Rédaction Africa Links 24 with Rebecca Arden Harris and David S. Mandell
Published on 2024-03-25 08:30:35
Methadone has played a crucial role in treating opioid use disorder since its approval by the Food and Drug Administration in 1972. However, strict regulations surrounding its distribution have made it challenging for individuals to access the treatment they need. Patients were required to visit a methadone clinic in person for an initial exam and then attend appointments five to six days a week to receive their doses under supervision. While this was intended to prevent medication diversion, it posed significant barriers for patients, including interference with work, family obligations, and transportation issues.
In response to the onset of the Covid-19 pandemic in March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) implemented policy changes to reduce the risk of coronavirus spread at opioid treatment programs. These changes allowed stable individuals to receive up to 28 days of take-home methadone doses, with less stable patients receiving up to 14 days. This flexibility offered relief to both patients and clinics during the challenging times of the pandemic.
In February 2024, SAMHSA made these policy changes permanent, providing long-term benefits for patient care. Despite the positive impact of take-home privileges, some states and local OTPs have rescinded extended take-home policies, citing concerns about methadone misuse and diversion. However, evidence suggests that increased flexibility in methadone delivery has not led to an increase in methadone-related overdose deaths and has actually resulted in fewer deaths among certain demographic groups.
Additionally, the take-home policy has been shown to improve patient retention in treatment, ultimately reducing the incidence of methadone-involved fatal overdoses. Methadone’s unique pharmacological profile, with its long half-life allowing for once-daily dosing, requires strict regimen compliance. Any deviations from this regimen can result in withdrawal symptoms, overdose, and increased risks associated with returning to drug use.
Recognizing the challenges associated with strict dispensing regulations, as well as the potential consequences of missed doses, some individuals in methadone treatment have resorted to informal arrangements to overcome these barriers. While medication diversion is illegal, a minimal and controlled level of sharing may be necessary to address unmet community needs effectively.
Cutting back on take-home methadone doses could push individuals towards illicit drug use, exacerbating the overdose crisis and leading to potential relapses and lives lost. The loosening of rules for methadone dispensing marked a significant step forward in the treatment of opioid use disorder. It is crucial to continue moving forward with policies that prioritize patient care and treatment effectiveness.
