opioid use disorder.
“Methadone has saved countless lives in Canada, Australia, several countries in Europe, and around the globe, providing more destigmatized care in more places safely and effectively,” he told CBS News.
Volkow also called for pharmacists to be allowed to dispense methadone in consultation with physicians. Previously, she has called for similar accessibility, including in a NIDA blog post in August in which she said methadone and similar treatments have been proven to make an impact.
“The full opioid agonist methadone (in use for half a century) and the partial agonist buprenorphine (first approved two decades ago) have proven to be life-savers, keeping patients from illicitly using opioids, enabling them to live healthy and successful lives, and facilitating recovery,” she wrote.
According to the Pew Research Center, in 2019, more than 400,000 people in the U.S. took methadone for addiction treatment, out of an estimated 1.6 million people who experienced opioid use disorder that year.
In 2021, provisional data from the Centers for Disease Control and Prevention estimated that about 107,000 Americans died of drug overdoses. The vast majority — about 81,000 — of those overdoses were due to opioids.
Methadone is a full-opioid agonist, and the restrictions are in place to prevent diversion of the substance. But according to a 2021 report by NIDA, methadone diversion is most common when the drug is used to treat pain, not opioid use disorders.
The medication is present in some overdoses: In August of 2022, 3.2% of overdoses involved the substance, according to NIDA, but that is a decline from January 2019, when it was present in 4.5% of overdoses. That decrease also overlaps with a loosening of methadone regulations by the Substance Abuse and Mental Health Services Administration during the coronavirus pandemic, and the NIDA data does not clarify if the overdoses involved other substances, or if the people who died were taking methadone to treat opioid use disorder or pain.
Volkow’s comments also come amid a complicated landscape for treating opioid use disorder. A medication similar to methadone, called buprenorphine, referenced in Volkow’s 2022 blog, is less tightly regulated and delivers similar effects, but doesn’t always work to treat dependency on fentanyl, a synthetic opioid that has permeated the U.S. drug supply. A 2021 study published in the Journal of Addiction Medicine found that people who use buprenorphine to treat fentanyl dependency may still experience severe withdrawal symptoms at some stages of treatment.
The Food and Drug Administration also recently warned about the risks of xylazine, an animal sedative and pain reliever that has entered the nation’s illicit drug supply. While the symptoms of xylazine use resemble those of opioid use, the substance is not an opioid and therefore it cannot be treated with medications like methadone, Bratberg said.