New research lays out the hypothetical impact of the Modernizing Opioid Treatment Access Act (MOTAA), a bill in Congress that would loosen methadone prescribing regulations.
The bill has faced backlash from many organizations in the behavioral health space.
Data analysis by researchers at the University of Pittsburgh, the University of Chicago, the University of Gothenburg and the University of Illinois projected that 14% more Americans, or about 43.5 million, would have access to the highly regulated medication for opioid use disorder (MOUD) under the proposed bill.
MOTAA, sponsored by Sen. Ed Markey (D-MA), would allow physicians or psychiatrists specializing in addiction medicine to prescribe methadone prescriptions for unsupervised use. Today, these clinicians are only allowed to prescribe methadone within the confines of opioid treatment programs (OTPs). OTPs are a specific clinic type that is overseen by both the federal government and state governments.
Unsupervised use of methadone is not the norm. Methadone, a powerful, long-acting opioid, is administered under the direct, in-person supervision of clinicians as part of an addiction treatment plan administered by OTPs and other health care providers. Methadone maintenance treatment helps blunt cravings and withdrawal symptoms in part by providing supervised use.
However, this delivery mode requires patients to go to an OTP, sometimes called a methadone clinic, every day for treatment, a potentially tall task for people recovering from addiction. And the status quo makes the presence of an OTP in any given community a 50-50 coin flip in the national aggregate.
Today, about 53% of Americans don’t have immediate access to an OTP, a reality that is a powerful impetus for regulatory change like the one put forward by MOTAA.
The research examined another hypothetical regulatory change: allowing all certified clinicians to prescribe controlled substances. In that scenario, 85% of Americans would have structural access to methadone.
Other major systemic challenges in addiction treatment muffle the impact of increased access to methadone by allowing more clinicians to prescribe it.
The lack of OTP access echos other behavioral health access challenges. U.S. either faces a shortage of some provider types and inequitable geographic distributions of others. About 87% of census tracts are defined as mental health professional shortage areas. About 37% of census tracts are both mental health professional shortage areas and do not have OTPs.
Health Affairs Scholar Health Affairs Scholar“Primary care clinician methadone prescribing may have benefits that extend beyond availability,” the study report states. “Allowing both physician and advanced practice provider prescribing would expand the pool of potential prescribers and allow health care organizations greater workforce flexibility to meet community needs.”
Not all advocates in the behavioral health space are thrilled about MOTAA.
The bill is opposed by several behavioral health organizations, including the American Association for the Treatment of Opioid Dependence (AATOD), the National Association for Behavioral Healthcare (NABH) and Program, Not A Pill.
The latter is a recently formed single-issue group whose partner organizations include Acadia Healthcare (Nasdaq: ACHC), AATOD, BayMark Health Services, Behavioral Health Group, Carolina Treatment Centers, Crossroads Treatment Centers, New Season and Western Pacific Med Corp.
Each of these organizations provides addiction treatment services or represents such organizations. And many of them operate OTPs or similar facilities that benefit from laws restricting access to certain medications. For example, 117 of BayMark’s 237 locations (49%) in the U.S. are OTPs, according to the company’s website.
“More prescriptions do not stop overdoses,” AATOD wrote in a brief laying out its opposition to MOTAA. “The OTP structure is what makes methadone safe and effective for OUD. Suggesting that methadone is safe and effective for OUD in any other setting is not evidence-based.”
Despite the opposition, MOTAA has momentum. The bill passed the Senate Health, Education, Labor and Pensions (HELP) in December. The Biden administration has been friendly to and has pushed for regulatory change in response to the increased behavioral health challenges Americans are coping with.
