A Call to Action for Methadone for Opioid Use Disorder
Zoe Weinstein, Director of Boston Medical Center (BMC)’s Addiction Consult Service and an Associate Professor of Medicine in the Section of General Internal Medicine, published a perspective article with co-authors from University of Rhode Island, University of Pittsburgh, and Yale School of Medicine. The article, “Actions Needed for Pharmacy-Dispensed Methadone for Opioid Use Disorder in the United States,” recommends several actions for clinicians and policymakers to take to overcome barriers in the implementation pharmacy-dispensed methadone for opioid use disorder (OUD).
As explained in the abstract, “Methadone is an essential tool for addressing opioid use disorder, especially with the prevalence of high-potency synthetic opioids in the drug supply. The current care delivery model in the United States with siloed methadone clinics has many limitations. Legislation has been proposed to expand access to methadone to office-based settings with pharmacy dispensing. Even with legal and regulatory changes, there are many practical barriers to implementation, which include insurance coverage and patient cost, prior authorizations, and stocking of methadone.”
The article breaks down these barriers into three categories – “(1) insurance coverage and patient cost, (2) prior authorizations, and (3) stocking adequate supplies of methadone formulations” – and presents practical steps for policymakers and clinicians to address each. The authors recommend that states take action to ensure insurance coverage for methadone, remove methadone from the algorithms that limit the amount of controlled substances pharmacies can order, and obtain concentrated methadone formulations.
The authors note that “federal regulations are the primary, but not the only, barrier to pharmacy-dispensed methadone in the US.” The paper concludes by emphasizing that all clinicians, distributors, and policymakers have a role to play to address these barriers and ensure that rapid implementation of pharmacy-based methadone is possible if federal regulations change.